IUI (Intrauterine Insemination) Guide by Dr Ryan Lee

What is IUI?

Intrauterine insemination, or IUI, is a type of fertility treatment that helps to increase your chances of pregnancy by placing your partner’s sperm directly into your womb. This procedure is less invasive and more cost-effective compared to other fertility treatments, such as in vitro fertilisation (IVF).

IUI is usually recommended as part of initial treatment for couples facing unexplained infertility, reduced sperm fertility, reduced sperm count, or cervical complications. To increase the chance of conception, this procedure is best performed during one's natural ovulation or with superovulation with IUI (SO-IUI).

What is SO-IUI?

In superovulation with intrauterine insemination (SO-IUI), medications are used to stimulate the ovaries to release two to three mature eggs instead of one, which increases the likelihood of fertilisation.

At the time of ovulation, the prepared sperm is placed directly into the uterus via intrauterine insemination, optimising its proximity to the eggs. This combined approach is particularly beneficial for couples facing unexplained infertility, mild male factor infertility, or ovulatory disorders.

When do I need an IUI procedure?

During your normal ovulation, the ovary will release one egg that’ll travel to the fallopian tube. Usually, when you and your partner are trying to conceive, this is the perfect time, as the sperm can unite with the egg and fertilisation occurs.

However, for some couples, natural conception can be a challenge due to various factors. In such cases, artificial insemination may be a suitable option. Here are some conditions where intrauterine insemination may be used:

• Reduced sperm fertility

  • This is a condition when your partner has low-quality sperm, leading to a reduced sperm count along with small, weak, slow, or abnormally shaped sperm and experiencing motility issues.

• Thick cervical mucus

  • The cervix is the narrow, lower part of the uterus that serves as an opening between the vagina and uterus. It produces mucus that helps sperm travel from the vagina into the uterus, so it can swim to the fallopian tubes, where the egg is located.

  • However, if cervical mucus is overly thick, it can hinder the sperm's passage. This thick mucus can be caused by scarring from a biopsy or other medical procedures.

• Endometriosis

  • Endometriosis is a condition where the tissue that’s similar to the inner lining of the uterus grows outside of it. This extra tissue can obstruct the fallopian tube, preventing sperm from reaching the egg and fertilising it.

• Ovulation problems

  • This condition is where there's a decline in fertility because of irregular ovulation, a reduced number of released eggs, or anovulation (absence of ovulation) during the menstrual cycle.

• Semen allergy

  • In rare cases, when trying to conceive, couples found that their partner had an allergic reaction to their semen.

  • This reaction can be triggered by an allergy to the proteins in semen, which causes a burning feeling and swelling where the semen touches the skin.

• Erectile dysfunction

  • Also known as impotence, this is a condition where your partner can’t get or sustain an erection that's firm enough for intercourse.

• Unexplained infertility

  • This condition is when the healthcare providers can't find the cause for your infertility after a thorough evaluation.

The success rate after IUI varies from 15% to 20% depending on various factors such as your female partner's age, underlying health issues, and the duration of infertility. Since IUI is a simpler and less invasive procedure, it can be a viable first option for fertility treatment with a reasonable success rate.

However, if you have had three or more unsuccessful attempts with IUI or are aged 35 or older, you are more likely to have a greater chances of pregnancy with IVF (in vitro fertilisation).

Think that you might be facing the conditions above and want to explore the options available to you? Reach out to our fertility experts at Thomson Medical today for an accurate diagnosis and a personalised treatment plan.

Preparing for an intrauterine insemination

Before starting IUI treatment, both you and your partner will need to go through a series of medical exams and fertility tests. Here are some tests that may be conducted by your doctor, such as:

• A uterine examination

• Ultrasounds check

• Semen sample analysis to assess fertility

• Screening for sexually transmitted infections (STIs) and other infectious disease

Your healthcare provider may also recommend fertility drugs to stimulate your ovaries to produce and release as many eggs as possible.

What is the IUI process?

On the day of the procedure, IUI is relatively quick and usually takes only a few minutes without the need for painkillers. It usually involves three main steps:

1) Ovulation monitoring

The first step of the IUI procedure is monitoring your monthly cycle to determine the ovulation date. To help track the growth of the egg in the ovaries, tests like ultrasound exams and blood tests are conducted.

The release of the egg from your ovaries (ovulation) can occur either naturally or with the aid of fertility medication. The use of such fertility medications as part of your IUI treatment classifies the procedure as superovulatory IUI (SO-IUI). The fertility medication can be administered either orally or by injection.

2) Sperm preparation

Once your ovulation date is confirmed, the next step is preparing the sperm for the insemination process. In this step, your partner will provide a fresh semen sample, which can be collected either on the day of the IUI procedure or in advance at a comfortable setting.

During this process, the sperm from the sample is prepared through a process called “sperm washing", which collects the healthiest and most motile sperm to increase the chances of implantation.

3) Insemination

At the time of ovulation, the prepared sperm is injected directly into the uterine cavity using a thin, flexible tube (catheter). IUI shortens the distance it takes for the sperm to reach the egg resting in the fallopian tube and increases the chances of fertilisation.

