Intratubal Insemination (ITI)

This is another assisted reproductive technique (ART) which aids with conception. It is one of 4 artificial insemination techniques available which also include:

  • Intra-cervical insemination (ICI)
  • Intra-vaginal insemination (IVI)
  • Intra-uterine insemination (IUI)

This technique works by placing sperm inside the woman’s fallopian tubes if sexual intercourse is unable to do so. The one advantage of this is that the sperm do not have to travel up the cervix to fertilise an egg. Fertilisation takes place in the fallopian tubes.

However, this is more intrusive than other ART procedures and is considerably more expensive as well. As a result of this it is very rarely used.

There are two types of intra-tubal insemination:

  • Intra-fallopian insemination (IFI)
  • Sperm intra-fallopian insemination (SIFT)

The ITI process

Sperm is collected and cleansed before being placed in a syringe. A catheter (thin tube) is inserted into the uterus via the vagina. The newly washed sperm are then injected into the catheter and pushed into either of the fallopian tubes.

This is known as intrafallopian insemination.

Sperm intrafallopian insemination differs in that the woman undergoes a laparoscopy so that the sperm can access the fallopian tube. A thin tube with a camera is inserted into the abdomen through a small incision. This enables the specialist to have access to the pelvic region.

A catheter (thin tube) is inserted through this incision and into the fallopian tubes. The sperm is deposited into the tubes using a sterile syringe.

Intra-cervical insemination (ICI)

This is very similar to the other 3 procedures mentioned above. Fresh sperm is obtained from the man via ejaculation, or if frozen, allowed to thaw out before being injected into the woman’s cervix.

This differs from other procedures which involve placing sperm in the uterus (IUI) or vagina (IVI).

Intra-vaginal insemination (IVI)

This is less popular than other procedures although it is equally as valuable. It involves placing sperm inside the vagina to increase your chances of fertilisation.

Intrauterine insemination (IUI)

This appears to be the most popular treatment out of the 4 artificial insemination techniques. It is an assisted reproductive technique (ART) which is suitable for both men and women.

However, you will have to undergo fertility tests beforehand to determine if this is the most suitable procedure for you.

If you are a man with a low sperm count then IUI is not a good choice as your sperm are unlikely to find an egg and fertilise it.

If you are a woman suffering from endometriosis then this treatment might not be an option although that depends upon the extent of your condition.

Other factors which might rule you out if you are a woman include:

  • Blocked fallopian tubes
  • Damaged fallopian tubes
  • Poor quality ova
  • Ovulation problems

Success rates of IUI

There is a possibility of conception happening in 10 to 20% of cases providing the conditions for conception are favourable.

This figure decreases with age as the older a woman is the less eggs are produced.

If 2 or 3 cycles of IUI are unsuccessful then IVF treatment will be recommended.

The IUI process

Step 1

Women: to start with, you will undergo a series of tests which include an ultrasound scan. This enables your specialist to check the size of your egg follicles to see if they will produce mature eggs.

Next, you will be prescribed fertility drugs in order to stimulate ovulation. It has been found that doing this results in an increased chance of conception.

These drugs will be given to you at the start of your menstrual cycle as this is the best time to stimulate the ovaries into producing mature eggs.

You may be given an injection of human chorionic gonadotrophin (HCG) to help with ovulation stimulation. This hormone can cause eggs to be released from the ovaries within 30 to 40 hours.

If IUI is dependent on this injection then it must take place 24 to 48 hours after this injection.

Follicle growth will be monitored via ultrasound and blood tests which will check oestrogen levels. Oestrogen is the hormone responsible for egg growth and development.

An important factor in all of this is that of timing. Timing is critical in that the sperm must be injected at the same time as ovulation takes place. This will ensure the best possible chance for fertilisation.

Step 2

Men: you will be asked to produce a sperm sample which can be done at home. Ideally you should not have ejaculated 3 days before producing this sample although check first with your clinic.

If fresh sperm cannot be obtained then donor sperm can be used instead.

You will be asked to take this to the clinic where it will be sent to a laboratory for ‘washing’. This washing separates the good, healthy sperm from the weak, poor quality sperm.

Step 3

Women: the next step involves the injection of the sperm into the uterus. The procedure for this is very similar to a cervical smear so you will have a good idea of what to expect.

The specialist places a speculum inside your vagina to allow access to your cervix. A catheter (thin tube) is inserted into your uterus via the vagina. The sperm are injected into this catheter where they will enter the uterus.

This is a relatively painless procedure which takes around 30 minutes.

Your progress will be monitored via ultrasound scans and pregnancy tests.

Side effects of IUI

There are a few risks with this procedure which include:

  • Uterine cramps
  • Infection
  • Transfer of venereal disease from donor sperm
  • Multiple pregnancies

Plus there is the risk of ovarian hyper-stimulation syndrome (OSS) which causes the ovaries to enlarge in size. This can be a result of fertility medication although it is a rare occurrence. If this does happen then IUI will be stopped until it has been treated.

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