Insemination (IUI)

Insemination in the uterus with semen from the male partner is one of the options treating unexplained infertility or if the semen quality is slightly decreased.

Insemination with semen from the male partner is often used with a mild hormone stimulation of the woman, if she has compromised egg (oocyte) maturation (long menstruation cycles).

Most women who are treated with donor insemination have normal fertility. Therefore it is often easy to obtain pregnancy.
Treatment with donor insemination may be performed on different ’levels’. Insemination with donor semen can be without any hormone stimulation. 

Read about the different types of semen donation: 
Anonymous’, ‘Extended profile’, ‘Open’ and ‘Own’ 

1. A referral from your own doctor (if you have a Danish social security) with relevant examinations and blood tests. 
2. Consultation and examination at Trianglen Fertility Clinic.
3. The treatment begins. When you have your period, call our secretaries on telephone 39 40 70 00 and make an appointment for an ultrasound scan.
4. Hormone stimulation with tablets and/or injections.
5. Ultrasound scan on day 10-12 in your cycle (your first day of "real bleeding" is called day number 1)
6. Maturation injection, when the follicles (eggs) are ready. If donor insemination is planned the donor sperm must be delivered to Trianglen before the day of insemination.
7. The sperm sample is delivered in the morning 1 1/2 days after the maturation injection. 
8. The sperm sample is analyzed and prepared in the lab. The insemination is performed approximately 38 hours after the maturation injection.,
9. You should take a pregnancy test 2 weeks after the insemination.
10. If the test is positive you will be offered an ultrasound scan of the early pregnancy approximately three weeks after the positive test    

The chance of becoming pregnant with donor insemination in our clinic is approximately 25% per cycle for women younger than 40. Approx. 60% will be pregnant after 3 cycles and 80% after 6 cycles.

For women over 40 years of age the success rate decreases significantly.

The chance of getting pregnant and give birth with insemination treatment decreases markedly with age and becomes low after the woman has turned 40 years of age.

When the woman has turned 40 but not yet 41 the chance of giving birth after insemination is around 8-9% per insemination. When the woman has turned 41 but not yet 42 the chance of giving birth per insemination is around 6-7% per insemination. Thus, on average it takes around 15 inseminations to obtain one childbirth for a woman aged 41. 

Because of these statistics we do not recommend insemination after the woman has turned 40, and we do not do insemination after the woman has turned 41.

In vitro fertilization (IVF) treatment is far more effective when the age is above 40. With IVF the chance of giving birth is around 15-20% for a woman who is 40 years old and around 13-15% for a 41-year old woman.

If insemination treatment is performed in women above 40 there is a quite high risk that she will use her last fertile months/years on a less efficient treatment. This may give a lower chance of ever obtaining pregnancy and childbirth because the time (age) for potential subsequent IVF is postponed.

If hormone stimulation has been used the woman will often produce more than one egg. In these cases, the probability of a twin pregnancy is increased. Twins are seen in approximately 10% of the pregnancies after hormone stimulation. Without hormone stimulation, the chance of a twin pregnancy is 1%. Triplets are very rare.

View IUI results

Insemination should be made only if the following conditions are met. Otherwise, the chance of pregnancy by this type of treatment is very low. 
We always start with a consultation at Trianglen, so we can find the right fertility treatment for you.

• There must be sufficient motile sperm. This means that there should be more than 2 million progressively motile sperm cells after sperm washing.
• The fallopian tubes has to function. Both fallopian tubes should be patent (open).

Insemination can be offered to couples where the man has a slightly decreased sperm quality and the woman has open fallopian tubes on both sides. Insemination may also be used in "unexplained" infertility.

For insemination with donor sperm the same conditions apply to the woman.

The maximum number of treatments
For couples who are inseminated with the partner's sperm (IUI-H) up to three insemination cycles are recommended. If the woman has a very long or absent menstrual cycle up to six cycles may be performed.

For donor insemination (IUI-D) we usually recommend up to 6 treatments.    

Maximum age - Woman
When the woman is over 40 years, the chance of pregnancy is around 10-14%.
If the woman is 41 years or more the chance of pregnancy by artificial insemination is very low, which is why we do not offer insemination treatment to this age group. This group we would recommend vitro fertilization (IVF / ICSI).

Maximum age - man
The man experiences a steady and slow decline in sperm quality through life. In couples where the man is 55 years of age, we can offer genetic counseling.

