Intrauterine Insemination (also known as artificial insemination) is the process of preparing and delivering sperm so that a highly concentrated amount of active motile sperm is placed directly through the cervix into the uterus. IUI is typically performed with fertility drugs for the female patient. Thus, for infertility patients, IUI is commonly performed as a low-tech, cost-effective approach to enhancing fertility in patients. Prior to initiating IUI treatment, women must have at least one documented open fallopian tube as demonstrated by a hysterosalpingogram (tubal dye study).

Process

• There are several techniques available for preparing the sperm for IUI. All of the techniques involve separating sperm from seminal fluid. It is not possible to inject semen that has not been separated directly into the uterus because of chemicals in the fluid that can cause extremely painful uterine contractions. We primarily use a method of sperm separation called "Density Gradient Separation". In this technique, motile sperm are separated from dead sperm and other cells through the use of viscous solution. Approximately 2 hours are required to process the sperm. After preparation, the sperm concentrate is placed through the cervix into the uterus by using a thin, flexible catheter. The time required for insemination is ~5-10 minutes. The patient may experience mild cramping during the procedure but this symptom should resolve shortly after the procedure is completed. There is a small risk of infection following this procedure (<1%). A hysterosalpingogram should be performed prior to IUI to document at least one open fallopian tube. 

• Every male partner providing a semen specimen for IUI preparation must be tested for infectious diseases. If a woman is using donor sperm from a sperm bank, we require that she have infectious testing performed prior to initiating donor sperm inseminations. The specific tests required are HIV, HTLV I, RPR (a test for syphilis), Hepatitis B Surface Antigen, and Hepatitis C antibody. This testing is required by California State Law and must be complete with results in our office before an IUI can be performed. There are no exceptions to this policy. Depending on the blood laboratory used and/or the doctor ordering the testing, the test results can take 7 days to 4 weeks to arrive in our office. We advise all those considering IUI to have these tests done as soon as possible to avoid added stress at treatment time. Patients are responsible for ensuring that these lab tests are in their medical records at UCSF. Once testing is complete, a woman can waive repeat testing for subsequent treatment cycles, if needed.

Studies suggest success rates with IUI are enhanced with the addition of moderate treatment of the female partner with medications. A decision regarding medication to stimulate the ovaries is made in consultation with the physician.  Most patients will start with either clomiphene citrate or Letrozole oral medications taken for five days shortly after menses begins. Alternatively, patients may be advised to take injectable fertility drugs which are more aggressive in stimulating multiple egg release from women (the more eggs that a woman produces during a treatment, the higher the chance for success but also, the higher the chance of a multiple pregnancy).

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