Intrauterine Insemination (IUI)

How does IUI work?

IUI is the fertility treatment which is closest to natural conception.

The chance of pregnancy is increased by giving drugs which ensure that at least one good oocyte (egg) is released, and preparing the partner’s sperm sample so that it can be placed much nearer the egg (in the uterus using a fine catheter).

Selecting couples for IUI

IUI is the right treatment for couples who have no identifiable cause for their infertility, and where a borderline sperm issue may have been detected. (For example, a man may have a reduced % motility, but such a high sperm count that it more than compensates for it.)

We determine whether IUI is the right course of action by using a Test Wash, a trial sperm preparation and an extension to the semen analysis which harvests the best sperm from a sample and determines whether there are sufficient for IUI. We need around 5 million progressively motile sperm for a reasonable chance of pregnancy.

For more information of semen analysis and test wash, please click here.

Process of IUI

IUI process is relatively simple. The female partner takes a drug by injection (Follicle Stimulating Hormone, or FSH) for a few days to ensure that at least one egg (oocytes) matures in that cycle. A second drug is given to trigger ovulation, and a date/time for the IUI is then planned.

On the day of treatment the male partner provides a semen sample, which the laboratory then processes to harvest the best (most motile) sperm – see below. These sperm are then placed inside the uterus (womb) using a specialised catheter.

How successful is IUI?

In the right hands, IUI can be more successful than natural conception. Pregnancy rates commonly quoted in the literature are usually between approximately 12-20% pregnancy rate per attempt – whereas it takes 85% of couples 12 months to conceive naturally, equating to about 7% per month

Over the past 5 years, our clinic has an average live birth rate of approximately 15%. We also don’t see any significant drop off in success rate whether it’s a 1st, 2nd or 3rd attempt.

IUI success depends on female age and quality of ovulation more than any other factor.

Who should not have IUI?

IUI is not appropriate for couples with moderate to severe male factor infertility, tubal infertility or severe endometriosis.

If IUI is not for you or it has not been successful after a number of attempts, we would recommend a referral for IVF (in-vitro fertilisation).

NICE guidelines and the changing face of fertility treatment

In 2013, NICE recommended a change in the approach to the treatment of unexplained infertility. It meant that even if there is no apparent cause of infertility, IVF is currently the recommended treatment for the patient without trying anything else first. NICE’s conclusions were based on very view studies, making the new guideline extremely controversial. It also dismissed other lower cost, less complex treatments, like IUI.

Since this time new evidence has come to light, in support of IUI in particular. Here at NUH, we are firm believers in ‘evidence-based medicine’ – and this approach is supported by our own data. A significant number of our couples with unexplained infertility achieve a live birth through IUI, without the need for IVF. At less than half the cost, we believe that is reason enough to pursue ‘low-complexity’ treatments – if it is right for the couple.

A similar view is taken across Europe with recent publications in the Netherlands (Van Ekelen et al, 2019), and more recently by the Canadian Fertility and Andrology Society (2019), suggesting that an evidence-based approach is required and IVF should not be used as the first option.

NUH Life therefore continues to recommend a more holistic approach in line with previous NICE guidelines of 2004, which recommends referral for IVF only when all other reasonable options have been tried. That said, IVF will always be the recommended treatment in patients with tubal occlusion, moderate-severe male factor, or in those couples who fail to achieve a pregnancy after several attempts at IUI.

What is meant by cost-effectiveness of treatment?

Since NHS funding for fertility treatment is often limited and some individuals or couples have to pay for their treatment, centres are very conscious of cost-effectiveness.

This is measured not only by the ‘success rates’ of a certain treatment, but also how much it costs and effectively the cost of a live birth. When calculating the cost-effectiveness of a treatment and comparing it with other treatments it is very important that this takes into account a relatively large number of treatment cycles, a realistic chances of success and the cost of the failed cycles.

What do we mean by a holistic approach to fertility investigations and treatment?

There is no ‘one size fits all’ approach to treatment, and we believe that we have to start by investigating the essentials, taking a very comprehensive history and talking through the options.

Sometimes the initial tests are very clear and treatment can be directed immediately. It maybe that time is against the couple, and treatments are recommended sooner rather than later simply because of age. Alternatively, it may be that all the couple requires is some advice, some relaxation therapies and possibly a tablet to help ovulation.

Somewhere in between are a whole number of different treatment options, but we always recommend that the simplest and least costly options are attempted first before embarking on the more complex ones.