Artificial insemination is a treatment for infertility that involves directly inserting sperm into a woman’s womb.

When is artificial insemination used?

Artificial insemination can be useful in helping couples to conceive in any of the following situations:

• there is a problem with the man’s sperm, or he cannot produce sperm during sexual intercourse
• there is no obvious reason why the couple can not conceive a child (unexplained infertility)
• the woman has minimal to mild endometriosis

Endometriosis is a condition where cells that are usually only found in the lining of the uterus (womb) begin to grow in other parts of the reproductive system, which can be a cause of infertility.

Women in same-sex partnerships have also used artificial insemination as a way of conceiving a child.

Intrauterine insemination (IUI)

Different techniques can be used to carry out artificial insemination. Intrauterine insemination (IUI) is the most widely used technique and has a good success record.

In IUI, a man will provide a sample of sperm which is then "washed" and filtered using special techniques. This ensures that only the most potent, high-quality sperm is used for the procedure.

During the procedure, the concentrated sperm is passed directly into the woman’s womb (uterus) through a tube called a catheter.

Sperm donation

In some circumstances, the man may not be able to produce any healthy sperm. If this is the case, frozen sperm, obtained from a donor, can be used.

Some couples have chosen to obtain donated sperm from somebody they know, a relative or a friend. In the majority of cases, sperm is taken from an anonymous donation.

Donor anonymity

In the past, sperm donors remained anonymous, from the parents and the child produced by the donated sperm. In 2005, the law regarding donor anonymity changed.

Any person who is born from donated sperm after April 1 2005 is entitled to apply to the Human Fertility and Embryology Authority (HFEA) to obtain information about the identity of the donor, once they have reached 18 years of age.

The HFEA is responsible for regulating all fertility clinics in the UK.

Artificial insemination on the NHS

The National Institute for Health and Clinical Excellence (NICE) recommends that up to six courses (or cycles) of IUI treatment should be offered to couples free of charge on the NHS if:

• the man’s sperm count is abnormal
• the woman has minimal to mild endometriosis or
• the couple have unexplained fertility problems

Fertility treatment that is funded by the NHS currently varies across the UK. In some areas, the waiting lists for treatment can be very long. The criteria that you must meet in order to be eligible for treatment can also vary, and in some cases it may depend on what is available from your local primary care trust (PCT).

IUI is also available from private fertility clinics. Costs can vary from £500 to £1,000 for each cycle of treatment.

The term cycle is used to refer to one course of IUI treatment. As each course is timed to coincide with the woman’s natural reproductive cycle, you will only be able to receive one cycle of IUI treatment a month.

Artificial insemination can be a useful treatment for couples who are capable of producing healthy eggs and sperm but, due to pre-existing health conditions, are unable to conceive a child through sexual intercourse.

Donor sperm can also be used in cases where a man is unable to produce any healthy sperm, or when a woman wishes to raise a child by herself, or as part of a same-sex relationship.

Health conditions that often cause people to choose artificial insemination are detailed below.

Men

If a man has a low sperm count, or erectile dysfunction (impotence), artificial insemination may be recommended.

Low sperm count

For reasons that are often unclear, some men are unable to produce sperm of a high enough quality to result in pregnancy.

Erectile dysfunction

Erectile dysfunction, or impotence is a condition where a man is unable to obtain (or maintain) an erection during sex. It is often caused by both physical and psychological factors.

Storing sperm

A number of medical treatments carry a risk of causing infertility in men. Treatments that can cause male infertility include:

• chemotherapy
• radiotherapy
• orchidectomy

An orchidectomy is a surgical procedure that is sometimes used to treat testicular cancer and involves removing one or both testicles.

If you are due to have one of the above treatments, and are still interested in having a child, you have the option of freezing a sample of your sperm so that it can be used at a later date.

Women

Cervical factor infertility

Artificial insemination, in particular, intrauterine insemination (IUI), is widely used to treat cervical factor infertility.

The cervix forms the neck of the womb, and sits in between the vagina and the womb itself. Usually, the cervix contains mucus (a liquid that is produced by the body’s tissue) that is specifically designed to help move any sperm from the vagina into the womb.

In cases of cervical factor infertility, the mucus is too thin to move the sperm into the womb. Also, the cervical mucus sometimes contains substances that can kill the sperm.

IUI is an ideal treatment for cervical factory infertility because it can be used to place sperm directly into the womb, bypassing the cervix in the process.

Endometriosis

Endometriosis is a condition where the special cells that usually only grow on the lining of the womb begin to grow in other parts of the reproductive system, such as the fallopian tubes or ovaries. 

The condition causes symptoms of heavy, and sometimes painful, periods and, in a minority of women, can result in infertility.

IUI is often used to treat women who have minimum to mild endometriosis and are having problems conceiving a child.

The severity of endometriosis is assessed by measuring the amount of uterine tissue that is growing outside of the uterus. In cases of minimal to mild endometriosis, only small patches of tissue are present outside the uterus.

