Intrauterine Insemination (IUI): Statistic Value, Causes, and Treatment for Infertility

IUI is a simple, cost-effective, noninvasive first-line therapy for cervical factor, anovulatory infertility, moderate male factor, unexplained infertility, and immunological infertility with clinical pregnancy rates ranging from 10 to 20%. Controlled ovarian hyperstimulation with close monitoring of folliculogenesis and ovulation to avoid adverse complications, such as ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies, may be used to obtain an adequate number of follicles. IUI is the preferred conception-enhancing technique for women < 35 years, functional tubes, short period of infertility, and moderate male infertility, particularly in technology-limited settings, and four to six IUI cycles may be performed before considering alternate therapy such as IVF. It is the method of choice versus timed intercourse or natural cycle IUI. 

Moreover, Intrauterine insemination (IUI) is a type of artificial insemination procedure for treatment of infertility. During an IUI procedure, inseminated sperm is placed directly into the uterus using a small catheter. The goal of this treatment is to improve the chances of fertilization by increasing the number of healthy sperm that reach the fallopian tubes when the woman is most fertile. Despite revolutionary advances in the field of assisted reproduction, such as in vitro fertilization (IVF), , and subzonal insemination (SUZI), intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI) remains an inexpensive, noninvasive, and first-line therapy for selected patients with cervical factor, moderate male factor,immunological infertility, unexplained infertility and infertility due to ejaculatory disorders and also as a therapy for endometriosis, ovarian dysfunction, and even for tubal factor. The technique of IUI has essentially remained the same, several advances in the type of stimulation protocols, gonadotropins, sperm preparation techniques, and ultrasound monitoring have led to promising success rates with IUI. 

Let’s talk about the statistic for infertility

According to the Vital Statistics Malaysia 2017 report, the national fertility rate in 2016 is the lowest ever recorded since the formation of Malaysia in 1963, with the fertility rate per woman aged 15 to 49 in 2016 was 1.9 babies, a decrease from 2.0 babies in 2015. The total fertility rate in Malaysia has been below the replacement level of 2.1 babies, which is the average number of babies born per woman throughout her reproductive life has been insufficient to replace herself and her partner.  The World Health Organization estimates that 48 million couples and 186 million individuals worldwide suffer from infertility.  Malaysia does not have official statistics on its infertility rates; our country saw the lowest fertility rate (measured by the number of children born each year) in four decades in 2020 —  1.7 children, compared to in 1970 when the fertility rate was at 4.9 children per woman.  Approximately 37% of infertility results from solely female factors, and 30–40% of infertility is caused by a combination of male and female factors. As such, pregnancy outcomes following IUI depend in part on maternal factors including age, BMI, race/ethnicity and infertility diagnosis. 

What are the possible causes for infertility?

Infertility results from male factors alone approximately 20% of the time although the epidemiological evidence is limited. IUI is an effective treatment for mild male factor infertility. Even when other infertility etiologies are suspected, paternal factors such as total motile count (TMC), post-wash sperm count, and DNA Fragmentation Index (DFI) are important considerations in predicting IUI success rates. Paternal age and BMI may also impact clinical outcomes. However, approximately 37% of infertility results from solely female factors, and 30–40% of infertility is caused by a combination of male and female factors. As such, pregnancy outcomes following IUI depend in part on maternal factors including age, BMI, race/ethnicity and infertility diagnosis. According to different cycle factors, specifically stimulation regimen, use of a trigger, number of cycles and insemination procedure affect pregnancy outcomes.

Who can get the service?

  • Couples who experience infertility due to medical conditions (e.g., endometriosis or low sperm count or quality).
  • Couples with unexplained infertility. 
  • Same-sex female couples using donor sperm.
  • Single women wishing to start a family with donor sperm

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