Intrauterine devices (IUDs) are a method of birth control that has few side effects. They can provide long-term effective protection towards prevention of pregnancy. The devices require precision and care to be fully effective and protect against infection. Improper insertion of an IUD can lead to pelvic inflammatory disease and other pelvic infections. IUDs should only be inserted or removed by a trained health care professional who will minimize risks for complications or serious damage.
During proper IUD insertion, the cervix and uterus are measured and the IUD is inserted to the proper depth with a tube. A string is left hanging in the cervical canal for maintenance and removal purposes. During removal, the strings are located and grasped with a clamp to slowly release and remove the IUD.
Intrauterine insemination, or IUI, is a fertility treatment that involves the placement of sperm cells directly into the uterus to facilitate the fertilization process. A commonly used form of artificial insemination, this procedure allows an increased number of active sperm to reach the fallopian tubes, and therefore improves the chances of conception. The goal of intrauterine insemination is for the sperm to reach the fallopian tube and fertilize an egg, resulting in pregnancy.
Depending on the reasons for infertility, IUI may be performed in conjunction with the normal ovulation cycle of the woman or with fertility medications that induce ovulation. Since IUI is a relatively simple treatment with few side effects, it is often recommended as an initial form of fertility treatment. Originally, artificial insemination was performed by placing concentrated sperm in the vagina. While this was a simpler procedure, it was not nearly as effective as IUI.
Candidates for Intrauterine Insemination
Intrauterine insemination is often recommended for couples experiencing infertility issues that may include:
- Low sperm count
- Decreased sperm motility
- Cervical mucus that is too thick
- Anatomical abnormalities of the reproductive organs
- Semen allergy
The reason IUI can be effective in women with a semen allergy is that the proteins that are usually responsible for the allergic reaction can be removed prior to insemination. IUI is commonly performed on women who are using donor sperm to become pregnant and is often the preferred first treatment for unexplained infertility.
The Intrauterine Insemination Process
Intrauterine insemination may be performed without additional fertility medications, but physicians may encourage ovulation induction treatment along with the process to increase the chances of fertilization. It is recommended that patients abstain from sexual activity for 2 to 3 days before treatment.
The intrauterine insemination process is relatively simple. First, a semen sample is collected and centrifuged in a laboratory to separate the sperm from the seminal fluid. Once the sperm have been separated, they are washed of mucus and potentially toxic chemicals. At the time of ovulation, a catheter is used to inject the prepared sperm directly into the uterus. This is a minimally invasive procedure performed quickly in the doctor's office with minimal discomfort. Patients may experience mild cramping during the procedure and light bleeding afterwards. After implantation, the doctor will advise the patient to remain lying down for a designated time, usually between 15 minutes and a few hours, to increase the probability of conception.
A pregnancy test is usually taken 2 weeks after the IUI procedure, although the doctor will provide specific instructions for each individual patient. Many couples will require more than one cycle of treatment in order to become pregnant, with the most successful results occurring in women less than 35 years of age.
Risks and Considerations of Intrauterine Insemination
Intrauterine insemination has relatively few side effects but may include light bleeding and the rare chance of infection. If ovulation induction medication is prescribed, side effects may include ovarian hyperstimulation syndrome (OHSS), a condition which produces nausea, hot flashes and swollen, painful ovaries. These medications also carry the risks of multiple pregnancy, miscarriage, ectopic pregnancy, or anembryonic gestation, a condition in which a fertilized egg attaches itself to the uterine wall, but never develops into an embryo
Success rates for intrauterine insemination vary. Factors that may lessen the chance of success may include:
- Advanced age
- Poor egg quality
- Poor sperm quality
- Duration of infertility
- Damage or blockage of fallopian tubes
- Severe endometriosis
The physician typically recommend IUI treatments for 3 to 6 months before considering additional infertility treatments that may be costly and more invasive.