However, IUI is not recommended for women who have more serious symptoms of endometriosis. This is because serious cases of endometriosis can result in scarring of the uterus, which means that IUI is unlikely to be successful.

Unexplained fertility

IUI can sometimes be an effective treatment for couples who are unable to conceive a child, but where there is no obvious medical reason why this is the case.

Research has shown that IUI is as effective as in-vitro fertilisation (IVF). IVF is a technique where an egg is surgically removed from the ovaries and is fertilised outside of the body. As well being effective at treating unexplained fertility, IUI is also considerably less expensive than IVF.

To maximise the chances of success, a cycle of intrauterine insemination (IUI) should be performed when a woman is at her most fertile.

This is usually just after you ovulate; ovulation is when one or more eggs are released from your ovaries into the fallopian tube for fertilisation.

For most women, ovulation takes place 12-15 days after the first day of your monthly period.

You may be given an ovulation prediction kit (OPK) so you can determine your date of ovulation with greater accuracy.

OPKs are a simple testing device that can detect the hormones in your urine or your saliva that are released during ovulation.

Intrauterine insemination using a partner’s sperm

If you decide to have intrauterine insemination (IUI) using your partner’s sperm, your partner will be asked to provide a sperm sample at the fertility clinic. The sperm sample will usually be taken on the same day that the IUI treatment takes place.

To obtain the sperm sample, your partner will be asked to masturbate into a specimen cup. Your partner may be asked not to have sexual intercourse, or masturbate for two days before the sample is taken because this could affect the sperm sample’s quality.

After a sample has been provided, it will be ‘washed’, which involves it being filtered using special equipment that removes any dead sperm and impurities to produce a concentrated sample of healthy sperm.

A special instrument called a speculum will be inserted into your vagina. The speculum will keep the walls of your vagina open.

A thin, flexible tube (catheter) will be placed inside your vagina and guided into your womb. This process is mostly painless, although some women can experience some mild cramping, similar to period pains. The sperm sample is then passed through the catheter and into your womb.

The whole IUI process usually lasts for no more than 10 minutes, and you should be able to go home shortly after the process is completed.

Intrauterine insemination using a donor’s sperm

If you decide to have IUI using the sperm of a donor, the procedure is the same as if your partner was donating the sperm. However, instead of using your partner’s sperm, a sample of frozen sperm will be thawed out and washed, before being inserted into your womb.

All donated sperm is carefully checked for:

• infections, such as HIV and hepatitis
• genetic and hereditary disorders, such as sickle-cell anaemia or cystic fibrosis, that could affect the health of a child

Your fertility clinic will be able to provide you with information about the physical characteristics of available donors, such as their ethnicity, hair and eye colour, and physical build. Therefore you can try to match a potential donor’s characteristics with your own. 

Fertility medication

In the past, women who had IUI were also given medication to stimulate ovulation. The routine use of fertility medication is not now usually recommended. This is because these types of medication increase the possibility of multiple births, such as having twins or triplets (see the Risks section for more information about this).

Where possible, fertility clinics usually try to avoid multiple births because there is an increased risk of complications associated with this type of pregnancy. The one circumstance where fertility medication is recommended is if you have minimal to mild symptoms of endometriosis.

Multiple births

There is an increased risk of experiencing multiple births if you receive intrauterine insemination (IUI) in combination with fertility medication.

Studies that looked at women who received IUI in combination with fertility medication because they had endometriosis related infertility, found that the number of women who went on to have multiple births ranged from between 18-33%.

Multiple births are associated with a slightly increased risk of:

• miscarriage
• low birth weight
• premature birth

Ovarian hyperstimulation syndrome (OHSS)

Ovarian hyperstimulation syndrome (OHSS) is an uncommon but potentially serious complication that can occur when fertility medications are used during a cycle of IUI treatment.

For reasons that are not fully understood, some women’s ovaries become swollen after the use of fertility medications.

In most cases, the amount of swelling will be minimal to mild, causing symptoms of:

• bloating
• mild to moderate abdominal pain
• nausea and vomiting (occasionally)

In an estimated 3% of cases, the ovaries will become significantly swollen, and the symptoms of OHSS will be severe. Severe OHSS can cause symptoms such as:

• chest pain
• dehydration
• shortness of breath

Mild cases of OHSS can be treated at home. Drinking plenty of water and taking paracetamol to help relieve symptoms of pain is recommended.

Severe cases of OHSS will require admission to hospital, so that the normal functions of the body can be supported until the swelling subsides.

Symptoms of OHSS usually develop between 4-5 days after the initial use of fertility medication.

If you are concerned that you may be developing OHSS, you should contact your fertility clinic as soon as possible.

Intrauterine insemination (IUI) has a success rate of around 15% per cycle of treatment. As with most other types of fertility treatments, the younger you are, the greater the chance of a successful pregnancy.

Most experts would recommend that you try no more than six cycles of IUI treatments.

If you are unable to get pregnant within six cycles of treatment, it is unlikely that any further IUI treatment would be successful, and you should consider trying other form of fertility treatments such as in-vitro fertilization (IVF).