What do you need to know for IUI?

Artificial insemination (AI) represents a medical technique of inserting sperm into the woman’s cervix or uterine cavity in order to achieve a pregnancy through in vivo fertilization. It is part of the group of assisted reproductive technologies (ART) that are available to increase the chances of getting pregnant.

Opposing to in vitro (“in glass”) fertilization, in vivo (“within the living”) fertilization happens in a woman’s body. Still, because of the application of advanced reproductive technology for the realization of this insemination, this technique belongs to the group of fertility treatments. Artificial insemination may be done also using sperm donation. 

Artificial insemination can be a solution for women who don’t want the fertilization to take place outside their bodies. Furthermore, it is suitable for women who may be single, who are in a same-sex relationship or women who are in a heterosexual relationship but their male partner has been diagnosed with infertility.
We would like to guide you through the several most common questions related to IUI. So, let’s start the tour.

What kind of Artificial insemination exists?

The Artificial insemination methods used today are:

• Intracervical insemination (ICI)
• Intrauterine insemination (IUI)
• Intrauterine tuboperitoneal insemination (IUTPI)
• Intratubal insemination (ITI)

ICI is the easiest method for artificial insemination and can be done at home. Yet, the effectiveness can not even be compared with insemination done in a fully controlled clinical environment. ICI is done with raw and unwashed or anyhow enhanced semen. The chances of achieving a healthy pregnancy with this type of insemination are low. Usage of unwashed semen can result in uterine cramping, expelling the semen and causing pain. Furthermore inserting an unwashed sperm can cause failed implantation.

The more developed method of insemination is IUI. Intrauterine insemination is the most commonly used type of artificial insemination that can be done at a fertility clinic. When performing IUI, fertility clinics use enhanced sperm for insemination. The chances of achieving a healthy pregnancy with IUI are higher. That’s due to the fact that the semen is washed since the overall semen quality is a priority.

Intrauterine tuboperitoneal insemination is done with inserting washed sperm into the uterus, and into the fallopian tubes. This type of artificial insemination can be a possible solution to getting pregnant with unexplained infertility, mild endometriosis or male infertility. 

Intratubal insemination (ITI) involves injecting of washed sperm into the fallopian tube. This technique is no longer listed as beneficial in comparison to the methods of IUI and more advanced fertility treatment. 

What is Intrauterine insemination (IUI)?

Intrauterine insemination (IUI) n Cyprus is performed with injecting washed and enhanced (concentrated) sperm into the woman’s uterus. It is often prioritized over the other artificial insemination techniques that allow the usage of unwashed sperm. 

How is it done and why is sperm washing important?

The quality of the sperm (motility, sperm count, sperm morphology) is of high importance for successful fertilization. Therefore, when a couple is experiencing issues with getting pregnant and reaching to assisted reproductive technologies, it is important to ensure the quality of the sperm. It’s been used for years by infertility clinics to boost the potency of a man’s semen when trying to help his female partner conceive.

Washing sperm techniques are very helpful in increasing the quality of the sperm for fertilization. With these techniques individual sperm cells are separated from the semen and used for fertilization with IUI. The separation is a process of extracting viable sperm from the mixture of mucus and less motile sperm in the semen. These techniques also make it possible to decrease the risk of transferring certain infectious diseases, such as HIV to the offspring. 

The procedure is done in a laboratory environment and several approaches are used. 

Sperm washing with centrifugation

This method of washing with centrifugation is based on density differences in the semen.
The sperm washing procedure means the spinning of the semen sample in a centrifuge to separate it into three parts: seminal fluids, other cells, and sperm cells. The first two parts and half of the sperm cells are usually used for testing of HIV.  If the results are negative, then an additional solution is applied and the healthiest sperm are extracted. The remaining part of the sperm cells is used for artificial insemination. 

Sperm washing with a swim-up method

The second approach is a direct “swim-up” method. The swim-up method uses the hospitable medium, towards which the most motile sperm moves when placed in a tube. The procedure is following several steps:

• Semen is placed in a test tube for washing 
• Specific culture medium to which the healthy sperm swim up to is placed on the top of the semen in the tube
• The tube should stay at least one hour angled, or/and in an incubator
• The top layer is collected for use

This technique can be used when the couple is attending a male offspring. This is based on the ability of the X and Y sperm to move. Small fractions of X – sperm have shown to be the fastest of all and are usually found on the top of the tube. Next fastest is the Y – sperm and the rest is coming last.
This technique can sometimes be also submitted for centrifugal washing but is more useful from the standard washing because it opens the chance for selection of the offspring’s gender. 

What is the procedure for IUI? 

This procedure is simpler than the other assisted reproductive technologies but also has lower success rates. IUI is usually done infertility clinics and is also subject to constant monitoring of each step. The steps vary based on the reproductive material used. If a sperm donor is going to be used, then the procedure will have some extra steps.
Standard steps for IUI are:

Fertility evaluation – Important steps of determining the chances of getting pregnant with IUI. It is done for both the partners but is more important to check the woman’s reproductive health and see if the necessary requirements are fulfilled. At this step, the woman’s ovaries reserves are checked, which leads to the next step.

 

• Mild ovarian stimulation – This preparational step includes medical therapy and constant ultrasound check to make sure that the number of oocyte production is sufficient for conception.
• Luteal phase support – This is taking place if there is a disbalance in the progesterone level. This hormone governs successful implantation, so it should be in the optimal range. 
• Sperm collection – This can be done both ways. If the male partner has not experienced issues with deposing a semen sample, then it is simple. If the male partner has problems with deposing the semen sample, then one of the sperm retrieval methods is applied.
• Sperm washing – The actual washing procedure of the sample takes place here. It can be done with any of the techniques mentioned (centrifugal or swim-up).
• Transfer of the collected sperm – The collected sperm is transferred with a catheter to women’s uterus. It is done around the time of ovulation or when the LH hormone indicates ovulation.
• Horizontal rest – After the procedure, the woman should stay in a horizontal position for some time. Usually not more than 1 hour.

If a sperm donor is used, then prior to the standard procedure is the preparation of the sperm donor. Usually, the donor sperm is thawed and prepared for transfer. 

Requirements for patients that can undergo IUI

There are several requirements that have to be respected in order for this treatment to be performed. This applies especially to those who would use their own reproductive material. So, let’s take a look at those, individually for man, and woman. 

IUI’s requirements for a woman

Typically, the female patient for IUI should have:

•  normal day 3 blood test results
•  unobstructed fallopian tubes
•  a normal uterine cavity
•  no distortion of the pelvic 

IUI’s requirements for man

IUI is based on using high-quality sperm for fertilization. Therefore, there are several important factors that are detected with the fertility evaluation and determine the male patient’s availability for this treatment.

The deciding factor is of the maximum quality. In addition, the man should have: 

• Optimal sperm count for fertilization (number of sperm per cc – 20 and 30 million/ml)
• Optimal sperm motility for fertilization (percentage of sperm moving)
• Proper sperm morphology (shape)

Who can benefit from this treatment? 

Based on the requirements mentioned above, there are several scenarios when people can use IUI. This treatment can help to achieve a healthy pregnancy as all fertility treatments. Is specifically helpful in cases when the female patient is:

• a single woman 
• in same-sex relationship
• has been diagnosed with mild endometriosis 
• under the age of 30
• woman with ovulatory problems, if she responds properly to the stimulation medications

Is the procedure painful?

The IUI procedure is not painful. Women who have undergone an IUI procedure might feel mild cramping during the procedure, very similar to a pap smear. Several side effects from the fertility medication can be experienced, but they usually disappear after the usage stops.
For the man, it depends on how the sperm was delivered. If a sperm retrieval method was applied, then slight bleeding might be experienced.
Overall, this procedure is not invasive and is safe. 

Can IUI fail?

As with any other fertility treatment, success rates are not 100%. Yet, the success rates of IUI are approximately 20%. That indicates a high risk of failure and the existence of many reasons for failure. The most common reasons why an IUI can fail, as follows: 

• Endometriosis – Can lead to failed implantation
• Poor egg quality – With IUI this is not evaluated and can cause complications
• Sperm’s inability to penetrate the egg – Even though the sperm is enhanced, this ability is hard to be tested and it can lead to failure
• Rejection of the sperm – In some cases, the women’s immune system fails to support the conception and refuse the sperm of the partner

Can IUI be used for gender selection

This is one of the biggest mistakes in understanding this AI technology. The sperm washing can help in getting a male baby thanks to the sperm’s features, but the accuracy in gender selection of this technology is very low.
Usually, gender selection is successful when the gender of the embryo is detected. IUI is a procedure that doesn’t evaluate embryo quality or features. Therefore, is hard to say that IUI is a technique for gender selection.

What is better, IVF or IUI? 

Intrauterine insemination is a technique that helps to treat infertility. It is quite a cheaper solution for fertility treatment than IVF but doesn’t offer the same success rates. IUI as a fertility treatment has limitations in the age of the woman.
Also, with this fertility treatment, the quality of the embryo is impossible to be evaluated. The chances to fail due to many reasons are very high since is hard to regulate the natural conception. Very often this technology must be combined with Sperm Donation and other fertility enhancements. Also, many patients have reported that they needed multiple IUI to achieve conception. So, the cost-benefit balance of this technology is quite not prosperous sometimes. 

On the other hand, in vitro fertilization (IVF) done with any of the available IVF treatments has shown success rates over 80%. The in – vitro fertilization treatments have been developed to cover and treat many infertility reasons and as many possible infertility scenarios. IVF procedures are done in high – tech laboratories and in a controlled environment.  The couples that undergo IVF in North Cyprus treatments are consulted about every possible outcome, and more important about the embryo selection for the final transfer. The embryo grading is possible only with IVF. 

Moreover, with undergoing an IVF treatment in North Cyprus, the preimplantation genetic tests are available for the patients. The preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD Cyprus) are making sure that no genetic disorder will be transferred to the offspring, thus increasing the chances of a healthy pregnancy and healthy baby. 

PGS Cyprus testing can be used for gender selection also. The accuracy is significantly higher than with IUI. 

In vitro fertilization also offers the possibility of using additional assisting technologies, such as assisted hatching, blastocyst transfer, and embryo glue, that can prevent implantation failure. 

Every step of the fertilization, the quality of the eggs and sperm, and the final embryo are under monitoring and evaluation. All in all is not hard to say that IVF is more efficient reproductive technology then the IUI.

What fertility treatment euroCARE offers?

EuroCARE offers both the IUI and many IVF treatments in North Cyprus. Our success rates speak for our quality and efficiency. The best fertility doctors in Cyprus are within our team and their mission is to help with treating each specific case. The team behind euroCARE’s success stories take care of the patients and evaluates individually every case. 

So, if you are curious about which treatment might be better for you, or want to consult your specific situation, book a free consultation with our team!