Sperm are inserted into the uterine cavity around the time of ovulation.
IUI can be done in
The ovaries are stimulated with
Ovarian response is monitored by vaginal ultrasound.
Human Chorionic Gonadotrophin injection is given to trigger ovulation; when one to three ovarian follicles are seen to have developed to the required size, usually with one dominate follicle.
Prepared sperm is inseminated 24 to 36 hours later. Insemination may be withheld if 2 or more mature follicles are seen to reduce the risk of multiple pregnancies.
Is the main risk to a mother and the baby and is linked to
Ovarian HyperStimulation Syndrome OHSS is a potentially life threatening condition and one of the main reasons that ovulation induction treatment is stopped or cancelled.
Other adverse events are:
There is significantly higher live birth rates with IUI with stimulation compared with IUI without stimulation, but also there were associated higher multiple pregnancy rates.
In Vitro Fertilisation IVF is an alternative to IUI with stimulation.
Several cycles of IUI with stimulation were required to match live birth rates achieved by a single IVF cycle, but with disadvantage of higher multiple birth rates as there was less control over the number of embryos produced.
IUI with stimulation should not be recommended in any situation.
IUI without stimulation is no better than expectant management.
IUI with stimulation is better than expectant management in all groups of women,but it significantly increases the risk of multiple pregnancies.
IUI with or without stimulation should not be routinely offered.
In certain groups where vaginal sex is inappropriate or not possible; IUI without stimulation with sperm from a male partner or donor would be the first-line approach.
Expectant management for two groups of women with unexplained infertility “mild endometriosis or mild male factor infertility” does not involve active clinical or therapeutic interventions and consist of:
In couples with unexplained infertility for 2 years ‘including the year before testing and diagnosis’ IVF should be considered to reduce anxiety and depression.
The additional cumulative success rates in the third year would be very small. Success rates decline with the age of the woman. This information should be explained early on to women with the diagnosis of unexplained infertility.
Donor Insemination DI in Unexplained Infertility (mild endometriosis or mild male factor infertility)
The cumulative success rates with intra cervical insemination (ICI) and Intra Uterine Insemination (IUI) in women who are 35 years or less is shown in the table:
Pregnancy after 6 cycles of DI
Pregnancy after 12 cycles of DI
Women in same sex relationships with a diagnosis of unexplained infertility “mild endometriosis or mild male factor infertility” should have up to 12 cycles of donor insemination. This would be equivalent to expectant management for that group ‘unexplained infertility’ in couples.
IUI using partner or donor sperm without ovarian stimulation would be appropriate treatment for up to 12 cycles:
Unstimulated Intrauterine Insemination is considered as a treatment option in the following groups as an alternative to vaginal sexual intercourse:
For people in the above groups who have not conceived after 6 cycles of donor or partner insemination, despite evidence of normal ovulation, tubal patency(not blocked} and normal semen analysis, further 6 cycles of unstimulated intrauterine insemination could be offered before IVF is considered.
In people with Unexplained Infertility “mild endometriosis or mild male factor infertility” who are having regular unprotected sexual intercourse Intrauterine Insemination, either with or without ovarian stimulation is not routinely offered (exceptional circumstances include, social, cultural or religious objections to IVF).
The advice is to try to conceive for a total of 2 years (including the one year prior to infertility investigations) before IVF is usually considered. However many circumstances including the age of the woman, the individual request and other reasons should be taken into consideration and IVF should be offered earlier.
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