HPP_img_8655 - IUI

Intrauterine insemination (IUI)

Insemination is a comparatively simple procedure and is mostly performed in cases of milder male fertility problems or problems in the cervical canal, such as abnormal mucous formation or previous cervical conisation. Depending on whether there are any problems with egg cell maturation, this treatment can be performed with or without hormone treatment. The goal of this treatment is to introduce prepared sperm at a high concentration close to the egg cell in order to increase the chance of fertilisation.

Intrauterine Insemination - IUI

Intrauterine Insemination - IUI. Diagram: The insemination process - above: preparing the sperm; below: insemination

Therapy within the natural cycle

If a woman’s cycle is regular, it can be assumed that it will result in the growth of a follicle (egg vesicle) in which the egg cell will mature. Typical changes in the mucous lining of the womb and hormone test results provide information about the status of this development. One to two ultrasound examinations and close monitoring of hormone levels make it possible in most cases to accurately predict the time and day of ovulation. Once this has been done, insemination (semen transfer) can be performed on the day identified. However, this is dependent on a high degree of flexibility on both sides, since the body’s own rhythm dictates the schedule. It is better if ovulation can be “scheduled”. This also results in an automatic improvement in the luteal phase.

Once a follicle size of approximately 18 20 mm has been reached, an “ovulation injection” can be used to induce ovulation at a specific time. Approximately 32 – 36 hours later, the appropriately prepared (“washed”) sperm can be placed in the uterine cavity (Intra uterine Insemination – IUI). Pregnancy rates can be estimated at a maximum of 10 15 % (20?) per treatment cycle. Intravaginal insemination has no advantages over natural sexual intercourse and therefore is of no therapeutic value.

Because cysts can only rarely be expected after a cycle of this type, every cycle can be used.

perm sample in the centrifuge tube

Sperm in the centrifuge tube. It will now be centrifuged using a special "separator solution".

Sperm sample in the centrifuge tube

Sperm sample in the centrifuge tube after washing in the centrifuge.

IUI in a stimulated cycle

As explained under Hormone treatment, medications are used to address a wide variety of hormonal imbalances.

Hormonal stimulation for IUI (intrauterine insemination/semen transfer) is used if no spontaneous follicle development (egg vesicle maturation) takes place to form a follicle ready for ovulation (a mature egg vesicle).

Clomifene stimulation

The easiest method of hormone stimulation is carried out with the active substance clomifene citrate, often abbreviated as CC. These tablets are most commonly taken over a five day period, from cycle day 5 to cycle day 9, and result in the increased production of FSH (Follicle Stimulating Hormone). The growth of the follicle (egg vesicle) is monitored by ultrasound, as well as by blood hormone testing, if necessary.

Once a follicle size of approximately 18 20 mm has been reached, an “ovulation injection” can be used to induce ovulation at a specific time. Approximately 32 – 36 hours later, the appropriately prepared (“washed”) sperm can be placed in the uterine cavity (Intra uterine Insemination – IUI). Pregnancy rates can be estimated at a maximum of 10 15 % (20?) per treatment cycle. Intravaginal insemination has no advantages over natural sexual intercourse and therefore is of no therapeutic value.

NOTE: Statutory health insurance funds include insemination with clomifene stimulation under UNSTIMULATED cycles. This should be noted when applying for confirmation of coverage (partial coverage).

FSH stimulation

If clomifene stimulation has thus far proven unsuccessful (no follicle growth or merely no pregnancy achieved), FSH (Follicle Stimulating Hormone) can be injected daily under the skin. These injections are usually given from cycle day 3 to cycle day 11/12. In most cases, the direct administration of FSH is effective. However, it is also more common for more than one follicle (egg vesicle) to grow under FSH injections than under clomifene stimulation. Therefore, FSH stimulation therapy should be handled by a specialist.

Stimulation process for insemination

Diagram showing the stimulation process for insemination.

Once a follicle size of approximately 18 20 mm has been reached, an “ovulation injection” can be used to induce ovulation at a specific time. Approximately 32 – 36 hours later, the appropriately prepared (“washed”) sperm can be placed in the uterine cavity (Intra uterine Insemination – IUI). Pregnancy rates can be estimated at a maximum of 10 15 % (20?) per treatment cycle. Intravaginal insemination has no advantages over natural sexual intercourse and therefore is of no therapeutic value.

— Diagrams: © Prof. Herrero, Barcelona