Procedure for intrauterine insemination (IUI) using processed sperm
- Elizabeth S Ginsburg, MD
Elizabeth S Ginsburg, MD
- Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Intrauterine insemination (IUI) is a procedure in which processed and concentrated motile sperm are placed directly into the uterine cavity.
Intravaginal insemination is a low cost, low resource alternative to IUI that is sometimes used by couples who are unable to have, or choose to avoid, vaginal intercourse (table 1).
Clinical use of intrauterine insemination (IUI) is based on the hypothesis that placing a large number of sperm high in the reproductive tract enhances the likelihood of conception. The minimum requirements for performing the procedure are ovulation in the IUI cycle, patency of at least one fallopian tube, inseminate with an adequate number of motile sperm, and absence of documented or suspected active cervical, intrauterine, or pelvic infection.
Because coitus can be avoided, IUI is particularly useful in couples with some types of severe sexual dysfunction (eg, severe vaginismus, ejaculatory dysfunction) or discordant for sexually transmitted disease carriage (eg, human immunodeficiency virus [HIV], hepatitis). For cervical factor or mild male factor infertility, IUI allows sperm to bypass potentially hostile cervical factors, thus increasing the number of sperm that gain access to the uterine cavity (and oocyte). For women undergoing ovulation induction, including those with unexplained infertility or minimal or mild endometriosis, pregnancy rates are thought to be higher when IUI is used as an adjunctive procedure instead of timed natural intercourse. In these couples, IUI is often used as an intermediate level and cost-effective intervention prior to proceeding to in vitro fertilization (IVF). The pregnancy rate after IUI depends on male factors, female factors, and technical factors.
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- CLINICAL USE
- SPERM COLLECTION AND PROCESSING
- Semen collection
- Sperm processing
- TIMING THE INSEMINATION
- Unstimulated cycles
- Stimulated cycles
- - Clomiphene citrate
- - Gonadotropin and hCG
- IUI PROCEDURE
- Patient preparation
- Postprocedure care
- NUMBER OF IUI CYCLES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS