IUI for Male Factor Infertility: When It Works and What to Expect

Trying to have a baby can feel overwhelming, especially when male factor infertility is part of the challenge. You might be wondering: Will IUI work for us? What do these sperm analysis numbers really mean?

If you're exploring IUI as a treatment for male factor infertility, understanding how it works, when it's recommended, and what to expect during the treatment process can help both of you move forward with confidence and clarity.

What is IUI?

Intrauterine insemination (IUI) is a fertility treatment where specially prepared sperm is placed directly into your uterus (womb) around the time of ovulation. This treatment helps increase the number of sperm that reach your fallopian tubes, enhancing your chances of fertilisation, especially when you have concerns about sperm quality.

IUI is less invasive and more affordable than other fertility treatments like IVF (in vitro fertilisation). That’s why it’s usually the first-line treatment your doctor suggests if you’re facing mild to moderate fertility challenges.

What is male factor infertility?

Male factor infertility refers to a problem with a man’s sperm that affects the ability to get pregnant. It’s actually more common than you might think – accounting for roughly 30%–50% of all infertility cases.

Your doctor will diagnose the problem through a semen analysis – a straightforward test that evaluates the concentration (number of sperm), motility (movement), and morphology (shape) of your partner’s sperm. 

Common causes of male factor infertility may include:

• Low sperm count (oligospermia)

• Poor sperm motility (asthenozoospermia)

• Abnormal sperm shape (teratozoospermia)

• Obstruction or blockage in the reproductive tract 

• Hormonal imbalances

• Varicocele (enlarged veins in the scrotum) 

• Prior illness, infection, or injury.

If you or your partner are affected by one of these conditions, you’re not alone. With the right treatment, many of these conditions can be identified and accounted for before you begin your fertility journey. Your doctor will work with you to identify the specific cause and explore the right approach for your situation.

Worried that you or your partner might be affected by male factor infertility? Schedule an appointment with Thomson Medical to speak with our fertility specialists who can guide you through the tests and provide advice on your next steps.

Can IUI help with male infertility?

IUI helps by:

• Bypassing cervical mucus, which may restrict sperm movement

• Delivering concentrated, motile sperm closer to the egg 

• Enhancing the odds of fertilisation during the fertile window 

However, if the sperm count is very low or sperm mobility is limited, your doctor may recommend other treatments that offer a higher chance of success, such as IVF with ICSI (intracytoplasmic sperm injection). If this happens to you, don’t worry; your doctor will talk you through every option so you can make the choice that feels right.

What sperm parameters affect IUI success?

Understanding the numbers in your semen analysis might help you and your doctor decide if IUI is right for you. 

Here’s what matters most:

• Total Motile Sperm Count (TMSC):

  • This is the number of moving sperm in the ejaculate after sperm processing.

  • A TMSC of more than 10 million is usually associated with higher IUI success rates, while 5–10 million may still be acceptable and gives reasonable chances. 

  • Below 5 million, the success rate drops significantly. In this case, your doctor might suggest alternative options.

• Sperm motility:

  • This measures the percentage of sperm that are actively moving, especially those swimming forward (called progressive motility). 

  • A motility rate above 32% is usually considered enough for IUI to work.

• Sperm morphology: 

  • This refers to how many sperm have a normal shape. According to the strict Kruger criteria, a morphology of 4% or higher is considered normal. 

  • IUI can still be beneficial if your sperm count and motility are within a healthy range, even if your morphology is a little below normal.

While these numbers give your doctor a clearer picture, they’re not the only factors that matter. Your doctor will help guide you through these tests and explain how they can be used to improve your chances with IUI.

When is IUI recommended for male factor issues?

IUI is a suitable option when your partner is dealing with:

• Mild to moderate low sperm count:

  • Your doctor will look for at least 5 million total motile sperm after processing.

• Reduced motility:

  • Even if motility isn’t perfect, IUI can work as long as there are enough active sperm after preparation.

• Mild morphology issues:

  • If sperm shape is slightly abnormal but your count and motility are within range, IUI is still effective.

• Situational issues:

  • IUI can help overcome difficulty with ejaculation or retrograde ejaculation.

• Borderline sperm abnormalities: 

  • If no other causes of infertility have been detected, your doctor will analyse all aspects to determine if IUI is the best first step for you.

Sperm preparation for IUI in male factor infertility

Before your IUI procedure, our doctor will prepare the semen sample through a process called sperm preparation or sperm washing. This step is especially important for male factor infertility because it isolates and concentrates the healthiest and most active sperm. 

The two most popular methods your doctor may use are:

• Swim-up method:

  • This technique depends on the sperm’s natural ability to swim upwards into a nutrient-rich medium, allowing your doctor to collect the most active ones.

• Density gradient centrifugation:

  • Your doctor layers the semen over special solutions and spins it in a machine (centrifuge). This separates the sperm by quality, and your doctor will collect the best ones from the bottom layers.

During preparation, your doctor removes dead sperm, debris, white blood cells, and chemicals (prostaglandins) from the semen that could cause uterine cramping or inflammation. The result will be a small sample of the healthiest and most active sperm that is ready for your IUI procedure.

IUI and male infertility: What to expect

If you and your partner are pursuing IUI due to male factor infertility, here’s what the process looks like:

• Initial evaluation:

  • Your partner undergoes a semen analysis, and your doctor will examine your ovulation and uterine health. 

  • Blood tests, pelvic ultrasounds, and cycle tracking may also be done.

• Cycle monitoring:

  • Your ovulation is tracked with urine LH kits, blood hormone levels, or an ultrasound. 

  • In some cases, you may get medication, such as clomiphene or letrozole, to stimulate ovulation and increase the chances of releasing a healthy egg.

• Sperm collection:

  • On the day of the IUI procedure, your partner will provide a semen sample through masturbation after 2–5 days of abstinence. Your doctor will ensure your partner’s privacy during the process.

  • If you use frozen or donated sperm, the sample is thawed and prepared in the lab.

• Sperm processing:

  • Your fertility specialist will wash and concentrate the sample to get the healthiest sperm.

• IUI procedure:

  • Your doctor inserts a small and flexible tube into your uterus and injects the prepared sperm.

  • The procedure takes about 5–10 minutes, and you won't need anaesthesia. It's usually painless, though you might feel a bit of pressure or discomfort. After that, your doctor may ask you to rest before leaving.

• Post-IUI:

  • You can go back to your normal activities right away. A pregnancy test is usually done 14 days later to determine if the cycle was successful.

  • It's completely normal to feel anxious during the two-week wait. Remember, you don’t need to go through this experience alone. Your doctor understands and is always available whenever you need support.

If you have any concerns about the procedure, don't hesitate to talk to your doctor. They'll make sure all your questions are answered and that you feel comfortable moving forward.

If you're concerned about male factor infertility or wondering whether IUI is right for you, schedule an appointment with Thomson Medical. Our fertility specialists will assess your specific situation, discuss your options, and create a personalised treatment plan that can help improve your chance of success.

FAQ

Is IUI effective for male factor infertility and low sperm count?

What is the success rate of IUI for male factor infertility?

Is IUI or IVF better for male infertility?

What is the best treatment for male factor infertility?

Can male factor infertility be cured?

Is donor sperm recommended for severe male factor infertility?

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice based on your unique situations, please consult a specialist at Thomson Medical. Request an appointment with Thomson Medical today.