Artificial insemination is a treatment for infertility, when a couple cannot conceive a baby. It involves directly inserting sperm into a woman’s womb.
It is most commonly used as part of a Donor Insemination (DI) programme, where donated sperm is used.
The National Institute for Health and Care Excellence (NICE) recommends that up to six cycles of IUI treatment on the may be offered if:
you are unable (or would find it very difficult) to have vaginal intercourse, for example because of a physical disability
you have a condition (such as a viral infection that can be sexually transmitted) that means you need specific help to conceive
you are in a same-sex relationship
Previously, IUI treatment on the was offered if:
a man has mild fertility problems
a woman has mild endometriosis
a couple has unexplained infertility
However, new guidelines released in 2013 state that IUI should no longer be offered in these circumstances. Instead, you should be advised to keep trying to conceive through regular unprotected sexual intercourse for a total of two years. After this time you may be offeredin vitro fertilisation (IVF).
The availability of this fertility treatment on the varies throughout the UK. In some areas, the waiting list for treatment can be very long. The criteria that must be met to be eligible for treatment can also vary.
IUI is also available from some private fertility clinics. Costs vary from £500 to £1,000 for each cycle of treatment.
Each cycle of IUI is timed to coincide with the woman’s natural reproductive cycle, so you will only be able to receive one cycle of IUI treatment a month.
Intrauterine insemination (IUI)
Intrauterine insemination (IUI) is the technique used for artificial insemination, and it has a good record of success.
Figures from the Human Fertilisation and Embryology Authority (HFEA) in 2006 suggest that intrauterine insemination (IUI) has a success rate of around 15% for each cycle of treatment. This estimate is based on women under 35 years of age using donor sperm.
As with most other types of fertility treatment, the younger a woman is, the greater her chance of having a successful pregnancy. Other things that can affect the success of IUI include:
sperm count and sperm quality – using fresh sperm is associated with higher conception rates than frozen and thawed sperm
technical aspects of IUI, such as working out the time of ovulation correctly
How is IUI performed?
In IUI, a man provides a sample of sperm, which is then "washed" and filtered using special techniques. This ensures that only the highest-quality motile sperm are used for the procedure.
During the procedure, the concentrated sperm is passed directly into the woman’s womb through a thin tube called a catheter.
It is not recommended to use fertility medication in combination with IUI. This is because there are associated risks such as a higher chance of multiple pregnancy.
If the male partner cannot produce healthy sperm, frozen sperm from a donor can be considered, although this is a personal decision.
In rare cases, couples obtain donated sperm from someone they know. However, in most cases, sperm is obtained and treatment is carried out at a registered or licensed sperm bank.
In the past, sperm donors remained anonymous from the parents and the child produced by the donated sperm. However, in 2005, the law regarding donor anonymity changed.
Anyone born from donated sperm after April 1 2005 can apply to HFEA to obtain information about the identity of the donor, once they have reached 18 years of age. They can apply for non-identifying information before this.
The HFEA is the independent regulator for all fertility clinics in the UK. If you are considering donor insemination (DI) you can visit the HFEA website for more information or to find your local fertility centre.
Around one couple in six in the UK is affected by infertility. If you and your partner have not conceived after one year of trying, see your GP.
It is best for both partners to see their GP because fertility problems can affect the man or woman. Sometimes, both partners are affected.
Your GP can give you advice about what to do next, and they will also carry out an initial assessment to investigate what may be causing your fertility problems.
When artificial insemination is used
Before having intrauterine insemination (IUI), a couple’s fertility will need to be assessed to find out why they are having difficulty conceiving and to determine whether artificial insemination is suitable.
Assessing a woman's fallopian tubes
For a woman to have IUI, her fallopian tubes must be open and healthy. The fallopian tubes connect the ovaries to the womb. Eggs are released from the ovaries into the fallopian tubes each month, and this is where fertilisation takes place. If there is a problem with the fallopian tubes, it may prevent IUI from working.
Checking that the fallopian tubes are open and healthy is sometimes called a tubal patency test. The fallopian tubes can be assessed using one of two methods:
A laparoscopy involves making a small cut in the lower abdomen. A thin, tubular microscope called a laparoscope is used to look more closely at the womb, fallopian tubes and ovaries. A dye may be injected through the neck of the womb into the fallopian tubes to highlight any blockages.
A laparoscopy is the preferred method of assessing the fallopian tubes. If a woman has had pelvic inflammatory disease (PID) in the past, this will be an important investigation as PID can damage and scar the fallopian tubes.
A hysterosalpingogram is a type of X-ray taken of the womb and fallopian tubes after a special dye has been injected. This will help detect any abnormalities or defects, such as tumours or scar tissue.
A hydrosonogram is a procedure where water is injected through the cervix and into the uterus to allow an ultrasound scan. This will help detect abnormalities such as fibroids or cervical polyps.
The timing of IUI
To maximise the chances of success, a cycle of IUI should be carried out just after ovulation. Ovulation is when one or more eggs are released from the ovaries into the fallopian tubes.
It is difficult to predict exactly when ovulation will occur, but in most women it usually happens 10 to 16 days before the start of their period. The menstrual cycle begins on the first day of a period (day one). Ovulation occurs some time after the period, which is followed by the next period 10 to 16 days later.
The exact day of ovulation can be detected by using urine ovulation kits or blood tests in the middle of the cycle.
IUI is usually carried out between day 12 and day 16 of the menstrual cycle.
Women may be given an ovulation prediction kit (OPK) to work out the date of ovulation with greater accuracy. An OPK device can detect hormones released during ovulation in urine or saliva. Alternatively, a woman may have blood or urine tests to find out when she is about to ovulate.
When an egg is mature, the woman may be given an injection of hormones to stimulate the egg’s release from the ovary.
How artificial insemination is performed
Intrauterine insemination (IUI) is the technique used to carry out artificial insemination.
IUI using a partner’s sperm
If a couple decides to have IUI using their own sperm, the man will be asked to provide a sperm sample at the fertility clinic, usually on the same day that IUI treatment takes place.
The man will be asked to masturbate into a specimen cup. He may also be asked not to have sexual intercourse or masturbate for two days before the sample is taken because this could affect the sperm sample’s quality.
The sperm sample will be "washed" and filtered using special equipment to remove any dead sperm and impurities. The faster-moving sperm will be kept and any slow-moving sperm will be removed. This produces a concentrated sample of healthy sperm.
An instrument called a speculum is inserted into the woman's vagina to keep the walls of the vagina open (in the same way as a smear test). A thin, flexible tube called a catheter is then placed inside the vagina and guided into the womb. This process is mostly painless, although some women may experience mild cramping, similar to period pains. The sperm sample will then be passed through the catheter and into the womb.
The process usually takes no more than 10 minutes, and the couple should be able to go home shortly after the procedure is finished.
IUI using a donor’s sperm
Choosing to use donated sperm can be a difficult decision, and a couple must have counselling before any decision is made by the clinic to proceed.
If a couple decides to have IUI using the sperm of a donor, the same procedure is used. However, a sample of frozen sperm from a donor will be thawed out, "washed" and then inserted into the woman's womb.
All donated sperm is carefully checked for:
infections, such as HIV, hepatitis B and hepatitis C
genetic and hereditary disorders, such as sickle-cell anaemia andcystic fibrosis, which could affect the health of a child
The fertility clinic can provide information about the physical characteristics of available donors, such as their ethnicity, physical build and hair and eye colour. This will enable a couple to try and match a potential donor’s characteristics with their own.