Insemination is a procedure in which the previously washed and concentrated husband's sperm is injected into the woman's uterus with the help of a thin catheter.

When is insemination needed?

Insemination is performed when:

  There is a cervical factor infertility, 

  There is a lower than normal sperm count or morphology,

  There is a case of unexplained infertility,

  The man is impotent,

  There is an ejaculatory disorder like retrograde ejaculation where the semen is released backward into the bladder during ejaculation (a condition found in diabetic men, or men with a history of trauma or surgery to the bladder neck),

  There is severe hypospadias or erectile dysfunction caused by drugs.

Timing the insemination with ovulation is very important. Men who store (freeze) their sperm for future use before having a vasectomy, testicular surgery, or radiation/chemotherapy treatment for cancer may also use IUI.

The insemination evaluation

Tests to determine the reason for the infertility are performed on infertile couples. These include 

  A semen analysis in men and,

  A gynecological evaluation,

  An HSG to view the uterus and tubes,  

  Hormone tests to determine ovarian response, and

  In some cases, a laparoscopyor a hysteroscopy in women.

How is semen collected?

The semen can be collected either by masturbating into a sterile cup at the clinic or during normal intercourse with the use of a special condom given by the doctor no more than two hours before insemination. If a man has retrograde ejaculation, the sperm can be retrieved in the laboratory from collected urine .

Sperm Washing

It is necessary to separate the sperm from the seminal plasma before inseminating the woman with the semen. This removes prostaglandins and other chemicals that could cause adverse reactions or severe uterine contractions when placed directly into the uterus. This procedure has the benefit of increasing sperm motility and concentration thus increasinf the sperm's ability to fertilize the egg.        

The insemination procedure

The insemination procedure is simple and only takes a few minutes to perform. The woman lies on an examining table and the doctor inserts a speculum into her vagina. The washed sperm is then injected directly into the uterine cavity. IUI allows the sperm to bypass the cervix so that an increased number can reach the uterine cavity and fallopian tubes where fertilization normally occurs. If the woman has irregular ovulation, ovulation induction may be considered before insemination. This will increase the chances of successful fertilization. 

Success Rates

The success of IUI depends mostly on the reason for the infertility. Couples where the man has a good sperm count and high sperm motility, but who is impotent or cannot achieve a pregnancy due to a cervical factor in the female partner have a much higher chance of success than couples with sperm abnormalities or unexplained infertility. 

The highest pregnancy rates have been observed after three cycles and other techniques like IVF are usually recommended after six unsuccessful IUI cycles. 

Success rates are also higher if there has been a previous pregnancy. Malformation risks are not increased by either the sperm washing procedure or by the insemination itself. The success rate of insemination may be as high as 15 percent per cycle, which is close to the chance that fertile couples have of conceiving during any given month.