Demystifying IUI, ICI, IVI and IVF

Demystifying Methods of Insemination

Artificial insemination is a form of assisted reproductive technology (ART) whereby sperm is placed into a woman’s reproductive tract by means other than sexual intercourse. The most common forms of artificial insemination are intrauterine insemination (IUI) and intracervical insemination (ICI). Although not as common, intravaginal insemination (IVI), which can be performed at home, is also considered a form of artificial insemination.

These forms of artificial insemination should not be confused with in-vitro fertilization (IVF), another form of assisted reproductive technology. IVF is the process of manually combining an egg and sperm outside of the womb, in vitro. Although donor sperm may be used for IVF, that will depend on whether IVF is being performed in response to female or male infertility issues.

Methods of Insemination

The procedures used for intracervical insemination and intrauterine insemination are very similar and are normally performed in a physician’s office. Inseminations may be timed based on a woman’s natural cycle or in conjunction with medications intended to induce ovulation. The woman is normally positioned on an examination table as if in preparation for a pelvic examination. A speculum is placed in the vagina so that the cervix is visible. A sperm sample is then inserted through the cervical opening using an insemination catheter attached to a syringe. For ICI, the sample is injected into the cervix. For IUI, the sample is injected directly into the uterus. Some practitioners may recommend that the woman remain lying down for 15-30 minutes following the procedure. Of the two procedures, IUI is commonly believed to have a slightly better success rate than ICI.

Although IUI and ICI require the assistance of a health care provider, artificial insemination in the form of intravaginal insemination (IVI) can be done at home. IVI involves the use of either a syringe or a cervical cap to place sperm as close to the cervix as possible. Although success rates are not as high, IVI is less expensive than either IUI or ICI.

Preparation of Sperm Samples

Sperm samples may either be “washed” or unwashed. Sperm washing is a procedure used to prepare sperm for insemination whereby viable sperm cells are separated from other contents of seminal fluid. Sperm washing results in the removal of dead and slow moving sperm, white blood cells and prostoglandins, which may interfere with fertilization.

Sperm must always be washed prior to IUI because the prostoglandins contained in semen cause severe pain and cramping when inserted directly into the uterus. Although most women purchase pre-washed donor sperm if they intend on utilizing IUI, some fertility clinics prefer to utilize their own washing procedures prior to insemination. Because ICI and IVI do not involve the introduction of sperm directly into the uterus, sperm used for ICI and IVI may be either washed or unwashed.

In Vitro Fertilization

In vitro fertilization is a process by which fertilization occurs outside of the body or in vitro. IVF may involve any combination of your own eggs and sperm and donor eggs and sperm. After egg and sperm cells have been harvested or obtained from donors, they are brought together in a laboratory environment to allow the sperm to fertilize the eggs. About 2 to 5 days after fertilization, one or more of the best fertilized eggs are inserted into the uterus using a catheter. The remaining fertilized eggs may be cryopreserved for future use. IVF requires the use of pre-washed sperm.

Consult your physician

Women should consult with their physicians about the insemination method that is most appropriate for their circumstances. Either the health care provider or the sperm bank can provide guidance on the type of sperm appropriate for the procedure selected and the number of recommended vials.