Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm directly into a woman's uterus to facilitate fertilization. This procedure is commonly used for couples experiencing unexplained infertility, mild male-factor infertility, cervical infertility, dysovulation, or mild to moderate endometriosis, often in combination with ovarian stimulation to enhance the chances of conception. IUI is often considered a first-line treatment for unexplained infertility or mild male-factor infertility because it is less invasive and costly than IVF. Pregnancy rates per cycle for IUI range from 8% to 20% depending on individual circumstances. Key determinants of success include female age, infertility duration, ovarian stimulation and follicle number, endometrial thickness, sperm quality, and number of IUI cycles. IUI is associated with a range of risks and potential complications in certain contexts. Diet & nutrition can significantly impact egg health and improve fertility outcomes, particularly through an antioxidant-rich diet and a focus on key micronutrients such as folic acid, vitamin D, and omega-3 fatty acids. Likewise for sperm health: omega-3s, antioxidants, carnitines, and vitamin D levels are key diet & nutrition interventions that can improve sperm health and enhance fertility outcomes.

While we at Chiyo are passionate about nutritional solutions, please note that this information is for educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. 

 

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Welcome to the world of intrauterine insemination (IUI) — a fertility treatment that has become a beacon of hope for many couples looking to start or grow their families. If you’ve ever wondered how whether this procedure might be right for you, you’re in the right place!

Intrauterine insemination involves placing sperm directly into a woman’s uterus, to facilitate fertilization at just the right time. It’s often recommended for unexplained infertility, mild male-factor infertility, and even some cases of endometriosis. Whether it’s your first foray into fertility treatments or you’re exploring options after other methods haven’t worked, understanding IUI can empower you on your journey.

In this article we’ll break down what IUI is, who it’s suited for, how the procedure works, and how diet and nutrition can play a vital role in optimizing your chances of success and improve egg health. 

Let’s dive into the details and demystify the IUI process.

 

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IUI 101

What Is It?

Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm directly into a woman's uterus to facilitate fertilization. This procedure is commonly used for couples experiencing unexplained infertility, mild male-factor infertility, cervical infertility, dysovulation, or mild to moderate endometriosis. [1-3] IUI can be performed during a natural ovulatory cycle or combined with ovarian stimulation (OS) to induce development of multiple follicles, which may increase the chances of pregnancy. [3]

The effectiveness of IUI varies based on several factors, including the woman’s age, the duration of infertility, and the underlying cause of infertility. Pregnancy rates per cycle for IUI range from 8% to 20% depending on these factors. [2] For male-factor infertility, the effectiveness of IUI is less clear, and further randomized controlled trials are needed to develop standardized IUI strategies. [1]

 

When Is It Used?

IUI may be a suitable option for several specific infertility conditions:

• Unexplained infertility: IUI is often used as a first-line treatment for couples with unexplained infertility. This is particularly recommended when combined with ovarian stimulation to increase the chances of pregnancy. [3]
• Mild male-factor infertility: IUI is indicated for mild male-factor infertility, where semen parameters (like sperm count, sperm motility, and semen volume) are slightly below normal but not severely impaired. Studies have shown that IUI can improve pregnancy rates in these cases, especially when combined with OS. [8-9]
• Cervical infertility: IUI is beneficial for cervical infertility, where the cervical mucus may be hostile to sperm, preventing them from reaching the uterus. By bypassing the cervix, IUI facilitates sperm entry into the uterine cavity. [9]
• Dysovulation: Women with irregular ovulation (dysovulation) can benefit from IUI, particularly when combined with OS to ensure timely ovulation and increase the number of available eggs. [2]
• Mild to moderate endometriosis: IUI is indicated for women with mild to moderate endometriosis. IUI combined with OS is recommended for these patients, as it has been shown to improve pregnancy rates compared to expectant management. [5, 10]

 

How Does IUI Work?

The steps of the IUI procedure for a range of conditions are as follows:

1. Ovarian stimulation: For many indications (including unexplained infertility, mild male-factor infertility, and endometriosis) ovarian stimulation may be used to increase the number of available eggs. This can be achieved using medications like clomiphene citrate or gonadotropins (FSH or hMG). [4-5]
2. Monitoring follicular development: Ultrasound monitoring is used to track the growth of ovarian follicles. The goal is to achieve at least one follicle measuring >16 mm in diameter and an endometrial thickness of >7 mm with a triple-line pattern. [4]
3. Triggering ovulation: Once the follicles reach the desired size, ovulation is triggered using an injection of human chorionic gonadotropin (hCG). This is typically done 36 hours before the IUI procedure. [4, 6]
4. Semen collection and preparation: On the day of the procedure, a semen sample is collected from the male partner. The sample is then processed in the laboratory to concentrate the motile sperm and remove seminal plasma and other debris. [7]
5. Insemination: The prepared sperm is loaded into a soft catheter and inserted through the cervix into the uterus. This is usually performed 36 hours after hCG administration. [4, 6]
6. Post-procedure: Patients are often advised to rest briefly after the procedure, although extended bed rest is not necessary. [7]

Depending on the context, some healthcare providers may also recommend an "unstimulated," or natural, IUI cycle, in which case no fertility drugs are used.

