Creating your family through artificial insemination requires considering and deciding upon many different issues. How do you know which type of artificial insemination is right for you?
If you are using donor sperm, deciding on the actual sperm donor is, of course, the most critical decision. The decisions don’t stop there, though. If you are NOT going the route of in vitro fertilization (IVF), then you have another choice to consider.
Should you go with intrauterine insemination (IUI) or intracervical insemination (ICI)? These are two of the main methods of artificial insemination. Your unique diagnosis might well dictate which type of AI to pursue, but if not, we offer these questions for your consideration.
What Types of Artificial Insemination Are Available?
Artificial insemination 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 sperm is placed on the cervix, it is known as intracervical insemination or ICI.
In ICI, the sperm cannot be placed “in” the cervix—only “on” the cervix. The cervix acts as a filter, allowing motile sperm to pass through to the uterus. Non-motile or dead sperm are left behind, as are other debris and cells which may be present in the semen.
With IUI, motile sperm are placed directly into the uterus, bypassing the cervix. This type of insemination gives the sperm a “head start.” This is an advantage, particularly for a male partner with a low sperm count or motility. However, before placement, the sperm must be washed free of the semen, in a process called sperm washing.
Sperm washing is necessary because semen contains the hormone called prostaglandin, which can cause severe cramping if the unwashed semen was placed directly into the uterine cavity. This process also cleanses the sperm of toxic chemicals that can potentially cause adverse reactions once in the uterus. Once washed, motile sperm is placed into a media that contains supportive nutrients to support the sperm.
Intrauterine insemination is generally considered the optimal type of insemination. Resolve.org has additional resources to learn more about intrauterine insemination (IUI) if you are interested.
What Factors Should You Consider in the Decision?
- Diagnosis: The first step is to talk with your physician to see if he or 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.
- Cost: The cost of an IUI is often significantly higher than the cost of an ICI. Using unwashed sperm is less expensive than choosing sperm that has been washed and prepared for an IUI. Your specialist should be able to help you sort out what option is the most cost-effective for you. Speaking of your specialist, because a healthcare provider must be involved with an IUI, but not necessarily for an ICI, that’s another factor in the cost differential between the two options. You will need to discuss the issues of insurance coverage and find the treatment plan that optimizes your opportunity for a successful conception.
- Availability: Most sperm banks provide both ICI and IUI vials for each sperm donor. However, it’s not uncommon that only one or the other type of vial may be the only type available for the desired donor. There are advantages to both ICI and IUI vials. If your preferred donor only has IUI vials available, then your decision-making process is simplified.
- Who Will Do the Sperm Washing: Your reproductive specialist may prefer to use a specialty andrology or infertility clinic laboratory to perform the sperm washing on thawed, unwashed semen. Some physicians feel it is more advantageous to wash the sperm after thawing, rather than before freezing. If that is the case with your specialist, you will want to purchase ICI vials.
Home Insemination or Doctor-Assisted?
If you want to perform home insemination, intracervical insemination is the preferred method since assistance from a medical professional for an ICI may not be needed. However, if you intend to do home insemination, you must be instructed in the insemination technique. It’s also essential to have a physician to call for questions or concerns.
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There are also important legal implications to consider when doing home insemination, particularly if you are using donor sperm.
It’s a lot of information to consider. The choices may not be clear cut for you. Educating yourself on the two types of artificial insemination and thinking through the factors equips you to work with your reproductive specialists for a plan that gives you a good chance of success!
Image Credit: BMW Foundation Herbert Quandt
*Originally published in 2016*