IUI (Intrauterine inseminations)

Intra-uterine inseminations may sound like a scary and invasive procedure, when you doctor first mentions it, but it really isn't.  It is a procedure to put sperm into the uterus and maximize the amount of sperm that gets to the egg, and it is very similar to a PAP smear in procedure and discomfort levels.  IUI is often one of the first-line fertility treatment options.  With intercourse, 99.9% of the sperm never makes it into the uterus;  it gets stuck in the mucus in the cervix or dies in the vagina before even entering the cervix.  By bypassing the vagina and cervical mucus, millions more sperm can be delivered to the egg.  Even when the male partner has normal sperm counts, this can help with achieving a pregnancy.  Medications like Clomid can make the cervical mucus even more impenetrable than usual, and so IUI is often used when Clomid is prescribed as well.

An IUI consists of two steps.  The first step is "washing" the sperm.  This is necessary because the fluid around the sperm contains substances called prostaglandins that will make the uterus cramp, if you put the fluid directly inside the uterus.  Washing the sperm can be done several different ways.  Basically, though, the sperm are spun in a centrifuge to bring them to the bottom.  The sperm are then removed and put in fluid designed to help them survive (media), or the fluid is removed and replaced with the media and the sperm are allowed to swim back up into the media.  No matter how it is done, the sperm are only put in a small amount of fluid (0.5 ml or so).  The helps keep the fluid and sperm from running back out the cervix after the insemination.

After the sperm are washed, they are placed into the uterus:  A speculum is placed into the vagina, and the cervix (opening to the uterus) is located.  A small flexible tube (only a millimeter or two in width) is threaded through the canal in the cervix and up to the top of the uterus.  The sperm is then deposited at the top, and the tube is withdrawn.  This feels similar to a PAP smear, and so should not cause much discomfort.   The speculum is removed, and the procedure is done at this point.  Many doctors will ask you to stay lying down for a few minutes afterwards, and, at our clinic, we actually prop your bottom up in the air a little to let gravity help.  Studies show that the sperm gets into the fallopian tube, which is where it meets and fertilizes the egg, within seconds to a minute.  So you do not need to stay lying down for very long.  After you leave the doctor's office, you may resume your normal activities.  It won't fall out! 

The risks to an IUI are pretty minimal.  It can cause a little spotting or light bleeding, just like a PAP smear can, but this should only last a day or so.  There is a theoretical risk of bacteria from the vagina getting pushed up into the uterus with the catheter and causing an infection.  In practice, however, this is extremely rare.  If your cervix is very curvy or scarred from procedures like D&C's, then it can be a little more uncomfortable too.  To have a reasonable chance of success with IUI, you need 10 million moving sperm, so severe sperm problems may not be amenable to IUI.  In those cases, IVF may be a better option (see previous blogs on IVF and on male factor infertility).  Many couples worry that IUI will cause triplets or quadruplets and such.  This is not the case.  It is the number of eggs ovulating, rather than the number of sperm, that determines the risks of a multiple pregnancy.  So if your doctor is recommending IUI, it is something to seriously consider.  It will increase the amount of sperm getting to the eggs and improve your chances of pregnancy!