Intrauterine Insemination (IUI)

• Individuals with sexual dysfunction
• Patients seeking donor sperm

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Initial Consultation and Assessment:

• Fertility evaluation for both partners: Fertility evaluation for both partners are essential in identifying the cause of infertility and guiding treatment decisions. For women, evaluation typically include a comprehensive history, blood tests to check hormone levels, and imaging tests like an ultrasound or tubal patency testing to assess the health of the ovaries, fallopian tubes, and uterus. Additionally, ovarian reserve testing may be done to evaluate the quantity of eggs. For men, the primary test is a semen analysis, which evaluates sperm count, motility (movement), morphology (shape), and sperm antibody testing. Further tests for infectious screening and genetics are also performed.
• Determining the timing for IUI based on ovulation tracking: IUI timing is determined by tracking ovulation using methods such as urine tests or ultrasound monitoring, with the procedure typically scheduled 24 hours after the LH surge or 36 hours after trigger of a dominant follicle.

Sperm Preparation:

• Sperm washing and selection techniques to ensure optimal sperm quality:​ Sperm washing and selection techniques are used to optimise sperm quality for IUI by separating healthy, motile sperm from semen components like debris, dead sperm, and seminal fluid. The process involves centrifugation, which spins the sperm sample to isolate the sperm from other components, followed by swimming up techniques where the most motile sperm are selected, ensuring that only the healthiest sperm are used for insemination. This improves the chances of fertilisation by increasing sperm concentration and motility, while reducing the risk of infection and enhancing the likelihood of successful conception.

Insemination Procedure:

• Steps involved in the insemination process​: The IUI insemination process involves several key steps: First, the woman undergoes ovulation monitoring using urine tests or ultrasounds to determine the optimal time for insemination. Then, sperm is collected from the male partner or thawed from a sperm donor and undergoes sperm washing. The prepared sperm is then injected into the uterus using a thin catheter. The procedure is quick, usually painless, and requires minimal recovery time. Afterward, the woman may resume normal activities.
• What to expect during the procedure (duration, discomfort level): During an IUI procedure, you can expect a relatively quick and straightforward experience. The procedure typically lasts around 10-15 minutes. It is minimally invasive, and most women experience only mild discomfort or cramping during the insertion of the catheter into the uterus. The discomfort is usually short-lived and similar to the sensations felt during a routine pelvic exam or cervical screen. Some women may experience light spotting afterward, but this is normal and resolves quickly. There is usually no need for anaesthesia, and the procedure generally does not require significant recovery time, allowing most women to resume normal activities immediately after.

While IUI (Intrauterine Insemination) is generally considered a safe and low-risk procedure most women tolerate the IUI procedure well. However, it’s important to discuss any concerns with your fertility specialist to ensure you’re fully informed before undergoing treatment and to understand the potential risks, such as:

• Multiple Pregnancies: The use of fertility medications during IUI to stimulate ovulation can increase the likelihood of releasing multiple eggs, leading to a higher chance of twins or, rarely, higher-order multiples. Multiple pregnancies carry additional risks, such as preterm birth and complications during pregnancy.
• Mild Cramping or Discomfort: Some women may experience mild cramping or abdominal discomfort during or after the procedure due to the insertion of the catheter or the body’s response to ovulation.
• Spotting: Light spotting or vaginal bleeding can occur after IUI, usually due to the catheter passing through the cervix. This is generally harmless and should resolve within a day or two.
• Infection: Although rare, there is a slight risk of infection from introducing bacteria into the uterus during the procedure. Proper sterile techniques minimise this risk.
• Ovarian Hyperstimulation Syndrome (OHSS): In cases where ovarian stimulation drugs are used, there is a small risk of OHSS, where the ovaries become swollen and painful.
• Vaso-Vagal reaction: Rarely this procedure can cause a loss of consciousness associated with low blood pressure.

It’s important to have a solid support network of partners, family, friends, or counsellors, and to openly communicate with your fertility clinic. Dr. Rachael Knights’ practice provides counselling and emotional support to help individuals and couples manage the challenges of fertility treatments. Practising self-care, setting realistic expectations, and taking breaks between cycles can also support emotional well-being during the IUI journey.

​IUI (Intrauterine Insemination) and IVF (In Vitro Fertilisation) are two different assisted reproductive techniques used to help couples conceive. IUI is a simpler, less invasive procedure where washed sperm is directly inserted into a woman’s uterus around the time of ovulation. It is less costly and has an average success rate of less than 15% per cycle. IVF, on the other hand, is more complex and involves stimulating the ovaries to produce multiple eggs, retrieving these eggs, fertilising them with sperm in a laboratory, and then transferring the resulting embryos into the uterus at the perfect time. IVF has a higher success rate of 30-50% per cycle. This treatment can minimise the time to pregnancy.

After an IUI procedure, it’s advisable to rest briefly but resume normal activities soon after, avoiding strenuous exercise, heavy lifting, and high-impact activities for a few days. Refrain from using hot baths, saunas, or hot tubs, as high heat can affect implantation. It’s best to avoid alcohol, limit caffeine intake, and abstain from sexual intercourse for the first 24-48 hours to reduce infection risk. Focus on staying hydrated, eating a balanced diet, and taking any prescribed medications as directed. Mild cramping or spotting is normal, but if severe pain or heavy bleeding occurs, contact your doctor immediately.

If IUI is unsuccessful, the next steps will depend on factors like the number of IUI attempts, the woman’s age, and the specific infertility diagnosis. Typically, fertility specialists recommend trying 2-3 IUI cycles before considering other options. If IUI repeatedly fails, the next step may be In Vitro Fertilisation (IVF), which has a much higher success rate due to its more advanced approach.