Intravaginal, Intracervical and Intratubal Insemination

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Insemination refers to the placement of sperm in a woman’s reproductive tract, with the aim to cause pregnancy. Insemination needs to take place during the woman’s most fertile time, about 24 to 48 hours before ovulation is expected.

Usually, when people talk about artificial insemination, they are referring to IUI or intrauterine insemination. IUI is a fertility treatment that involves taking specially washed semen, and transferring the semen into the woman’s uterus using a special syringe.

While IUI is the most common form of artificial insemination, there are other methods of transferring sperm to a woman’s reproductive system.

Intravaginal Insemination (IVI)

Intravaginal insemination (IVI) is the simplest kind of insemination and involves the placement of sperm into the woman’s vagina. It’s pretty much what happens during sexual intercourse in terms of placement of sperm.

This method of insemination may be used when using donor sperm, and when there are no problems with the woman’s fertility.

Because success rates are lower than IUI, this form of insemination isn’t common but is more common with “home insemination” treatments. Home insemination may be used by lesbian couples, wanting to get pregnant using purchased donor sperm or sperm provided by a friend. It may also be used for women who experience pain during sexual intercourse.

Intracervical Insemination (ICI)

Ideally, sperm should be placed as close to the cervix as possible. With intracervical insemination (ICI), the sperm is placed directly inside the cervix, using a needless syringe.

The sperm does not need to be washed, as with IUI, because the semen is not being directly placed inside the uterus. However, it may be pre-washed to increase the chances of success.

Intracervical insemination is more common than IVI but less common than IUI. It may be used if a couple wants to save money on the treatment procedure, as ICI is less expensive than IUI, especially if the semen is not pre-washed.

ICI is less expensive than IUI. But how do the success rates looks? A large metaanalysis looked at IUI compared to ICI, when women were using donor sperm. They didn’t find enough evidence to say one method was more likely to lead to a live birth than another.

Intratubal Insemination (ITI)

Intratubal insemination involves the placement of pre-washed sperm directly into the woman’s fallopian tube. This is also sometimes referred to as “fallopian tube sperm perfusion.” The sperm may be transferred to the tubes through a special catheter that goes through the cervix, up through the uterus, and into the fallopian tubes. The other method of intratubal insemination involves laparoscopic surgery.

Unfortunately, intratubal insemination has been associated with greater risk for infection and trauma, and there’s a debate on whether it’s more effective than regular IUI.

Because of its invasive nature, higher expense, and uncertain success rate, it’s rarely performed and is the least common form of artificial insemination.

How Do You Decide Which Form of Insemination to Use?

To say one form of insemination is always better than another is inaccurate. It depends on the reasons for using insemination in the first place.

IUI is the most expensive form of insemination, because semen requires a special washing procedure. IUI also must be done in a fertility clinic. An “at-home” IUI is not possible.

IUI could be the better option when treating unexplained infertility or infertility that is associated with cervical factors.

IUI may also be the better choice when male infertility is involved. IUI helps sperm get to their primary destination—the fallopian tubes—without needing to travel through as many obstacles (like the vaginal environment and cervix.) If sperm motility or sperm count isn’t normal, this extra boost may help.

On the other hand, if there are no male factor fertility issues and no known cervical issues, intracervical insemination (ICI) or intravaginal insemination (IVI) may be good options. They are less expensive and may be just as effective.

For example, if donor sperm is being used, and there are no female fertility issues, ICI or IVI could work just as well as IUI. This situation could occur if a single woman or a lesbian couple wanted to conceive using donor sperm. This may also occur if a couple has male factor but no female factor fertility issues, and have decided to use donor sperm.

ICI or IVI may be appropriate painful sexual intercourse is the reason for insemination.

However, pain during sex is often (but not always) a sign that something physically is wrong. For example, low estrogen levels can cause pain during sex. Another possible cause could be pelvic inflammatory disease (PID) or endometriosis. In these situations, there could be female fertility issues that remain undiagnosed.

A Word From Verywell

Insemination may be used in cases of male factor infertility, cervical factor infertility, unexplained infertility, or when donor sperm is being used. Donor sperm may be an option when male factor infertility is involved, or it may be chosen when a single woman or lesbian couple want to have a baby.

Many fertility clinic doctors suggest IUI, or intrauterine insemination, by default. This is what they are most used to offering in an infertility setting. But IVI or ICI may be potential options for you, and they cost less. Don’t be afraid to ask your doctor if another form of insemination could be better for you. 

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