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Intrauterine Insemination

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In Vitro Fertilization

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Abstract

Intrauterine insemination (IUI) is an assisted reproductive technique that involves the deposition of a processed semen sample in the uterine cavity, overcoming natural barriers to sperm ascent in the female reproductive tract. It is a cost-effective, noninvasive first-line therapy for selected patients with functionally normal tubes and infertility due to a cervical factor, anovulation, moderate male factor, unexplained factors, immunological factors, and ejaculatory disorders with clinical pregnancy rates per cycle ranging from 10% to 20%. It, however, has limited use in patients with endometriosis, severe male factor infertility, tubal factor infertility, and advanced maternal age ≥ 35 years. IUI may be performed with or without ovarian stimulation. Controlled ovarian stimulation (COH), particularly with low-dose gonadotropins, with IUI offers significant benefit in terms of pregnancy outcomes compared with natural cycle or timed intercourse while reducing associated COH complications such as multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). Important prognostic indicators of success with IUI include patient’s age, duration of infertility, stimulation protocol, infertility etiology, number of cycles, timing of insemination, number of preovulatory follicles on the day of hCG administration, processed total motile sperm >ten million, and insemination count >1 × 106 with >4% normal spermatozoa. Alternative insemination techniques, such as fallopian tube sperm perfusion, intracervical insemination, and intratubal insemination, provide no additional benefit compared to IUI. A complete couple workup that includes patient history, physical examination, and clinical and laboratory investigations is mandatory to justify the choice in favor of IUI and guide alternative patient management, while individualizing the treatment protocol according to the patient characteristics with a strict cancellation policy to limit multifollicular development may help optimize IUI pregnancy outcomes.

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Author information

Authors and Affiliations

  1. Indo Nippon IVF, Mumbai, India

    Gautam N. Allahbadia & Goral Gandhi

  2. A Rotunda – The Center for Human Reproduction, Mumbai, India

    Rubina Merchant, Akanksha Allahbadia & Swati Allahbadia

Authors
  1. Gautam N. Allahbadia
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  2. Rubina Merchant
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  3. Akanksha Allahbadia
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  4. Goral Gandhi
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  5. Swati Allahbadia
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Editor information

Editors and Affiliations

  1. Reproductive Biology Associates – Prelude, Atlanta, GA, USA

    Zsolt Peter Nagy

  2. Astra Fertility Group, Mississauga, ON, Canada

    Alex C. Varghese

  3. Cleveland Clinic, Cleveland, OH, USA

    Ashok Agarwal

Review Questions

Review Questions

  1. 1.

    How do you select a patient for IUI?

  2. 2.

    How will you work up the patient couple for IUI?

  3. 3.

    What will be the stimulation protocol you would select for your patient in an IUI cycle?

  4. 4.

    What is the correct technique of sperm preparation for IUI?

  5. 5.

    Would you prefer a blind IUI or an ultrasound-guided IUI?

  6. 6.

    Are there any known complications of IUI?

  7. 7.

    Are there any recent advances in the practice of intrauterine insemination?

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Allahbadia, G.N., Merchant, R., Allahbadia, A., Gandhi, G., Allahbadia, S. (2019). Intrauterine Insemination. In: Nagy, Z., Varghese, A., Agarwal, A. (eds) In Vitro Fertilization. Springer, Cham. https://doi.org/10.1007/978-3-319-43011-9_30

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