 

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Difference Between IUI and IVF

IUI and in vitro fertilization (IVF) are both fertility treatments, but they differ in when they are used, how they work, and their cost-effectiveness.

IVF is a more invasive procedure and involves several steps including ovarian stimulation, egg retrieval, fertilization in the lab, and embryo transfer. It is generally indicated for:

• Severe male-factor infertility: IVF with intracytoplasmic sperm injection can overcome significant issues with sperm quality. [12]
• Tubal factor infertility: IVF bypasses the fallopian tubes entirely, making it suitable for women with tubal blockages or damage. [13]
• Severe endometriosis: IVF is often preferred for severe cases where other treatments have failed. [13]
• Failed IUI cycles: IVF may also be considered when multiple IUI cycles have not resulted in pregnancy. [14]

IUI is generally more cost-effective than IVF for certain conditions. Studies have shown that IUI offers similar pregnancy rates to IVF for specific indications like unexplained fertility and mild male-factor infertility, but at a significantly lower cost. [11, 15]

 

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Factors Impacting Success

Several factors affect the success of IUI outcomes, particularly in cases of unexplained infertility, mild male-factor infertility, cervical infertility, dysovulation, and mild to moderate endometriosis. Key factors include:

• Female age: Younger women, particularly those under 35, have higher success rates. [17-18]
• Duration of infertility: Shorter duration of infertility is associated with higher success rates. [19-20]
• Ovarian stimulation and follicle number: Successful ovarian stimulation leading to the development of multiple mature follicles (typically 2-3) significantly increases the chances of pregnancy. The presence of at least one follicle over 16 mm is crucial. [4, 6, 19]
• Endometrial thickness: An endometrial thickness of ≥7 mm with a triple-line pattern on the day of hCG administration is associated with higher pregnancy rates. [4, 18]
• Sperm quality: Total motile sperm count (TMSC) post-wash is a critical factor. A TMSC of ≥5 million is generally considered optimal for higher success rates. Sperm motility and morphology also play significant roles. [4, 17, 21]
• Type of infertility: Women with cervical infertility, dysovulation, or mild to moderate endometriosis have better outcomes compared to those with other infertility types. IUI is particularly effective in these conditions when combined with ovarian stimulation. [4, 6, 18]
• Number of IUI cycles: Success rates tend to be higher in the first three cycles. Beyond three cycles, the likelihood of success diminishes, and alternative treatments like IVF may be considered. [22]
• Lifestyle: Non-smoking status, healthy BMI, and absence of significant lifestyle-related risk factors positively influence IUI outcomes. [2]

 

Risks and Potential Complications

The risks and potential complications of IUI include:

• Multiple pregnancies: The use of ovarian stimulation in IUI increases the risk of multiple pregnancies, which are associated with more complications for both mother and child. The American Society for Reproductive Medicine (ASRM) recommends strict cancellation criteria to mitigate this risk. [3, 23-24]
• Ovarian Hyperstimulation Syndrome (OHSS): OHSS is characterized by enlarged ovaries and fluid accumulation in the abdomen and chest, which can lead to significant morbidity. Although less common than in IVF, OHSS can occur with IUI, especially when gonadotropins are used for ovarian stimulation. [25]
• Pelvic Inflammatory Disease (PID): The risk of PID following IUI is low, with a reported rate of 0.16 per 1000 cycles. This risk is slightly higher in cycles using husband sperm compared to donor sperm. [26]
• Miscarriage: Factors such as advanced maternal age, history of spontaneous miscarriage, and certain ovarian stimulation protocols can increase the risk of miscarriage following IUI. [27]
• Ectopic pregnancy: Although rare, there is a risk of ectopic pregnancy with IUI, where the embryo implants outside the uterus, typically in the fallopian tube.
• Endometriosis recurrence: In patients with endometriosis, IUI with ovarian stimulation may increase the risk of recurrence of endometriosis-related symptoms. [28]
• Obstetric and perinatal complications: Multiple pregnancies resulting from IUI are associated with higher rates of preterm birth, low birth weight, and increased need for neonatal care. However, singleton pregnancies from IUI generally have similar obstetric and perinatal outcomes compared to spontaneous pregnancies. [29]

 

 

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For Her: Nutrition for IUI & Egg Health

Nutritional interventions can significantly impact egg health and improve IUI outcomes, particularly through an antioxidant-rich diet and a focus on key micronutrients such as folic acid, vitamin D, and omega-3 fatty acids. Important to note: egg quality improvements take a minimum of three months to be impacted by nutrition, because it takes three months for an egg to mature .

