One of the more popular infertility treatments to increase the numbers of sperm reaching the egg is intrauterine insemination (IUI) with washed sperm. Previous treatments to try to accomplish this goal, including antibiotics to decrease inflammation, estrogen to improve mucus production, guaifenesin (Robitussin) to thin the mucus, and insemination into the cervical mucus were not very effective. Placing the sperm in the uterus bypasses the mucus and eliminates a cervical problem as a factor. It is known to be useful in the treatment of poor-quality mucus or mucus that has antibodies which clump and immobilize sperm. This technique is also successful for mild to moderate reductions of semen quality.
Although the chance of success varies with the individual problem, IUI yields about a 30 percent conception rate over three to six cycles, or 5 to 10 percent per cycle. In such couples the monthly conception rate without treatment might be one to three percent. It is entirely possible that this treatment "telescopes" successes into the treatment cycle, which may have occurred spontaneously within another year or so of trying on their own. But we have not met many infertile couples willing to keep their lives perpetually on hold.
The procedure is usually scheduled based on the results of ultrasounds and the urinary LH testing kit. Based on the woman's cycle and ultrasound observation of the developing follicle, she is instructed when to begin testing and to schedule the insemination on the day following detection of the surge. The test is done in the afternoon or early evening so as not to miss the surge, which usually begins early in the day but may not be detectable in the urine until several hours later. On the day of insemination, the husband masturbates a specimen into a sterile, nontoxic plastic container. Preferably, the couple has avoided intercourse for about two days before the anticipated day of insemination. After the specimen liquefies, it is washed in a nutrient medium. This can be done by a variety of techniques and in any one of several media. The washing procedure produces a concentrated pellet of motile sperm that is mixed with medium and placed into the uterus through the cervix by means of a thin plastic tube.
The wash and insemination are relatively inexpensive. Side effects are rare but may include cramping. The risk of complications is low and related chiefly to the possibility of introducing infection and so we usually administer a prophylactic antibiotic at the time of the procedure to prevent infection.