In many cases, the woman receives a mild hormonal stimulation at the beginning of the cycle. The aim of the hormone stimulation is to get 2-3 eggs to mature. The mild hormone stimulation is given as daily hormone injections from day 3 of the cycle or as tablets (Clomid).

If the woman has very long or "no" menstrual cycle, we usually aim to develop 1-2 eggs.

Women with PCOS (polycystic ovary syndrome) often do not develop eggs on treatment with Pergotime®. In these women, it is necessary to cause egg maturation by daily injections of FSH (follicle stimulating hormone) for 10-20 days.

Ovulation injection
When the follicles are large enough, the woman is given an injection of "ovulation hormone" (Ovitrelle® or Pregnyl®).

Ovulation occurs approximately 38 hours after injection with ovulation hormone.

'The woman injects the ovulation hormone at home in the evening on a specified date. Insemination takes place in the morning 1½ days (about 38 hours) later - close to the time when ovulation occurs. 

Most women who are treated with donor insemination have normal fertility. Therefore it is often easy to obtain pregnancy. 

Treatment with donor insemination may be performed on different ’levels’. 

Level 1: The woman finds out when the time of ovulation will be by using an ’ovulation test’ daily in the days preceding ovulation. The insemination is performed the day after the test becomes positive. This method is only recommended for women with a regular menstrual cycle of 26-30 days. 

Level 2: The growth of the follicle is monitored by ultrasound scanning. When the follicle (and thus the oocyte) is ready an injection for ovulation induction is given. Insemination is performed approximately 38 hours later. 

Level 3: Mild hormone stimulation is given. The purpose is to develop 2-3 oocytes. Ultrasound scanning, ovulation induction and insemination are as for Level 2.

Hormone stimulation Level 3
In most cases, mild hormone stimulation is given in the early part of the menstrual cycle. The purpose of the hormone stimulation is to make 2-3 follicles grow in the ovaries. The most common form of hormone treatment is clomiphene citrate 50 mg twice daily from cycle day 3-7. In some cases additional hormone injections with follicle stimulating hormone (FSH or hMG) is given on cycle days 8-10. 

If your menstrual cycle is very long, the aim of the hormone stimulation is to make one or two follicles grow. 

Women with PCOS (PolyCystic Ovary Syndrome) often do not develop follicles when treated with clomiphene tablets. In these women, it may be necessary to induce follicle development with daily injections with FSH (Follicle Stimulating Hormone). The injections are normally given for 10-20 days.

Ovulation induction (Maturation injection)
When the follicle is ready, you should take an injection with hCG (Ovitrelle® or Pregnyl®) for ovulation induction. Ovulation takes place approximately 38 hours later.
Normally the injection for ovulation induction is taken in the evening. The precise time is arranged with our secretaries. The insemination is performed in our clinic approximately 38 hours later, close to the time where ovulation occurs. 

Overview over IUI-D treatment

Precautions
You can behave as usual after insemination. You can go to work, and you are allowed to have intercourse around the time of insemination. Only if the cause of treatment are antibodies in the semen of the man, sex can be inadvisable in the days around the insemination.

Pregnant?
After the insemination, we give you a pregnancy test, which you should use 14 days later. It is best to test on the first urine you void in the morning. Please call our secretaries on Tel: +45 39 40 70 00 and tell them whether the test was positive or negative. If the test is positive, you should be ultrasound scanned approximately three weeks later, when the early embryo should be visible.

In general, insemination treatment is safe and there are very few risks associated with the treatment.

Side effects of the medicine 
These are temporary and generally mild. You may experience nausea, breast tenderness, headache, hot flushes and tiredness.

Allergic reactions against the medicine are very rare. Symptoms may include rashes and difficulty breathing. If you suspect an allergic reaction, you should not take more of the medicine and you should consult a doctor.

Complicated pregnancy 
As described earlier there is an increased risk of twin pregnancies when hormone stimulation is used. The risks of complications – especially preterm delivery – are increased in twin pregnancies.

No risk of cancer
Recent studies do not indicate that the hormones used for fertility treatment result in an increased risk for later development of ovarian cancer. However, no studies that can completely exclude such a risk have been performed. 

There is no fixed limit. In general it is reasonable to inseminate three times if it is artificial insemination with sperm from the man (IUI-H). If the sperm is from a sperm donor (IUI-D), we usually perform up to six treatments. Those numbers may vary depending on an assessment of the individual woman / couple.