After a full examination and elimination of external factors that would make fertility difficult the doctor may suggest IUI (intra uterine insemination). Generally IUI is only indicated in one or more of the following cases:
An unsuccessful course of ovulation induction
Advanced maternal age
In the aforementioned cases, conception may be hindered by the inability of sperm to make the journey from the vagina to the fallopian tubes. IUI aims to deliver healthy sperm as near to the fallopian tubes as possible immediately prior to ovulation.
IUI begins with the collection of a semen sample and its delivery to the laboratory. There, the sample undergoes processing by centrifuge to obtain the optimal concentration of healthy sperm. In the doctor's office, the concentrate is injected via catheter through the vagina directly into the uterus.
The odds of success are reported to fall in the range of just under 6 percent to as high as 26 percent per cycle. The overall success rate seems to be between 15-20 percent per cycle.
See the article on semen collection and its halachic issues.
Timing of IUI
There is a difference of opinion among halachic authorities as to the permissibility of performing IUI while the woman is a niddah. While all authorities agree that a woman is prohibited from intercourse while she is a niddah, they disagree as to whether the prohibition extends to include conception.
In cases where the medical indication suggests an IUI prior to mikveh immersion, consult your Puah counsellor or Rabbinic advisor.
IUI & Niddah
IUI does not generally cause uterine bleeding. As such, the woman should not become niddah as a result of this procedure. Any mild bleeding that does occur is usually the result of the instrument used to hold the cervix open.
Rare cases of significant bleeding may occur. This may be uterine bleeding (which will render a woman niddah). In such cases consult your Puah counsellor or Rabbinic advisor.
If the IUI was performed when the woman was niddah (see halachic discussion above) consult your Puah counsellor or Rabbinic advisor as to how to proceed with the calculation of the seven clean days.
It is essential to have the process supervised. IUI supervision begins with the delivery of the sperm sample to the laboratory. As noted in the discussion of supervision, supervision should be scheduled as early as possible.