IUI (Intra-Uterine Insemination) is the least invasive of the assisted treatments and also the least expensive, costing about £600 a cycle in the UK. Usually a maximum of 3 to 6 IUI treatments are given before treatment options such as IVF or ICSI are usually recommended, and recent research has supported the use of IUI (with clomid) before IVF as the success rates are very similar. However neither treatment has been proven to be more effective than trying naturally for couples with unexplained infertility!i However one big advantage of IUI is that it offers a relatively low-cost, low-intervention solution when a couple are experiencing cervical mucus issues (which account for about 15% of infertility) and IUI is generally offered when:
- There are problems with ovulation
- Unexplained infertility for the couple
- The male partner experiences impotence or premature ejaculation
- The woman’s fertile and using donor sperm
Two Cochrane reviews have evaluated the effectiveness and safety of IUI, with both suggesting there’s insufficient evidence to conclude that either IUI or IVF is more effective compared to natural sexual intercourse in couples with unexplained sub-fertility. NICE (National Institute for Health and Care Excellence) have recommended that IUI is no longer offered and suggests a policy of two years of sexual intercourse followed by IVF, but given the emotive (and financial) issues involved this recommendation has generated a lot of debate and only 4% of gynaecologists in the UK have stopped using IUI.
The requirements for IUI are:
- At least one Fallopian tube is open and healthy (patent), and if only one tube is patent the IUI can only proceed when follicle tracking shows ovulation will be from the patent side
- That sperm numbers and quality are sufficient for success
IUI is performed either with stimulation to increase egg production or ensure ovulation, or as part of a natural cycle.
- Without drugs: The IUI is just before the predicted ovulation (usually between day 12 and 16) with an ovulation predictor kit (usually provided by the clinic) showing this
- With fertility drugs: Either clomiphene citrate (clomid) is given early in the cycle to induce ovulation, or follicle stimulating hormone (FSH) is given to stimulate many follicles to maturity, with follicle tracking by vaginal ultrasound showing when the eggs are mature. A human chorionic gonadotropin (hCG) injection is then given to stimulate the release of the eggs and the procedure is carried out. The stimulation level is usually mild to reduce the risks of multiple pregnancy or over-stimulation of ovaries
The man needs to provide a fresh sperm sample on the day; the sperm are then washed to remove the fluid surrounding them and all the rapidly moving sperm are separated out, placed in a small soft catheter tube and inserted into the uterus.
The success rates for IUI are:ii