Intrauterine insemination and Infertility Treatment

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Intrauterine insemination

(IUI - artificial insemination AI) of your partner's sperm has a place when there is:-

•  mildly reduced male fertility, as recognised from semen analysis. Even when there is moderate male subfertility, treatment using ovulation induction and IUI would seem to be a valuable initial treatment before contemplating more expensive and invasive assisted reproductive techniques. Severe male factor infertility does not usually respond to IUI.
•  unexplained infertility.

At one time, untreated semen was used but adverse reactions sometimes occurred. These days, sperm for insemination are prepared by washing or swim-up to improve success rates and reduce possible complications. The swim-up preparation involves washing the sperm with culture medium, and, after centrifugation (controlled rapid spinning), the supernatant (fluid) is removed. The pellet of sperm is covered by 0.5ml of culture media. In the swim-up preparation, the sperm in the pellet are incubated at body temperature for 30-60 minutes. The supernatant subsequently carries a relatively high concentration of motile sperm and this is used for the insemination procedure. A variety of swim-up techniques and media such as Percoll have been used in an attempt to improve success rates.

Clearly artificial insemination should be undertaken around the time of ovulation. The relationship between the day of insemination in relation to the last day of hypothermia (low temperature) on the basal temperature chart and conception rates in a donor insemination protocol has been studied. The over-all conception rate was 12% and the best results were obtained for insemination 3 days (20%) and 1 day (21%) before the last day preceding the temperature rise that is typical following egg release. LH predictor tests can be used to indicate the fertile phase for a woman with irregular cycles, perhaps increasing the success rate. Success rates with artificial insemination depends on the age of the female partner and the total motile sperm count.

Artificial insemination with donor sperm (AID) has been the most successful treatment for male factor infertility although, not withstanding economic considerations, more modern treatments with IVF and ICSI (25) have an increasing role to play. Success rates in donor insemination programmes of 70% over six cycles have been reported. Frozen samples are now recommended to allow adequate testing of donors for HIV although fresh donor samples have achieved pregnancy rates of 19% per cycle compared to frozen samples giving 5 ?10 % per cycle.

Related Medical Abstracts - Click on the paper title:-

• Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization (2001)
• A comparison of intrauterine versus intracervical insemination in fertile single women (2001)
• Prospective, randomized, crossover study to evaluate the benefit of human chorionic gonadotropin-timed versus urinary luteinizing hormone-timed intrauterine inseminations in clomiphene citrate-stimulated treatment cycles. (1999)
• Single versus double insemination: A retrospective audit of pregnancy rates with two treatment protocols in donor insemization (1997)
• Intrauterine insemination: Evaluation of the results according to the woman's age, sperm quality, total sperm count per insemination and life table analysis (1996)
• Time interval from human chorionic gonadotrophin (HCG) injection to follicular rupture. (1995)
• A comparison of intrauterine insemination in superovulated cycles to intercourse in couples where the male is receiving steroids for the treatment of autoimmune infertility (1995)
• Cumulative conception rate following intrauterine artificial insemination with husband's spermatozoa: Influence of husband's age (1995)
• Intrauterine insemination as treatment for antisperm antibodies in the female.(1988-01)
• The treatment of infertility by the high intrauterine insemination of husband's washed spermatozoa.(1988-02)
• Superovulation with intrauterine insemination in the treatment of infertility: a possible alternative to gamete intrafallopian transfer and in vitro fertilization (1987)
  
  

  

  
  
  
  

  

  
  
  
  

  Thank you for choosing to visit us.

  
  

  This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

  I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.