Intrauterine Insemination At Home

Who is a candidate for Intrauterine Insemination?

How is IUI done?

How important is timing?

What about sperm count?

How is sperm collected?

What is "sperm wash" and how is it done?

Why is sperm washing necessary?

What are the risks associated with IUI?

Who is a candidate for Intrauterine Insemination?

Intrauterine Insemination (IUI) may be useful for couples with a cervical factor, vaginal anomalies, anti-sperm antibodies in the cervix or uterus, male-factor infertility (which accounts for the inability to conceive in approximately 40% of cases), sexual dysfunction in either partner, and unexplained infertility. 

IUI is not appropriate for women with ovarian failure, pelvic disease, or tubal blockage. Women with these complications require other therapies and, in most cases, should see a reproductive endocrinologist.

As with any infertility treatment, a full evaluation of both partners should be performed before attempting IUI. It is important to determine that, in addition to the condition that would make a woman a candidate for IUI, she does not have another condition that would prevent successful insemination.

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How is IUI done?

An IUI  is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn't take very long — it only requires the insertion of a speculum and then the catheter, a process that only takes a few minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove the catheter — going slowly helps reduce discomfort).

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How important is timing?

Timing is of the essence when performing IUI. The procedure must be done on the anticipated day of ovulation, or as close to it as possible. For that reason, ovulation prediction is crucial to successful insemination.  Numerous over-the-counter ovulation predictor kits are designed for home use. These kits have an overall accuracy rate of 98%.  Some women choose to use the kits twice a day - morning and evening - to more accurately pinpoint the LH surge that indicates imminent ovulation.

Ideally, IUI should be performed within 6 hours of ovulation  When the LH surge is detected by the ovulation prediction kit, the IUI should be done 24 hours later. If 2 IUI's are planned, they are usually spaced at least 12 - 24 hours apart.  Some reports show no increase in success rates with two IUIs, but others suggest it may increase success as much as 6 percent.

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What about sperm count?

A count above one million washed sperm appears necessary for success, with a significant reduction in pregnancy rates when the inseminated is count is lower than 5-10 million. In most cases, one should consider 5 million a lower limit for success but some couples have been successful with insemination of less than one million sperm.

Basic sperm analysis can be done at home and some labs offer private semen analysis for at-home treatment.

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How is sperm collected?

The most comfortable and convenient (and FUN!) method for collecting sperm at home is the Male Factor Pack, a non-spermicidal condom that is worn during intercourse. The sperm is then collected from the condom for processing. Ideally, semen is obtained within an hour of the procedure. 

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What is sperm wash and how is it done?

Sperm washing is a procedure used to prepare sperm for IUI. It allows your partner’s sperm a better chance for survival and fertilization. Sperm washing separates sperm cells from a man’s semen, helping to get rid of dead or slow-moving sperm as well as additional chemicals that may impair fertilization. There are a variety of different sperm washing procedures but the simplest and most cost effective for at-home semen preparation is the swim-up technique.

First, the semen is allowed to sit for 15-30 minutes to liquefy. Then, the semen is drawn up into a syringe and deposited into the bottom of a swim up chamber. A layer of sperm preparation fluid is then placed over the sperm. The sperm "swim-up" out of the semen and into the sperm preparation fluid. After 30 - 45 minutes, the fluid containing the healthy sperm is drawn off, leaving the dead and unhealthy sperm behind.

Some labs prepare sperm for home insemination or cryopreservation for later use.  The lab will usually provide a collection kit and all shipping materials for getting the sample to and from the lab quickly.

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Why is Sperm Washing Necessary?

Sperm must be washed in order to be used with IUI. Raw semen cannot be inserted directly into a woman’s uterus. This is because semen contains chemicals called prostaglandins. Prostaglandins cause muscular contractions and are responsible for cramps during menstruation and pregnancy. If raw semen is inserted directly into your uterus it could cause severe pain and cramping. It could also cause your uterus to collapse, causing severe complications.

Sperm is also washed in order to increase your chances of becoming pregnant. Sperm washing can remove dead sperm and those sperm with poor motility. This leaves behind sperm that can swim faster and that are more likely to fertilize your egg. Sperm washing can also get rid of the white blood cells, mucous and seminal fluid surrounding the sperm, which can also interfere with fertility.

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 What are the risks associated with IUI?