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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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Wearing tight pants and underwear

Studies show that men who wear looser underwear have higher sperm concentration and total sperm count compared to men who wear tighter underwear. So, lose the tight clothes and wear something loose to give your testicles some air.

CONCLUSION: learn more about how heat can affect sperm quality here.

Stress

Besides higher mortality rate and various diseases, stress is associated with low sperm quality. Stress is known to be associated with lower testosterone levels and oxidative stress with both playing an essential role in producing and maintaining healthy sperm cells.

CONCLUSION: If you feel stressed, we recommend you get some help so you can have a balanced mental health. For a stress management guide, download the ExSeed app for free and start your personalized action plan today.

Physical activity

Scientific studies show that men who are physically active have better semen parameters than men who are inactive. Fertility specialists also state that regular physical activity has beneficial impact on sperm fertility parameters and such a lifestyle can enhance the fertility status of men.

Prioritizing exercise can help improve your overall health and result in healthy, fast swimming sperm cells that have good chances of fertilizing an egg.

CONCLUSION: Try incorporating exercise in your weekly schedule to you ensure exercising at least twice weekly. We recommend a combination of cardio training and strength exercise. Read more about exercise and male fertility on our blog.

Nutrition

Fast Food
Processed foods damage the health of sperm-producing cells and cause oxidative stress, which lead to poorer sperm quality. Heavy consumption of junk food (every week) can increase the likelihood of infertility since men who consume vast amounts of unhealthy food are at risk of having poor sperm quality. Besides harming your fertility, junk food enlarges your waistline, harms your cardiovascular system, kidneys, and more.

Vegetables
Eating more fruit and vegetables can increase your sperm concentration and motility. It’s important that you consume a healthy diet filled with antioxidants and that you eat vegetables every day. Foods such as apricots and red bell peppers are high in vitamin A, which improves male fertility by nurturing healthier sperm. Men who are deficient in this vitamin tend to have slow and sluggish sperm.

Sugary snacks/beverages: several times a week Excessive consumption of high sugar items can lead to oxidative stress, which negatively impacts testosterone levels and sperm motility. Sugary snacks and beverages are also highly associated with obesity and low fertility.
CONCLUSION: To boost sperm quality, stay away from fast food, processed food, and sugary snacks or beverages. You need to implement a healthy prudent diet filled with necessary superfoods needed for good sperm production. Check out our guide to Male Fertility Superfoods. For personalized guidance and support on how you can start improving your sperm health, check out the Bootcamp.

Heat

Direct heat can inhibit optimal sperm production and cause Sperm DNA damage. Sperm cells like environments that are a couple of degrees lower than body temperature. Avoid overheating from warm blankets, seat warmers, heat from your laptop, hot showers, and saunas.

Cigarette smoking

The exposure to tobacco smoke has significant negative effects on semen quality. The damage of cigarettes and nicotine of course depends on how many cigarettes you smoke per day and for how long, but even low usage (up to 10 cigarettes / day) can inhibit healthy sperm production.  

CONCLUSION: Stay as far away from cigarette smoking as possible if you care about your general health and your fertility. Read more here.

Cell phone

When you have your cell phone in your front pocket, your testicles are exposed to electromagnetic radiation, which studies have shown to damage the sperm cells. Put your phone in the back pocket of your pants or in your jacket pocket.

BMI

There is a clear association between obesity and reduced sperm quality. At least part of the reason for this is that obese men may have abnormal reproductive hormonal profiles, which can impair sperm production and lead to infertility. 

A BMI higher than 30 can lead to several processes in the body (overheating, increase in oxidative stress in the testes, sperm DNA damage, erectile dysfunction) that can have a negative impact on male fertility. This can result in problems when trying to conceive.  

CONCLUSION: BMI is one of the risk factors that influence semen quality and, for example, sperm motility.  

Alcohol

A beer or glass of wine now and then do not really harm sperm quality. But excess alcohol drinking (more than 20 units per week) can reduce the production of normally formed sperm needed for a successful pregnancy.

CONCLUSION: If you want to stay safe, stay under 14 units of alcohol per week. For more information on how alcohol can affect male fertility, take a look at our blog: “Alcohol and Sperm Quality”.

Age

Studies show that women younger than 35 and men younger than 40 have a better chance of getting pregnant. Men can produce sperm cells almost through their entire life, but the sperm cell DNA is more fragile and prone to damage after the age of 40.

As men age, their testes tend to get smaller and softer resulting in a decline in sperm quality and production. These changes are partly because of an age-related decrease in testosterone level, which plays a very important role in sperm

production. Higher male age (>40 years) is not only associated with a decline in sperm production but also with increased sperm DNA fragmentation and worsened morphology (shape) and motility (movement). These negative effects make the sperm cells less qualified for egg fertilization.

CONCLUSION: with an age under 40, you shouldn’t have to worry much about age as a factor in itself. However, studies have shown a slow decline after the age of 30-35 years

and if you are above 40 years of age, your sperm quality can be affected due to increased sperm DNA damage resulting in a decrease of sperm motility and concentration. Remember that you cannot evaluate the quality of a sperm sample by just looking at it – this requires a sperm analysis.