Eleanor Stevenson
Eleanor Stevenson
Ph.D, RN, FAAN, Duke University

IUI with donor sperm – How does it work?

IUI allows the sperm a head start and increases the number of sperm cells that can potentially reach the egg than through regular intercourse. Also the semen samples are prepared to only contain sperm and the ovulation is carefully timed to try to ensure the right conditions for a succesful insemination

Elsewhere on this site, we will talk about the process of donor sperm. But some may wonder what happens once a donor is selected and now, you’d like to move on to attempting a pregnancy. For many such people, Intrauterine Insemination (IUI) is the treatment of choice. It can also be used if you are someone whose sperm count was improved enough though medication, or if you were told that you have mild male infertility, as the fertility team may recommend less invasive options before considering options like IVF or ICSI.  Some guidelines state that IUI is used when there is male infertility as long as there are at least 2-5 million motile sperm after the sample is collected and prepared. However, there are many factors that go into this decision and your fertility team will be able to talk more to you about this.
There are other reasons for IUI treatment, including unexplained infertility (male and/or female), the female having cervical mucus problems or scar tissue in her cervix from past procedures (these issues may block the sperms’ ability to enter in the uterus), and ejaculation dysfunction.

The insemination process

The semen sample will be prepared in the lab by being washed; this removes all the seminal fluid, leaving only the sperm. This sperm is placed into a sterile syringe that has a flexible catheter (a thin hollow tube) at the end. This catheter is inserted through the opening in the woman’s cervix (the entrance of the womb), and the sperm are then injected inside the womb. The IUI treatment procedure takes only a few minutes and is slightly uncomfortable.

Risks of IUI

If the woman is taking medications to enhance ovulation, there is an increased change of multiple pregnancy (twins, triplets). The fertility team will discuss this with you, as the risk will depend on the medication and dosage that she receives. There is also a very small chance of infection after the insemination, but all efforts are made by using sterile techniques to minimize this risk.

IUI: Fertilization IN the woman’s body

The goal is to increase the number of sperm that reach the woman’s egg and therefore increase the chance of fertilization. Normally, during intercourse, only a few dozen sperm make it inside the uterus and reach the egg in the fallopian tube. Most never make it past the entrance of the womb. IUI allows the sperm a head start and increases how many can potentially reach the egg because all the sperm, (often in the millions) go directly into the womb. While the sperm still has to reach and fertilize the egg on its own, it is a less invasive and less expensive option compared to IVF. The timing of the IUI is around ovulation, and sometimes women are put on medication (a process called Controlled Ovarian Hyperstimulation-COH) to help them to ovulate (release an egg). These medications can be either tablets/pills or injections. Timing of insemination is typically about 24-36 hours after the luteinizing hormone surge, which tells us ovulation will soon occur. Some fertility centers will monitor women with blood tests and ultrasound scans of their ovaries to time the insemination.

Success of IUI

How likely a cycle of IUI is to result in a pregnancy will depend on many factors, such as the age of the woman, the quality of the semen sample, and if medications are used to help ovulation. When the conditions are right, the success can be as high as 20% per cycle. It is best to talk with the fertility team to understand the unique situation when learning about the change of success.