Intrauterine Insemination or IUI (also known as Artificial Insemination/ AI) is a procedure, where washed and concentrated sperms are placed directly in a woman’s uterus (womb) bypassing the cervix (narrow, lowest part of the womb) around the time of ovulation (egg release) through a catheter.

In natural conception, sperm travel from the vagina through the cervix, into the uterus (womb), and up into one of the fallopian tubes. If sperm arrive in a tube soon after the release of the egg from the ovary (ovulation); the sperm and egg can meet and unite (fertilization) in the tube. The cervix naturally restricts the number of sperm that enter the uterus so that only a small percentage of the sperm in the ejaculate actually reach into the fallopian tubes.

This makes the passage to the fallopian tubes much shorter, and there is a better chance that more sperm will encounter the egg. The goal of this procedure is to improve a woman’s chance of getting pregnant.

The sperm needed for IUI can be collected in several ways. The commonest way is masturbation into a sterile glass or plastic cup that is provided by the doctor’s office or andrology laboratory, Sperm can also be collected by having sex in a special condom that the doctor provides. Few men have retrograde ejaculation(sperm goes in their urine), this sperm can be retrieved in the laboratory from urine he has collected.

Men who have a difficult time with erection or ejaculation despite using medications, as well as men with a spinal cord injury, may be able to produce a sperm sample with the help of vibratory stimulation or electroejaculation. Vibratory stimulation commonly takes place in an office and uses a handheld vibratory device. Electroejaculation uses electrical stimulation in order to produce a sperm specimen. For men with a complete spinal cord injury, electroejaculation is commonly performed in the office, while patients with an incomplete spinal cord injury may have an electroejaculation procedure performed under anesthesia in the operating room.

Once the semen is collected, the semen sample is processed, and a concentrated preparation of more motile sperm is obtained. This process can take up to one to one and half hours.
The IUI procedure is relatively simple, does not need sedation and only takes a few minutes. The woman lies on an examining table and the clinician inserts a speculum into her vagina to see her cervix. A catheter is inserted through the cervix into the uterus and the washed semen sample is slowly injected. Usually this procedure is quite painless, but some women may have mild cramps.

You will be asked to remain lying down for around 10–20 minutes and then you will be able to resume your normal routine.
IUI is a straightforward first treatment option for many patients but itis not appropriate if there are problems with the woman’s fallopian tubes, as this need to be open and functioning for the sperm and egg to meet.

There are many reasons why couples experience difficulty having a baby. IUI may be useful for some of them.

• Unexplained infertility: In about 10-15% of couples, a cause for infertility may not be found even after thorough investigation of both partners. IUI is often performed as a first treatment for unexplained infertility along with ovulation-inducing medications.
• Mild endometriosis: For infertility related to endometriosis, using medications to obtain a good-quality egg along with performing IUI is often the first treatment approach. the insemination is being performed in a woman’s natural cycle or in combination with ovulation induction, the doctor uses ultrasound scans of the ovary to identify the time of ovulation and when the insemination should take place.
• Mild male factor infertility (subfertility): Your partner's semen analysis, one of the first steps in the medical assessment of infertility, may show below-average sperm concentration, motility, or morphology. IUI can overcome some of these problems.
• Ejaculation problems: due to erectile dysfunction or anatomic problems of the penis or retrograde ejaculation - the semen goes backward into the bladder instead of coming out of the penis.
• Physical problems with sexual intercourse: Vaginismus is an involuntary clamping of the vaginal muscles, which may prevent some women from having frequent intercourse.
• Cervical stenosis (narrowing) or other anomalies: IUI helps when a woman’s cervix has scarring that prevents the sperm from entering the uterus from the vagina. This may be seen in women who have had surgery on their cervix (cryosurgery, cone biopsy, Loop Electrosurgical Excision Procedure [LEEP], etc.). IUI can also assist when a woman has a cervix that is shaped abnormally in a way that prevents the passage of sperm.
• Donor sperm: For women who need to use donor sperm to get pregnant, IUI is used to achieve pregnancy. Frozen donor sperm specimens are obtained from certified labs and thawed before the IUI procedure.
• Anovulatory (lack of ovulation) infertility: Most of the time women who do not release an egg regularly (ovulate) can become pregnant through intercourse. Sometimes, IUI may be benefecial.
• Fertility preservation: Men may collect and freeze (cryopreserve) their sperm for future use before having a vasectomy, testicular surgery, or radiation/chemotherapy treatment for cancer. The sperm may be thawed later and used for IUI.

An IUI can be performed with a woman’s natural cycle, with oral fertility medications, or with injectable medications. It includes a monitoring phase with or without stimulation, triggering of ovulation, processing of the sperm sample to filter out the most motile sperms, and gentle insemination into the uterine cavity.

The success with IUI is dependent on both the sperm quality as well as the fertility status of the female partner. The chances of pregnancy can be as high as 20% per cycle depending on whether fertility medications are used, age of the female partner, and infertility diagnosis, as well as other facts that could impact the success of the cycle. Therefore, it often takes more than one cycle of IUI to achieve a pregnancy.

Intrauterine insemination is a relatively simple and safe procedure, and the risk of serious complications is low. Risks associated with use of ovulation induction drugs include:

• OHSS (Ovarian Hyperstimulation Syndrome): If your treatment plan also involves ovulation induction, there is a small risk of Ovarian Hyperstimulation Syndrome (OHSS), where a woman over-responds to the ovulation hormones and can become either moderately or severely unwell. IUI cycles are monitored by ultrasound scans and sometimesblood tests and medication doses are adjusted to avoid OHSS or the treatment cycle is cancelled if there is a risk of OHSS.
• Multiple pregnancy: If a woman is taking fertility medications when she has IUI, her chance of getting pregnant with twins or triplets is greater than if she were not taking fertility medications as more than one follicle might develop.