During this procedure, you may experience slight discomfort, similar to that of a pap smear. When the IUI procedure commences, you can expect to:

• Lie down on the examination table with your legs placed into stirrups; after that, a tool called a speculum is inserted into your vagina, widening the vaginal wall.

• A vial containing your partner's healthy sperm will be attached to the catheter.

• The catheter will be inserted in your vagina, through the cervix, and into the womb.

• The sperm sample is then pushed into the womb through the tube.

• Once the procedure is complete, both the catheter and the speculum are carefully removed.

After the procedure

After IUI, you may be advised to rest for a while before resuming your normal activities, especially strenuous exercise. Because although it's a safe procedure, you may experience some mild symptoms after the procedure, such as mild cramping or light spotting for a day or two.

Your doctor will schedule a follow-up pregnancy test approximately two weeks after the IUI procedure to assess the results of the procedure.

It's important to have a thorough consultation with your fertility specialist to determine if IUI is suitable for you. Request a consultation with our fertility specialist at Thomson Fertility Centre for personalised recommendations and tailored advice.

Advantages of IUI

In your journey towards conception, you may decide to undergo an IUI procedure, which offers several advantages, such as:

• Less invasive

  • Compared to other fertility treatments, like in vitro fertilisation (IVF), IUI is less invasive and uses fewer fertility drugs.

• Cost-effective

  • IUI is generally more affordable than IVF, making it a more accessible option for couples hoping to have children.

• Minimal disruption to menstrual cycle

  • IUI can be performed during the natural ovulation cycle or with minimal use of medication so as not to disrupt your natural monthly cycle.

• Increased conception chances

  • An IUI procedure can increase your chances of a successful pregnancy by increasing your pregnancy rate from 15% to 20%, particularly for couples who are struggling to conceive.

Risks of IUI

Even though IUI is a simpler and less invasive fertility treatment, it's not without risks. Here are a few risks that are related to this procedure, including:

• A small risk of pelvic infection and vaginal bleeding post-IUI.

• The use of hormones in the SO-IUI procedure can lead to the development of 3–4 eggs, increasing the chances of multiple pregnancies, such as twins or triplets.

• A fertility medication can also cause ovarian hyperstimulation syndrome (OHSS), which causes the ovaries to become painful and swollen.

What are the factors that can reduce the effectiveness of IUI?

Several factors may reduce the success rate of intrauterine insemination (IUI) treatment. These include:

1. Age 

   • Women over 35, and especially over 40, have reduced fertility due to a decline in egg quality and ovarian reserve, which can significantly lower IUI success rates

2. Poor egg or sperm quality

   • Low-quality eggs or sperm with poor motility or high DNA fragmentation can hinder fertilisation

3. Hormonal imbalances

   • Conditions like Polycystic Ovary Syndrome (PCOS) can disrupt ovulation and reduce the effectiveness of IUI

4. Endometriosis 

   • Moderate to severe endometriosis can affect egg quality and create an unfavorable environment for implantation

5. Lifestyle choices 

   • Smoking, alcohol consumption, obesity, and stress can negatively impact fertility and IUI outcomes

6. Underlying health conditions 

   • Uncontrolled diabetes, autoimmune disorders, or pelvic infections can interfere with conception

7. Unexplained infertility 

   • In cases where no clear cause of infertility is identified, IUI might not yield successful results

8. Failed fertilisation 

   • Even with healthy eggs and sperm, fertilisation may not occur for unknown reasons

FAQ

Is IUI better than IVF?

Neither is better than the other, as treatment for fertility depends on your condition; IUI and IVF serve different purposes. IUI is a good starting point for couples facing ovulation problems or reduced sperm fertility, not to mention it's also less invasive and more affordable than IVF.

However, if you're 35 or older, having had three unsuccessful IUI attempts and experiencing severe male infertility, IVF might offer better chances of conception. It is best to discuss with a specialist at your nearest fertility clinic what is the best option for you.

How long does IUI take to get pregnant?

After the artificial insemination procedure, it takes approximately two weeks to determine if the treatment is successful after a positive pregnancy test. The success rate for IUI ranges from 15% to 20%, depending on factors like age, existing medical condition, and egg quality.

Is IUI allowed in Singapore?

Yes, IUI is a legally approved fertility treatment in Singapore. It's available at healthcare facilities, such as Thomson Medical, where it's performed under proper medical supervision. This procedure is also covered by Medisave and government co-funding.

How successful is IUI on the first try?

On the first attempt, the success rate for IUI can vary between 15% and 20% for couples under the age of 35. While some couples succeed on their first try, others might need multiple attempts before conceiving.

Is IUI painful?

No, IUI is a safe and straightforward fertility care that involves injecting sperm directly into the uterine cavity using a catheter. However, after the procedure, you might experience mild discomfort, such as mild cramping or a little spotting, for a day or two.

Can you pick gender with IUI?

No, IUI does not allow for gender selection. The procedure simply places prepared sperm closer to the egg to increase the chances of natural fertilisation. Gender is determined by which sperm fertilises the egg, which happens naturally and cannot be controlled through IUI.

If you're considering IUI as a fertility treatment option, request a consultation with our fertility specialist at Thomson Fertility Centre for personalised recommendations and tailored advice.