Intrauterine insemination (IUI) is the placing of sperm into a woman’s uterus when she is ovulating. This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. IUI is often done in conjunction with ovulation-stimulating drugs. IUI can be performed using the husband’s sperm or donor sperm. Before IUI, the woman should be evaluated for any hormonal imbalance, infection or any structural problems.
Insemination is performed at the time of ovulation, usually within 24-36 hours after the LH surge is detected, or after the “trigger” injection of hCG is administered. Ovulation is predicted by a urine test kit or blood test and ultrasound.
In the case of husband inseminination, the male partner produces a specimen, at home or at the clinic or doctor’s office. The sperm is then prepared for IUI. Sperm from the male partner or third-party donor are “washed” or separated. Separation selects out motile sperm from the man’s ejaculate and concentrates them into a small volume. Sperm washing cleanses the sperm of potentially toxic chemicals which may cause adverse reactions in the uterus. The doctor uses a soft catheter that is passed through a speculum directly into the woman’s uterus to deposit the semen at the time of ovulation.
IUI may be used in conjunction with ovulatory medications, such as clomophine citrate, gonadotropins, or urofollitropins. If injectable ovulation stimulating drugs are used in an IUI cycle, careful monitoring is essential. Monitoring includes periodic blood tests and ultrasounds beginning around day 6 of the woman’s cycle. Results of these tests will indicate when eggs are mature, prompting the hCG shot.
IUI is also used with specially prepared donor sperm. The sperm bank sends the doctor’s office sperm that is already prepared for IUI. IUI is a relatively quick procedure and is performed in the doctor’s office without any anesthesia. It should not be painful, although some women report mild discomfort.
Myths About IUI-ART-IVF
MYTH: You will have multiple babies (high order multiples)
Busted: It is true that fertility treatment increases the risk of having a multiple pregnancy. However, most twins result from spontaneous conceptions — couples who conceive on their own! Triplets or more are a different story; approximately 15% of triplet and 7% of quadruplet pregnancies were conceived spontaneously.
The increased risk of a multiple pregnancy during fertility treatment is a result of the medication used to cause or boost ovulation. Approximately 5-8% of pregnancies conceived with the use of clomiphene citrate, an oral fertility drug, are twins. Triplets or greater occur very infrequently. Use of gonadotropins, which are injectable fertility drugs, result in twins about 15% of the time and more than twins in about 3% of cycles.
The risk of multiple pregnancies is also increased with IVF. Younger women are more likely to have twins than those who are somewhat older. For example, in this country approximately one third of women under the age of 35 undergoing IVF will have twins, where as less than 10% of women over 42 will have twins. The risk of triplets is low in all age groups because most women under 35 will have only one or two embryos transferred.
Though fertility treatment generally increases the risk of a multiple pregnancy, the majority of individuals and couples will have a single baby!
MYTH: People think IVF always works. Everyone who uses it is successful and has a baby.
Busted: Though we would like for all individuals and couples trying to get pregnant to be successful, unfortunately, there is no fertility treatment, including in vitro fertilization (IVF), that always works for everyone. The likelihood of success in an IVF cycle is impacted by a number of factors, the most important being the age of the female partner. Information collected from almost all of the IVF programs in the country found that women under 35 had a 41% chance of having a baby from a single IVF cycle. The chance of success drops to 32% in women between the ages of 35 to 37, and 22% in women between the ages of 38 to 40. That number is even lower in women over 40 years of age. Success rates also vary with the number of embryos transferred; the likelihood of pregnancy increases with when more embryos are replaced, but so does the risk of a multiple pregnancy. The chance to have a baby from IVF increases when more than a single cycle is done. Though not everyone who undergoes IVF treatment will have success, the majority will!
MYTH: It’s covered by insurance.
Busted: Many insurance companies do offer coverage for the various stages of the evaluation and treatment of infertility. Exactly what is covered often varies from insurer to insurer, and from policy to policy. Some insurers will only cover the examination and testing to determine the cause of infertility, while others will cover treatment and medications. The kind of treatment that is covered also varies. For example, some policies may cover intrauterine insemination (IUI) when used in conjunction with medication to boost ovulation, but may not cover in vitro fertilization (IVF) where as others may cover both. In addition, 15 states require that insurers include infertility benefits in their policies, though what is covered also varies from state to state.
As a result, it is important to study your policy to determine if, and to what extent, you may be covered. Many fertility practices have financial counselors to help you through this, to answer your questions about your insurance benefits and to work with the insurer to determine what is covered.
MYTH: These are the only options for couples struggling with infertility.
Busted: There are many options for couples experiencing infertility. Treatment protocols are tailored to each couple and are dependent on factors like age, how long a couple has been trying to get pregnant, and the results of testing. For example, a woman may have a problem with her thyroid gland that causes her not to ovulate; treating with thyroid hormone can restore ovulation allowing for pregnancy. A man may have a semen analysis that shows decreased motility; IUI, with or without medication, may be the best treatment option. If a woman doesn’t ovulate, medication to cause ovulation would be the most appropriate treatment-insemination may not be necessary at all. Women with blocked tubes are probably best treated with IVF, though surgery may also be an option. The treatment approach may be more aggressive in a woman approaching 40 or in a couple who has been struggling with infertility for several years. These are just a few examples of available treatment approaches. Treatment plans are individualized; there are several alternatives and there should not be a “one size fits all” approach.
MYTH: The babies conceived through ART will have problems such as birth defects, low birth weight, developmental delays.
Busted: Though we hope all babies will be born without any problems, unfortunately this is not the case. Children conceived naturally to couples who have never struggled with infertility have a 3 – 5% risk of birth defects and a 1 – 2% likelihood of experiencing developmental delays. Pregnancies conceived naturally in women experiencing infertility may be at a slightly higher risk for pregnancy complications.
IUI, when used without stimulation medication, does not appear to further increase the risk of birth defects or developmental delays. Pregnancy related complications are increased with ovarian stimulation, though this can be largely attributed to risks associated with multiple pregnancy.
Babies born from IVF may be a little smaller than those conceived naturally, though they are typically still in the normal range. The majority of studies have not found an increased risk of birth defects in babies conceived with IVF. The use of intra-cytoplasmic sperm injection (ICSI), which is typically used when sperm quantity and/or quality is reduced, is associated with a very slight increase in chromosomal abnormalities and birth defects.
Fortunately, if there is an increase in problems such as birth defects, low birth weight, and developmental delays in babies conceived through ART, it is very small. The overwhelming majority of babies born as a result of fertility treatment are fine!