IUI is sometimes chosen as a “first line” treatment for infertility. Which therapy is chosen depends upon numerous variables, including the presence of a male infertility, previous treatment history and outcomes, female age, and many others.
Using intrauterine insemination, specially washed, concentrated and prepared sperm are placed directly into the uterus. “Unwashed” sperm are rarely inserted into the uterus as very serious reactions can result. IUI is often used when cervical factor infertility is present because it avoids contact between the sperm and cervical mucus. This is especially important if the cervical mucus contains antisperm antibodies which will deactivate or destroy sperm.
IUI is sometimes effective in mild cases of male infertility, but “per cycle” success rates are higher using IVF. IVF with intracytoplasmic sperm injection (ICSI) is usually the best treatment choice in cases of moderate to severe male infertility.
The fertility drug follicle stimulating hormone (FSH) is usually administered to infertile women undergoing IUI. FSH stimulates the recruitment and development of eggs and must be carefully administered. In fact, FSH should only be administered by a reproductive endocrinologist, fertility specialist thoroughly trained in its use because of the potential for side effects, including high order multiple births.
The majority of multiple births reported in the media are from IUI cycles administered by non-specialists. When a woman ovulates after FSH stimulation for IUI, there is little, or no, control over how many eggs are ovulated, increasing the possibility of multiple pregnancy. When IVF is employed, the number of embryos placed into the uterus is controlled, thus limiting high order pregnancy (3 or more).
In general, per cycle success rates using IUI are lower than IVF. However, IUI is significantly less expensive. If IUI is not successful after three attempts, the fertility specialist will usually employ a different therapy, such as IVF. However, infertility therapy is highly individualized and treatments for a particular patient will vary.