Folic acid: Folic acid is crucial for DNA synthesis and cell division. Folic acid supplementation (at least 400 μg daily) is recommended by the Society for Reproductive Endocrinology and Infertility and the American Society for Reproductive Medicine to reduce the risk of neural tube defects and improve fertility outcomes. Higher doses of folic acid have been consistently related to lower infertility rates, reduced pregnancy loss, and greater success in infertility treatments. [30, 34-35]. Sources of folic acid include:

• Spinach
• Liver
• Asparagus
• Legumes
• Beets
• Avocados
• Brussels sprouts

Vitamin D: While the role of vitamin D in fertility is still being explored, sufficient levels of vitamin D are associated with better reproductive outcomes. Vitamin D supplementation has been shown to improve endometrial thickness and embryo quality, which are critical for successful implantation and pregnancy. However, the benefits are more pronounced in individuals with vitamin D deficiency. [35, 36] Sources of vitamin D include:

• Shiitake mushrooms
• Beef liver
• Cod liver oil
• Egg yolks

Omega-3 fatty acids: Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential for reducing inflammation and improving oocyte quality. They also help support a healthy menstrual cycle. Increased intake of omega-3 fatty acids has been linked to better egg health and higher live birth rates in women undergoing ART. These fatty acids help in maintaining cell membrane integrity and reducing oxidative stress, which are vital for egg health. [34, 37-38] Sources include:

• Salmon
• Mackerel
• Sardines
• Anchovies
• Flax seeds
• Chia seeds
• Walnuts

CoQ10: Coenzyme Q10, also known as ubiquinol or CoQ10, is an antioxidant that the human body naturally produces. Supplementation of CoQ10 may enhance ovarian response to stimulation, particularly in women with diminished ovarian reserve or poor response to previous stimulation protocols. CoQ10 has been suggested to improve mitochondrial function in eggs, potentially enhancing their quality and increasing the chances of successful fertilization and implantation. [31] This is particularly important because egg cells (oocytes) have the highest amount of mitochondria, compared to other cells in the body. [43] Sources of CoQ10 include:

• Beef
• Pork
• Chicken
• Sardines
• Liver
• Peanuts
• Sesame seeds
• Parsley

Inositol: B vitamins, particularly myo-inositol, support healthy ovulation by promoting estrogen production and increasing follicular sensitivity to follicle-stimulating hormone. [54-55] Sources include:

• Citrus fruits
• Brown rice
• Almonds
• Lentils

Dietary patterns: A diet characterized by high intakes of vegetables, fruits, whole grains, fish, and olive oil (sometimes known as the Mediterranean diet) has been associated with improved fertility outcomes. Studies have shown that adherence to these dietary patterns can enhance clinical pregnancy rates and live birth rates in women undergoing assisted reproductive technologies. The anti-inflammatory properties and high antioxidant content of this diet are believed to support reproductive health by improving health health and reducing oxidative stress. [30, 33] The Society for Reproductive Endocrinology and Infertility and the American Society for Reproductive Medicine recommends these dietary patterns to optimize natural fertility. [30-31]

Lifestyle modifications: Maintaining a healthy BMI (and avoiding smoking) are critical lifestyle factors that can improve IUI outcomes. Obesity and underweight status are associated with poorer reproductive outcomes, and weight management through diet and exercise can enhance fertility. [30]

 

For Him: Nutrition for IUI & Sperm Health

Nutritional interventions can significantly improve sperm health, which is crucial for IUI success. Key nutrients and dietary patterns have been shown to enhance various sperm quality, including concentration, motility, and morphology. Important to note: it takes an average of 3-4 months for sperm to mature and be influenced by nutrition.

