Artificial Insemination – Intracervical vs. Intrauterine
There are many decisions to make when creating your family through artificial insemination. If you are using donor sperm, deciding on the actual sperm donor is the most important decision, but the decisions don’t stop there. Assuming that you will not be using in vitro fertilization (IVF), you will also need to decide whether to go with an intrauterine insemination (IUI) or intracervical insemination (ICI). The decision may be dictated by your diagnosis, but if not, here are some things to consider.
What Types of Artificial Insemination is Available?
Artificial insemination, or AI, is the placement of sperm into a woman’s cervix, or directly into the uterus, by means other than sexual intercourse. When sperm is placed directly into the uterus it is known as intrauterine insemination, or IUI; when placed on the cervix it is known as intracervical insemination, or ICI.
Sperm cannot be placed “in” the cervix—only “on” the cervix in ICI. The cervix acts as a filter, allowing motile sperm to pass into the uterus, leaving behind non-motile or dead sperm, debris and cells which may be present in the semen.
With IUI, the motile sperm are placed directly into the uterus, bypassing the cervix. This type of insemination gives the sperm a head start, and is particularly helpful when the male partner has a low sperm count or motility. In order for the sperm to be placed directly into the uterus, however, the sperm must be washed free of the fluid, in a process called sperm washing. Semen contains a hormone, prostaglandin, which can cause severe cramping if unwashed semen was placed directly into the uterine cavity. The motile sperm fraction are placed into a media that contains supportive nutrients to help the sperm. IUI is generally thought to be the optimal type of insemination.
Artificial Insemination with ICI or IUI- How to Decide?
The first step is to talk with your physician to see is she sees clinical reasons why an IUI should be performed rather than an ICI. These reasons include what is referred to as “cervical” factors, for example if the cervical mucus is too thick to allow easy penetration of sperm, an IUI would give a better probability of success.
The cost of an IUI is often significantly higher than the cost of an ICI because the cost of unwashed sperm is less than sperm washed and prepared for an IUI. Further, a healthcare provider must be involved with an IUI, but not necessarily for an ICI.
Most sperm banks provide both ICI and IUI vials for each sperm donor, but often, one or the other type of vial may be the only type available for a desired donor. If your preferred donor only has IUI vials available, then your decision making process is simplified.
Who Will Do the Sperm Washing:
Your physician may prefer to have a specialty andrology or infertility clinic laboratory perform the sperm washing on the thawed unwashed semen. There are some practitioners who feel it is more advantageous to wash the sperm after thaw, rather than before freezing. In this case, you will want to purchase ICI vials.
Home Insemination vs. Doctor Assisted
If you want to perform a home insemination, intracervical insemination is the preferred method since the assistance of a medical professional for an ICI may not be needed. However, it is important that, if you intend to perform a home insemination, you are instructed in the insemination technique, and have a physician to call if you have questions or concerns. You also need to think through the legal implications when doing a home insemination.
ICI or IUI vials? Advantages to both. Whichever you choose, here’s to your success!
Other Creating a Family resources you will enjoy:
- 8 Tips for Getting Pregnant With Intrauterine Insemination
- Clomid, Medicated IUI, or Straight to IVF?
- Having a Baby as a Single Mom: Things to Consider
- How to Treat Infertility in Women Younger than 35
By: Grace M. Centola, Ph.D., HCLD/CC/ALD (ABB), Tissue Bank Director at Manhattan Cryobank, New York, New York