ABSTRACT
Intrauterine insemination (IUI) was introduced over 50 years ago and is one of the most commonly administered fertility treatments. It is a rational treatment for infertility secondary to a cervical factor, mild male factor, and ejaculatory dysfunction, but the most common indication is unexplained infertility. It is also the best approach to therapeutic donor sperm insemination (TDI). In cases of TDI, a nonmedicated or natural cycle is used initially, but for other indications this approach has a low success rate. Therefore, the use of fertility medications to increase the development of multiple follicles is an important part of IUI treatment and has been shown to increase the chance of success. In addition, the success rate with ovulation induction plus IUI is higher than that with ovulation induction alone. How does an IUI increase the chance of pregnancy? The explanation remains obscure, but it may be the result of several factors. The sperm washing procedure may eliminate toxins or bacteria in the seminal plasma and has been shown to induce the acrosome reaction causing activation of the sperm. Performance of the IUI may bypass an impediment in the cervical mucus. In contrast to intercourse, the IUI results in a higher number of motile sperm that find their way into the uterine cavity. Finally, the IUI may overcome faulty coital technique on the part of the couple. Despite all of these theoretical benefits of IUI, the overall success of IUI treatment is low in comparison to in vitro fertilization (IVF). Nevertheless, for many infertility patients, IUI is their first introduction to treatment. This chapter provides an overview of the treatment.
