Intrauterine Insemination

Intrauterine insemination (IUI) is a treatment that we utilize for a variety of causes of infertility. In particular, couples with unexplained infertility, cervical factor infertility, endometriosis-associated infertility and male factor infertility can be treated by this technique. We have found that very severe male factor infertility is not effectively treated by IUI so men with extremely low sperm counts or motility are generally advised against proceeding with this treatment.

With natural intercourse many of the ejaculated sperm never make it past the cervix up to the fallopian tubes where fertilization takes place. The concept behind IUI is to isolate the motile sperm out of the ejaculate and place many of these sperm high in the reproductive tract. By placing the sperm past the cervix and into the uterus, more of the sperm will be present in the fallopian tube to fertilize the ovulated egg. Several studies have now demonstrated that IUI is more effective than intercourse in couples with infertility problems.

How IUIs are performed

The IUI cycle begins by having the woman test for ovulation. Most often, we have women do this by using ovulation predictor kits which are performed by testing the urine for the hormone LH. When this hormone is detected, it indicates that ovulation is likely to occur approximately 24 to 36 hours later. We typically have patients test their urine in the later part of the afternoon and if the test is positive, she calls the clinic to schedule an IUI for the next morning.

The couple should arrive at the Reproductive Testing Laboratory the next morning and a sperm sample is produced to allow preparation of the IUI sample. We generally recommend between two and seven days of abstinence from ejaculation prior to producing this sample. If ejaculation has occurred more recently than two days, the sperm count may be low. In contrast, if it has been too long since an ejaculation, sometimes the quality of the sperm and particularly the motility of the sperm is impaired.

After the couple has provided the semen sample, our laboratory personnel wash and separate out the motile sperm from the ejaculated semen. The preparation time in the lab is one and one-half to two hours. The sample will be released to the couple to carry to the clinic for the insemination procedure. The insemination will be performed in our clinic by one of our nurses.

The insemination is performed by placing a speculum into the vagina to visualize the cervix. A small catheter is placed past the cervix into the uterus where the motile sperm are deposited. Women are then asked to rest in the room for approximately 15 minutes before they leave the clinic area.

Pregnancy tests are performed two weeks after the insemination. Results with IUI are highly dependent upon several factors, most importantly the age of the woman. Another important factor is the number of motile sperm present in the ejaculate. Intrauterine inseminations alone result in a pregnancy rate of between 5 percent and 10 percent per cycle. We typically recommend that couples try IUI at least for 3 to 4 cycles before moving on to other forms of treatment. Pregnancy rates seem to be maintained from cycle to cycle through at least 6 cycles in our program. In other words, there is no drop-off in pregnancy rates if the first few cycles are unsuccessful.

Other treatment options in conjunction with IUI

Often we combine IUI with use of ovulation inducing medications including the use of clomiphene citrate, tamoxifen, Letrozole or gonadotropin injections. The purpose of these medications is to increase the number of eggs that are released or to regulate ovulation more precisely. The use of these medications increases the risk of multiple birth and you will be counseled about this in our clinic. The use of gonadotropins also adds to the expense of the cycle but enhances the pregnancy rates that are seen after IUI. Pregnancy rates are typically between 10 to 20 percent per cycle when IUI is used after gonadotropin stimulation. Use of gonadotropin injections require that we monitor follicular development more carefully by utilizing transvaginal ultrasound and estradiol levels. The purpose of this monitoring is to try to reduce the risk of multiple birth as well as reduce the risk of ovarian hyperstimulation if at all possible. Despite careful monitoring, we are unable to completely prevent the occurrence of multiple births following the use of gonadotropin injections with IUI.

Possible complications from IUI

For the most part, IUIs are a safe infertility treatment. Possible complications from this treatment include the risk of bleeding, cramping, or uterine pain following the insemination. There is also a slight risk of infection, although this is very rare. We ask you to notify us if you have excessive pain or fevers following the IUI. Children born from IUI seem to have no adverse outcomes; IUI does not change your risk for having a child with a birth defect. Intrauterine insemination alone does not increase the risk of multiple birth, although if it is performed in conjunction with ovulation inducing medications, then there is an increased risk of multiple pregnancies. There is no increased risk of miscarriage of a pregnancy resulting from an IUI.

Requirements prior to having an insemination include an initial appointment with the medical team to review the couples' infertility evaluation. Required testing includes: (1) Documentation of rubella immunity; (2) Normal Pap Smear within the past year; (3) Report of recent semen analysis.

Cost

Insurance coverage for fertility procedures varies. Your company may require prior approval or a referral from your primary care provider. The billing code (or CPT code) for intrauterine insemination is #58322. Please contact our Financial Counselor at 319-356-3145 for further information.

Male Partners

Instructions for collection of semen for intrauterine insemination: In order to maximize the number of sperm for insemination, please attempt to abstain from ejaculation for two to seven days prior to collection. Longer periods of abstinence (greater than seven days) should be avoided, as this may increase the number of dead sperm in the ejaculate. Sperm quality can be affected by adverse health conditions and certain medications. Please inform us if you have had any health problems (fever, injury, severe flu, etc.) in the past six months or if you are taking any medications.

The semen sample must be collected into a special container provided by the Reproductive Testing Laboratory. Please do not attempt to collect the semen into any other container, as this may result in decreased survival of the sperm. Because the sperm will be inseminated directly into the uterus, it is necessary to avoid bacterial contamination of the semen during collection. This can best be accomplished by thorough washing of your hands and genital area prior to collection. The semen must be delivered to the Reproductive Testing Laboratory promptly after collection.

To schedule your insemination procedure: Monday through Friday call 319-356-1767 after 8 a.m.

You may call anytime until 4:30 p.m. to schedule for the following day. You may also schedule using voice mail after hours:

Call 319-384-8352 (4:30 p.m. to 8:00 a.m.). Please listen to the greeting and provide the requested information in your voice mail message. The following information should be included in your voice mail message:

• Pronounce and spell your first and last name
• Pronounce and spell your partner's first and last name
• Provide the male partner's date of birth
• If arriving Monday-Friday, indicate your anticipated time of arrival (between 8 to 9 a.m.).

The laboratory staff will inform the clinic of your appointment time.

Inseminations to be performed on Saturday, Sunday or Holidays: The insemination service is available on weekends and certain holidays (Memorial Day, Martin Luther King Jr. Day, Memorial Day, Labor Day, Thanksgiving Day and the following Friday). Inseminations will not be available over the Christmas and New Year's holiday weekends. Please contact the clinic for specific dates. Please contact us on Thursday or Friday if you are anticipating a weekend insemination. This will allow the weekend staff to plan in advance for your procedures. Please do this in addition to calling with your LH surge to schedule your procedure.

Please call 319-384-8352 no later than 6:30 a.m. the morning of your insemination and leave a voice mail message. All patients are expected to arrive at the laboratory at 8 a.m. for Saturday, Sunday, or holiday inseminations.

Registration: Prior to arriving at the laboratory, the male partner must register as a University of Iowa Hospitals and Clinics patient. If you are unsure if your partner is a registered patient, please stop by the Registration Desk in the main lobby before you report to the laboratory. Patients must update their registration annually.

Directions to the laboratory: Take elevator L to Level 3.

Directions from the laboratory to the clinic: Take elevator L to Level 3. Be sure to check in with the clerk at the front desk upon arrival to the clinic. Trials performed in our laboratory have shown that extended incubation at body temperature (up to three hours) does not decrease sperm viability or motility. Therefore, a delay between the time of sample retrieval from the laboratory and the actual insemination will not adversely affect the quality of the sperm.