Omega-3 fatty acids: Supplementation with omega-3 fatty acids has been shown to increase total sperm concentration and motility. Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), help reduce oxidative stress and inflammation, which are detrimental to sperm quality. [39-40] Sources include:

• Salmon
• Mackerel
• Sardines
• Anchovies
• Flax seeds
• Chia seeds
• Walnuts

Antioxidants & Minerals: Antioxidants such as selenium, zinc, and coenzyme Q10 (CoQ10) have been shown to improve sperm health. Selenium and zinc supplementation can increase sperm concentration and motility, while CoQ10 has been shown to enhance sperm count and morphology. These antioxidants work by minimizing oxidative stress, which can damage sperm DNA and cellular structures. [39-40] Sources include:

• Liver
• Oysters
• Shellfish
• Beef
• Turkey
• Eggs
• Sardines
• Broccoli
• Brazil nuts
• Black beans
• Lentils
• Cashews

Carnitines: Carnitine supplementation has been associated with improved sperm motility and morphology. Carnitine play a role in energy metabolism, which is essential for sperm motility and overall function. [39-40] Sources include:

• Beef
• Pork
• Cod
• Chicken breast
• Avocado
• Eggs

Vitamin D: Adequate levels of vitamin D are beneficial for sperm motility and overall semen quality. Vitamin D receptors are present in sperm, and its active form has been shown to promote sperm motility and fertilization capacity. [42] Sources include:

• Shiitake mushrooms
• Beef liver
• Cod liver oil
• Egg yolks

Dietary patterns: Similarly for women, adherence to a Mediterranean diet, which includes high intakes of vegetables, fruits, whole grains, fish, and olive oil, has been associated with better sperm quality. This diet is rich in antioxidants and anti-inflammatory nutrients that support overall reproductive health. [40-41]

 

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Before IUI: What to Avoid

For Her

When trying to get pregnant or preparing for IUI, women should watch out for:

• Smoking
• Drinking alcohol
• A significantly low BMI
• Exposure to environmental toxins like pesticides and heavy metals
• High stress levels (this one’s tricky, we know!)

Avoiding these factors when preparing for IUI can help improve your chances of successful conception. [52-53]

 

For Him

When trying to conceive or going into IUI, men should avoid:

• Smoking of any kind (including marijuana)
• Drinking alcohol
• Excessive/high heat near the scrotum like saunas or hot tubs

These factors have been shown to decrease sperm parameters which could inhibit fertility outcomes. [30, 44-51]

 

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Conclusion

Navigating the path to fertility, through IUI or other methods, can be both hopeful and challenging. It’s essential to remember that fertility is a process, one that often requires patience and resilience. Embracing integrative methods like targeted nutrition for egg health can provide vital support along the way. A balanced diet rich in essential nutrients not only nurtures your body but also empowers you to take an active role in your fertility journey.

Know that you are not alone in this journey, and every effort you make is a meaningful step forward. Keep believing in yourself, and take it one day at a time.

 

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FAQs

What is IUI?

Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm directly into a woman’s uterus to enhance the chances of fertilization.

Who is a good candidate for IUI?

IUI is often recommended for couples experiencing unexplained infertility, mild male-factor infertility, cervical infertility, dysovulation, or mild to moderate endometriosis.

How is the IUI procedure performed?

The procedure typically involves ovarian stimulation, monitoring follicle development, triggering ovulation, preparing the sperm, and then inseminating the sperm into the uterus using a soft catheter.

What are the success rates of IUI?

Success rates for IUI can vary, typically ranging from 8% to 20% per cycle, depending on factors like the age of the female partner and the cause of infertility.

What are the risks associated with IUI?

Potential risks include multiple pregnancies, ovarian hyperstimulation syndrome (OHSS), pelvic inflammatory disease (PID), miscarriage, ectopic pregnancy, and complications related to endometriosis.

How does nutrition support the IUI process?

A nutrient-rich diet can enhance egg health and improve IUI outcomes. Key nutrients like folic acid, vitamin D, and omega-3 fatty acids play vital roles in reproductive health.

What foods are high in folic acid?

Good sources of folic acid include leafy greens (like spinach and kale), legumes (such as lentils and chickpeas), fruits (like oranges and avocados), and nuts.

How does IUI compare to IVF?

IUI is less invasive and generally more cost-effective than in vitro fertilization (IVF). While both are fertility treatments, IVF involves more steps, including egg retrieval and fertilization in a lab.

How many IUI cycles should I try?

Success rates are often higher in the first three IUI cycles. If there is no success after this, it may be advisable to consider other treatment options like IVF.

Is lifestyle important during the IUI process?

Yes! Maintaining a healthy lifestyle, including a balanced diet and a healthy weight, can significantly improve IUI outcomes. Avoiding smoking and managing stress are also beneficial 

 

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