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What's the Difference Between IUI and ICI?

The world of fertility is full of acronyms – but IUI and ICI are two that often get confused. IUI (Intrauterine insemination) and ICI (Intracervical insemination) are both kinds of artificial insemination. These two different types have key differences, including the type of sperm you can use for each procedure and in this blog we’ll tell you all you need to know about both of them!


Reasons for artificial insemination

Firstly, let’s understand what this fertility treatment is and whether it’s the right route for you. Artificial insemination is essentially when a fertility doctor takes over the role the penis plays in natural conception. They use a syringe to insert sperm (either donor sperm or the sperm of a partner) directly into the female partner. This can be in to their cervix (ICI) or Uterus (IUI).

Artificial insemination can be a useful form of fertility treatment for various reasons. You might be in a same-sex couple and be using donor sperm (if neither of you can produce sperm) – or a surrogate (if neither of you can carry a pregnancy).

You could also be in a heterosexual couple and be having issues conceiving naturally. Artificial insemination can be helpful for couples with both female and male factor fertility problems or specific issues including semen allergy or if there are reasons why penetrative vaginal sex is difficult or impossible.

Artificial insemination tends to be a more affordable form of assisted fertility treatment, which is why some couples prefer to try it before going straight to IVF or ICSI. For same-sex couples, some CCGs require a certain amount of artificial insemination attempts before they will fund IVF on the NHS.


What is Intrauterine Insemination?

IUI is the process where sperm is inserted directly into the uterus. This process can be very helpful if sperm motility is the problem – or if there are issues connected to the cervix. By inserting the sperm sample directly into the uterus, you bring it a lot closer to the egg and increase your chances of conceiving! Just like with conceiving naturally, the best way to improve the success rate of IUI is to ensure that the procedure takes place within the fertile window. In some cases, especially if there are female infertility factors at play, you will be offered stimulating medications like Clomiphene (Clomid) tablets or hormone (FSH) injection to help stimulate ovulation. Whether you have a natural cycle or a stimulated cycle, the process of IUI is quite complicated and must be done by a trained medical professional.


What sperm do you need for IUI?

For IUI you need to use washed sperm – and we don’t just mean it needs to be squeaky clean. The process of washing sperm separates the sperm cells from the semen. This is important for IUI because the sample is going directly into the uterus. During sex, the semen from an ejaculate goes through a sort of filtering process as it makes its way to the uterus. With IUI this process doesn;t happen and there can be elements of an unwashed semen sample that can cause complications and health issues in the uterus.

If you’re ordering donor sperm, sometimes your clinic might ask you to order a vial of unwashed sperm and then they will prepare it (wash it) themselves before your procedure.

Sperm washing can also be useful if there are things in your sperm you don’t want to pass on to your children, including viruses like HIV. If you need to have washed sperm for this reason.

Whilst IUI can help with some male factor fertility problems, you still need a fairly healthy sample for it to be successful. After washing, fertility experts believe there should be at least 5 million motile sperm in the sample for the IUI to be successful.


What is Intracervical Insemination?

Intracervical insemination (ICI) is when sperm is inserted into the cervix, rather than the uterus. This is very similar to the process of conceiving naturally, however most research indicates that ICI does have a better chance of a successful pregnancy compared to timed sex.

Because the sperm still has quite a long way to go from the cervix, ICI is not particularly helpful for people with male factor fertility issues. However, it can be a great option for people using healthy donor sperm, or if vaginal sex is not possible. It is also one of the cheapest options for fertility treatment, so can be a good place to start on your assisted fertility journey.

ICI can technically be done in a clinic or at home by a medical professional, or you can even attempt it at home by yourself. A 1988 study found that there was no significant increase in success rates when looking at at-home insemination vs in a clinic. Like IUI, you will want to time the ICI procedure around the fertile window and again, you can have either a natural or stimulated cycle.


What sperm do you need for ICI?

For ICI you can technically use washed or unwashed sperm, but many people prefer to use unwashed – as it’s believed the seminal fluid helps the sperm cells travel up the cervix more effectively. When you are purchasing sperm from a sperm bank, most banks will offer both unwashed and washed sperm samples.

If you decide to use unwashed sperm – and are using your own sample rather than a donor’s – it can be helpful to test your sperm quality beforehand. Then, if your sperm health is good, ICI could be successful for you, but if not you may want to consider another route.

If you are keen to keep costs down and avoid trips to the fertility clinic, our at-home sperm testing kit can help you understand your Total Motile Sperm count and your overall sperm health. You can learn more about our at-home sperm testing kit here.

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