Intrauterine Insemination, IUI
IUI is often used as a first line treatment for infertility. Using IUI, sperm are collected, concentrated, and placed directly into the uterus. In most cases, the female undergoes ovulation induction with FSH (Gonal-F, Follistim, Repronex, etc.) to cause the development of multiple eggs thus increasing the chances for fertilization and development.
IUI’s are planned around ovulation and once the follicles mature, an injection of human chorionic gonadotropin (hCG) is given and the IUI’s are planned 36 hours later. Where possible, the male partner’s sperm is used, or if this is not possible, donor semen is purchased. Lesbian couples can purchase donor sperm from one of many suppliers, many of which supply background information on the donor.
Causes of male sperm abnormalities include lack of sperm caused by high dose chemotherapy or radiation, congenital, trauma to the testicle, failed ejaculation, vasectomy, and other conditions, which cannot always be identified. IUI is employed in cases of mild male factor infertility or when donor sperm is used. IUI is effective in some cases of male factor because the sperm are concentrated prior to placement into the uterus.
However, in borderline moderate or severe male infertility, IVF is usually the treatment of first choice. ICSI is usually used to insure fertilization of the selected eggs. Using ICSI, the sperm are inserted directly into the eggs. IUI also avoids exposure of the sperm to the cervical mucus. Thus when antisperm antibodies are present, or the cervical mucus is inadequate, IUI is often a treatment of first choice. Conditions where IUI is commonly employed are listed below:
- Inadequate sperm count
- Male or female antisperm antibodies that destroy the sperm
- High number of abnormal sperm
- Poor sperm motility
- Unexplained infertility
Even though some OB/GYN’s offer stimulated IUI treatments, the procedure should only be administered by a trained reproductive endocrinologist/infertility specialist. There is a comparatively high risk of multiple births in stimulated IUI cycles because there is little control over how many mature eggs are ovulated.
The cycles must be monitored very carefully to prevent drug side effects and avoid high order (3 or more) multiple births. In fact, most of the cases of quintuplets reported by the media are from stimulated IUI cycles. Monitoring includes periodic measurements of estradiol hormone levels and vaginal ultrasound to view the follicles.
Dr. Borkowski has extensive clinical experience monitoring and performing the IUI procedure.