Intrauterine Insemination (IUI)

The process of intrauterine insemination (IUI) involves four steps and can take up to four weeks from the start of the menstrual period to the pregnancy test. This technique is relatively simple and requires two main conditions. Firstly, the fallopian tubes must be open, and secondly, a normal sperm sample is needed (known as normozoospermia) or working with a donor sperm. IUI is recommended for couples who have been trying to conceive for a relatively short period, less than two years, for patients who are experiencing anovulation as their primary issue or mild male factor (mild asthenozoospermia) or a combination of the above, and also it is recommended for same-sex couples or single women. The success rate of IUI is normally around 16-18% live birth rate.

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The steps are described below:

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1. Assessment to determine suitability for treatment.

• Typically, when undergoing this fertility treatment, various blood tests such as AMH, FBC, and TSH are conducted alongside a transvaginal scan known as HyCoSy or saline infusion sonogram (SIS tubal). These tests are done to assess the uterus, ovaries, and tubal patency. On the male side, a semen analysis (SA) is also important to ensure that the sperm is suitable for the treatment. In the event of working with a donor sperm sample most of the times, the sample would be suitable for IUI treatment. If the Fallopian tubes are blocked and/or the SA is unsuitable for treatment, we would recommend another technique like IVF/ICSI.

 

2. Stimulation of ovaries using gonadotropins or tablets (clomiphene or letrozole)

• During this stage, which lasts for about 10-12 days, the ovaries are stimulated with medications to induce follicle growth. Transvaginal ultrasounds are performed during this time to monitor the ovaries and count the number of follicles and their size. When follicle(s) reach a size of 17-22 mm, a trigger shot is administered, and the patient is instructed to attend the clinic 24-36 hrs after the last injection. Gonadotropins are administered subcutaneously whereas the tablets are normally taken for 5 days.

 

3. Insemination at the fertility clinic

• After attending the clinic, the male partner will be asked to provide a sperm sample. The sample will be prepared in the laboratory to select the best sperm possible. When working with a donor sperm sample, the sample will be thawed out and checked after preparation. The procedure can be performed in a theatre or a scan room. It involves placing a gynaecological speculum and passing the prepared sperm sample through the cervix, leaving it in the uterus. After the procedure, the patient will take progesterone (P4) to aid the attachment of the potential embryo. A pregnancy test will be conducted after 14 days of the insemination.

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4. Pregnancy test 

• The pregnancy test should be conducted normally after 14 days following the insemination. It is recommended to have a determination of B-HCG level in the blood rather than a urine test, as it is more precise. If the result is positive, instructions will be given to return after 4-6 weeks to perform a transvaginal scan to check the viability of the embryo. If the result is negative, the medication intake will stop and a conversation with your doctor will occur in most cases.

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