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Intrauterine Insemination (IUI)
If a patient does not become pregnant after three to six cycles of ovulation induction therapy, she is often a candidate for injectable ovulation induction drugs (gonadotropins) combined with intrauterine insemination (IUI). IUI involves the placement of specially washed and prepared sperm directly into the uterus using a small catheter. Whether or not a patient is a candidate for IUI depends on the specific cause or causes of her infertility.
IUI requires that the female produces and ovulates viable eggs that travel unimpeded through the fallopian tubes and are capable of being fertilized by sperm. IUI is sometimes used as a "first line" treatment in combination with ovulation inducing medications, such as clomiphene citrate, Gonal-F or Follistim.
IUI is often effective in treating infertility caused by poor cervical mucus. The sperm are placed directly into the uterus, thus bypassing the cervical mucus. IUI is also sometimes used in cases of "mild" male factor infertility. The sperm are specially prepared and concentrated, increasing the probability that they will fertilize the egg. Additionally, IUI is sometimes appropriate in cases of infertility due to unknown causes.
Indications for IUI include:
- low sperm count
- decreased sperm motility
- increased numbers of abnormal sperm (abnormal morphology)
- poor cervical mucus with a poor post coital test
- antisperm antibodies in either the male or female
- minimal or mild endometriosis
- unexplained infertility
If the partner's count is low, his sperm can often be collected, specially prepared, washed, concentrated, and placed into the uterine cavity. Unwashed sperm should never be placed directly into the uterus, as fatal allergic reactions can occur. In cases of moderate to severe male factor, in vitro fertilization (IVF) - with or without intracytoplasmic sperm injection (ICSI) - is the treatment of first choice. Per cycle, success rates with IVF are higher than IUI in most cases and many patients opt for IVF as the first line treatment. Since IUI is less expensive per cycle than IVF, some patients can afford more attempts; however, statistically the chance of conception from two IVF attempts is significantly higher than 3-4 IUI cycles.
Men with severe sperm deficiencies, such as having no sperm in the ejaculate, can still father genetically related children using procedures such as IVF with testicular sperm extraction (TESE). In such cases, sperm cells can be "retrieved" from the male's reproductive tract and inserted, using ICSI, into the female's egg.
Some couples choose to use donor sperm in cases of severe male factor or where there is a high probability that the male will transmit a severe heritable disease for which there is no screen, such as preimplantation genetic diagnosis (PGD). The Jones Institute for Reproductive Medicine of Eastern Virginia Medical School began cryopreservation of sperm in 1985 and was one of the first cryopreservation laboratories in the United States to be certified by the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88). The Institute maintains a pool of donors and supplies physicians throughout the country. All donors are strictly screened, and samples are quarantined to ensure that they are free of HIV or other disease-producing agents.
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