Tips for a Successful IUI From a Fertility Expert
IUI (intrauterine insemination) is one of the most commonly used fertility treatments in the world. Today, I am going to discuss how IUI works and what techniques you can use to maximize your chances for success.
How does IUI improve the chance for pregnancy?
IUI is a technique in which sperm is put directly into the uterus. Why would this help?
When a couple has sex, the sperm from the man is released into the vagina. Most sperm are going to be killed in the vagina. Some will reach the opening of the uterus known as the cervix. The cervix is a long tunnel filled with sticky mucus.
Of those sperm that don't die in the vagina, most will get stuck in the cervix and never make it out. Together, the vagina and cervix present a considerable barrier to the passage of sperm. This is a problem since the egg gets fertilized in the fallopian tube. If the sperm are not making it into the fallopian tube, then pregnancy can't happen.
So how does an IUI work exactly?
IUI stands for intrauterine insemination.
During an IUI, the sperm are placed directly into the uterus. This bypasses the vagina and the cervix. As a result, a lot more sperm can swim into the fallopian tubes where fertilization happens.
Many studies have shown that compared to intercourse alone, the chance for pregnancy with IUI is better.
3 minimum requirements for IUI success
In order to become pregnant with IUI, there are 3 absolute requirements.
- The male must have sperm
- The female must ovulate either on her own or with fertility medications
- The female must have at least one fallopian tube that is open
What fertility tests should you have before attempting IUI?
All women should have an HSG to make sure that at least one fallopian tube is open. All men should have a semen analysis to make sure that they have sperm and to see how many sperm there are, how many are moving and how many look normal under the microscope.
We also strongly recommend that men have a sperm test called a Cap-Score.
When is IUI most effective? (How to determine timing for IUI)
In order to be most effective, the IUI must be performed at the time of ovulation. IUI timing needs to be more precise than for intercourse.
Figuring out the time of ovulation can be done at home with an ovulation predictor test of some type. These tests are generally pretty accurate.
Women can also be monitored in the doctor's office by having ultrasounds of the ovaries and blood tests.
Do not try to time an IUI by using an app or using temperature charting.
Another tip: if you are a woman with one fallopian tube or have one blocked fallopian tube, monitoring with ultrasound may be a better choice since you can see when the eggs are maturing on the same side as the open tube.
What is a sperm wash for IUI?
You may hear your doctor refer to something called a sperm wash. What's that?
Well, we are not actually washing the sperm. Before sperm can be placed into a woman's uterus it must first be prepared. Here's the reason why:
When a man ejaculates, the fluid that he releases is composed of two main components: seminal fluid and sperm.
Seminal fluid contains many types of hormones and chemicals. One group of chemicals in particular can cause problems and are known as prostaglandins. If high levels of prostaglandins are placed directly into the uterus they can cause a woman to become very sick.
The symptoms of prostaglandin absorption include nausea and vomiting, fever, diarrhea and cramping. The symptoms usually begin within a few minutes of performing the IUI.
To avoid this problem, we separate the fluid part from the sperm and only inject the sperm into the uterus. This is called a sperm wash. Sperm wash for IUI is actually a bad term because the sperm are not actually being washed or cleaned, but just separated from the fluid.
There are several methods for performing a sperm wash for an intrauterine insemination. The medical literature does not clearly indicate that any method is better than any other. It is therefore up to the personal preference of the physician performing the IUI.
How do sperm counts affect IUI success?
One question that I am asked a lot is about male sperm counts and their impact on IUI.
IUI seems to work best with men who have normal sperm counts or counts that are mildly low. Guys who have very low sperm counts have a much lower chance for pregnancy with IUI.
We recommend that those couples go directly to IVF. This brings up a very interesting question:
Are two IUIs more successful than one?
If doing an IUI increases the number of sperm that reaches the fallopian tubes and the number of sperm clearly matters for pregnancy, would it be better to do two IUIs than one?
The answer to this question was provided by a 2015 study: Couples with infertility were split into two groups. One group had a single IUI at the time of ovulation. The other group had two IUIs each month. One about a day before ovulation and the second one at the time of ovulation.
Couples continued to do either single or double IUIs for each month up to four months. At the end of the study, there was no difference in the number of couples who became pregnant.
Multiple IUIs each month do not help!
Does bed rest after IUI increase the chance for pregnancy?
What about resting after IUI? Does that help? This question was answered by a well-done study in the Netherlands.
About 400 couples with infertility who were going to have treatment with IUI were split into two groups. In half the couples, women rested for 15 minutes after the IUI. The women in the other half of the group were allowed to get up right away and walk around.
Couples who didn't get pregnant right away could repeat the IUI a few more months.
The results were pretty astounding! Women who rested for 15 minutes after an IUI became pregnant more commonly than women who didn't.
By the time couples had tried four IUIs, 27% of the resting group had become pregnant versus 18% of the get up and go group. That's a 50% improvement in the success rate.
Does a high percentage of abnormal appearing sperm lower IUI success? (morphology)
Another question I get a lot is about men who have a lot of abnormal appearing sperm.
All men have some sperm which appear abnormal under the microscope. When a man has a high percentage of abnormal appearing sperm, it is referred to as teratospermia.
Guys with teratospermia seem to have more difficulty producing pregnancies than their partners.
Several studies have looked at the impact of abnormal sperm and the success rate of IUI and found that on any given attempt the chances for pregnancy are a little bit lower.
After four attempts with IUI the total number of couples who have achieved a pregnancy was about 20% lower when the men had lots of abnormal appearing sperm.
Does the use of fertility medication improve the success rate of IUI?
The answer here is a little more complicated. Some women benefit from using fertility medication and some women don't.
The group who does benefit from the use of fertility medication are couples who have unexplained infertility. The group who does not benefit are women who are using donor sperm. Because they either don't have a partner, have a female partner or who have a partner without any sperm.
Even after several months using fertility medication did not result in those women getting pregnant more quickly or more often.
Our bottom line is this:
IUI is a relatively easy non-invasive, inexpensive fertility treatment. For certain couples it can speed up the time it takes to get pregnant compared to just having sex. By following the tips I set out, you can maximize your chances for IUI success.