Before having intrauterine insemination (IUI), a couple’s fertility will need to be assessed to find out why they are having difficulty conceiving and to determine whether artificial insemination is suitable.
Read diagnosing infertility for more information about how infertility is assessed and the tests involved.
Assessing a woman’s fallopian tubes
For a woman to have IUI, her fallopian tubes must be open and healthy. The fallopian tubes connect the ovaries to the womb. Eggs are released from the ovaries into the fallopian tubes each month, and this is where fertilisation takes place. If there is a problem with the fallopian tubes, it may prevent IUI from working.
Checking that the fallopian tubes are open and healthy is sometimes called a tubal patency test. The fallopian tubes can be assessed using one of two methods:
- laparoscopy
- hysterosalpingogram
Laparoscopy
A laparoscopy involves making a small cut in the lower abdomen. A thin, tubular microscope called a laparoscope is used to look more closely at the womb, fallopian tubes and ovaries. A dye may be injected through the neck of the womb into the fallopian tubes to highlight any blockages.
A laparoscopy is the preferred method of assessing the fallopian tubes. If a woman has had pelvic inflammatory disease (PID) in the past this will be an important investigation as PID is an infection that can damage and scar the fallopian tubes.
Hysterosalpingogram
A hysterosalpingogram is a type of X-ray taken of the womb and fallopian tubes after a special dye has been injected. This will help detect any abnormalities or defects, such as tumours or scar tissue.
Hydrosonagram
A hydrosonogram is a procedure where water is injected through the cervix and into the uterus to allow an ultrasound scan. This will help detect abnormalities such as fibroids or cervical polyps.
The timing of IUI
To maximise the chances of success, a cycle of IUI should be carried out just after ovulation. Ovulation is when one or more eggs are released from the ovaries into the fallopian tubes.
It is difficult to predict exactly when ovulation will occur, but in most women it usually happens 10 to 16 days before the start of their period. The menstrual cycle begins on the first day of a period (day one). Ovulation occurs some time after the period, which is followed by the next period 10 to 16 days later.
The exact day of ovulation can be detected by using urine ovulation kits or blood tests in the middle of the cycle.
IUI is usually carried out between day 12 and day 16 of the menstrual cycle.
Women may be given an ovulation prediction kit (OPK) to work out the date of ovulation with greater accuracy. An OPK device can detect hormones released during ovulation in urine or saliva. Alternatively, a woman may have blood or urine tests to find out when she is about to ovulate.
When an egg is mature, the woman may be given an injection of hormones to stimulate the egg’s release from the ovary.
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