Intrauterine Insemination (IUI)

Intrauterine insemination can be carried out during both natural and stimulated cycles.

Procedure: An ultrasound examination between days 10-12 of the cycle to determine the maturation of the follicle. An injection to trigger ovulation enables exact planning of the correct moment for ovulation and, consequently, insemination.

On the day of ovulation, the couple visits the practice, and the man provides a sperm sample. After processing (washing, centrifugation), the sperm is injected into the partner’s uterus.

Therapy During a Natural Cycle

If a women’s cycle is regular, then it is assumed that there is normal development of the follicle in which the maturation of the egg cell takes place. The typical changes to the endometrium and hormone levels provide information on development. One or two ultrasound examinations and regular hormone level testing usually allows for an accurate prediction of the day of ovulation. Insemination then takes place on the predicted day. This requires a high level of flexibility from both sides because the body’s own rhythm determines the schedule, Therefore, it is advantageous to “schedule” ovulation. This also has the consequence of an automatic improvement of the luteal phase.

After a follicle size of between 18-20 mm has been reached, ovulation can be triggered using an “ovulation injection”. Approximately 24-32 hours later, the suitably processed sperm can be placed into the uterine cavity (intrauterine insemination IUI). The pregnancy rate is reported at 10-15% per treatment cycle and depends greatly on the age of the woman and the spermiogram findings.

Intravaginal insemination provides no advantage compared with sexual intercourse and is therefore without therapeutic significance.

Because cysts are expected only in rare cases following this type of cycle, an attempt can be made during every cycle.

IUI during a Stimulated Cycle

As mentioned in the “Hormone Treatments” section, medications are used to treat a wide range of hormonal imbalances.

In the case of IUI (intrauterine insemination/sperm transfer), hormonal stimulation is used in cases where follicular development, leading to egg cell maturation, is absent.

Clomiphene Stimulation

The simplest form of stimulation is carried out using clomiphene citrate, often abbreviated as CC. Alternatively, nowadays the active pharmaceutical ingredient Letrozole can also be used and has shown itself to be more beneficial than Clomiphene in several studies. However, the use in fertility treatment continues to be on an off-label basis (outside of the range of use for which it was originally approved). The use of both medications in tablet form usually takes place during days 5-9 of the menstrual cycle and results in increased FSH (follicle stimulating hormone) production. The growth of the follicle is then monitored via ultrasound and, if necessary, blood hormone level testing.

After a follicle size of between 18-20 mm has been reached, then the ovulation can be triggered using an “ovulation injection”. Approximately 24-32 hours later, the suitably processed sperm can be placed into the uterine cavity (intrauterine insemination IUI). The pregnancy rate is reported at 10-15% per treatment cycle and depends greatly on the age of the woman and the spermiogram findings.

Intravaginal insemination provides no advantage compared with sexual intercourse and is therefore without therapeutic significance.

Please note:

The statutory health insurance providers only subsidise clomiphene stimulation during UNSTIMULATED cycles. This should be considered when applying for cost coverage (partial cost coverage).

FSH Stimulation

If clomiphene stimulation has been unsuccessful (no follicular growth or simply no pregnancy), the FSH (follicle stimulating hormone) can be injected daily under the skin. This usually takes place between days 3 and 11/12 of the menstrual cycle. The direct administration of FSH usually has positive benefits, but it does cause the development of more than one follicle more frequently than clomiphene stimulation. Therefore, FSH stimulation therapy should be carried out by specialists.

After the follicle has reached a size of between 18 and 20 mm, ovulation can be triggered using an “ovulation injection”. Approximately 24-32 hours later, the sperm, following suitable processing, can be transferred into the uterine cavity (Intrauterine insemination – IUI). The maximum rate of pregnancy per round of treatment is reported at between 10 and 15%.

Intravaginal insemination offers no advantages when compared to natural sexual intercourse and is therefore without therapeutic significance.