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IUI

Insemination is one of the relatively simple procedures and is performed in cases of relatively mild male fertility problems or disorders in the cervical canal, e.g., disorders of mucus production or after a conectomy (incision of the external opening of the vagina). The treatment can be performed with or without hormone treatment depending on any pre-existing oocyte maturation disorder. The purpose of this treatment is to bring the prepared sperm in high concentration close to the egg cell in order to promote the occurrence of fertilization.

Intrauterine Insemination (IUI)
Schematic representation of insemination, with sperm processing at the top and insemination at the bottom

Therapy in the natural cycle

During a woman’s regular cycle, it is assumed that a follicle (ovary) will develop, in which the egg cell matures. Typical changes in the uterine lining and hormone levels provide clues about the stage of this development. Through one to two ultrasound examinations and close hormone monitoring, the timing of ovulation can usually be accurately predicted. Then, on the day determined accordingly, insemination (sperm transfer) can be performed. However, this requires a maximum degree of flexibility on both sides, since the body’s own rhythm dictates the schedule. It is better to „schedule“ the ovulation. This also results in an automatic improvement of the corpus luteum (yellow body) phase.

After a follicle size of approximately 18–20 mm has been reached, the ovulation can be triggered specifically with the „ovulation syringe“. Approximately 32–36 hours later, the sperm can be transferred into the uterus after appropriate preparation (Intra uterine Isemination – IUI). The pregnancy rates can be stated as maximum 10 – 15 % (20?) per treatment cycle. Intra-vaginal insemination has no advantages over natural intercourse and therefore has no therapeutic significance.

Since cysts are rarely expected after such a cycle, each cycle can be used.

Sperm diagnostics
The sperm in the test tube. Now it is centrifuged using a special separation solution.
Sperm diagnostics
The sperm sample in the test tube after preparation in the centrifuge.

IUI in the stimulated cycle

As shown below Hormone treatment As explained, medications are used in the treatment of various hormonal imbalances, which are intended to correct the disorders.

Hormonal stimulation for IUI (intrauterine insemination / sperm transfer) is used when there is no independent follicle development (ovary follicle maturation) that leads to a „mature follicle“ (mature ovary).

Clomiphene stimulation

The simplest stimulation is achieved with the active substance Clomifencitrate, Often CC abbreviated. The intake of these tablets usually takes place over 5 days from the 5th to the 9th day of the cycle and results in an increase in FSH production (Follikel sstimulating Hhormone) as a result. The follicle growth (egg follicles) is detected by ultrasound, possibly also by Hormone tests in the blood, controlled.

After a follicle size of approximately 18–20 mm has been reached, the ovulation can be triggered specifically with the „ovulation syringe“. Approximately 32–36 hours later, the sperm can be transferred into the uterus after appropriate preparation (Intra uterine Isemination – IUI). The Pregnancy rates can be specified with a maximum of 10 – 15 % (20?) per treatment cycle. The Intravaginal insemination has no benefits compared to natural sexual intercourse and therefore has no therapeutic significance.

NOTE: The statutory health insurance funds lump the insemination with clomiphene stimulation together. UNSTIMULATED cycles. This should be taken into account when applying for cost recovery (partial reimbursement).

FSH Stimulation

If clomiphene stimulation has so far been unsuccessful (no follicle growth or only no pregnancy success), daily FSH (Follikel sstimulating Hhormone) is injected under the skin. This usually takes place on the 3rd – 11th/12th day of the cycle. The direct administration of FSH usually has a good effect, but in this case it often leads to the maturation of more than one follicle (ovary follicles) than with clomiphene stimulation. Therefore, FSH stimulation therapy should at least be performed by a specialist.

Single versus double intrauterine insemination
Schematic representation of the stimulation for insemination

After a follicle size of approximately 18–20 mm has been reached, the ovulation can be triggered specifically with the „ovulation syringe“. Approximately 32–36 hours later, the sperm can be transferred into the uterus after appropriate preparation (Intra uterine Isemination – IUI). The pregnancy rates can be stated as maximum 10 – 15 % (20?) per treatment cycle. Intra-vaginal insemination has no advantages over natural intercourse and therefore has no therapeutic significance.

—
Schematic representations: Prof. Herrero, Barcelona

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Monitoring / VZO (intercourse to the optimum)

Depending on the couple's wishes, the present findings and other basic requirements (age, duration of the unmet desire for a child, etc.) may indicate that it is advisable to first monitor the course of the natural cycle through more intensive examinations (hormone levels; ultrasound). As a result, you can be informed about the optimal time for conception (the best time to achieve pregnancy).

Hormone treatment

If the hormone test performed at the beginning (if necessary after further evaluation) revealed a significant hormone disorder, this can be treated specifically. Of course, various hormone disorders can also occur simultaneously, so that several medications may occasionally have to be taken in parallel.

Anaesthesia

General anesthesia puts you into a sleep-like state; that is, it shuts down your consciousness and, above all, your sense of pain.

IUI

Insemination is one of the relatively simple procedures and is performed in cases of relatively mild male fertility problems or disorders in the cervical canal, e.g., disorders of mucus production or after a conectomy (incision of the external opening of the vagina). The treatment can be performed with or without hormone treatment depending on any pre-existing oocyte maturation disorder. The purpose of this treatment is to bring the prepared sperm in high concentration close to the egg cell in order to promote the occurrence of fertilization.

IVF

IVF (Reagent glass insemination) is typically used when the woman has bilateral fallopian tube blockage. But the man’s reduced sperm quality, the woman’s age, the couple’s distress, and the failure of other treatments can also lead to the decision to IVF seek this treatment.

ICSI

In cases of severely impaired sperm quality, or when only sperm can be obtained via testicular tissue sampling, an additional test is ICSI required.

Cryoconservation

Thus, if IVF or IVF + ICSI „excessive“ (partially fertilized) eggs have been frozen, they can be used in the so-called „cryocycle“.

ADI

If no sperm are present at all, the use of donor sperm can also be considered. Other reasons may also seem reasonable.

Blastocyst culture

In blastocyst culture, the embryos are further cultured until the 5th day.

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