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Intracervical Insemination: An Introduction to ICI

Intracervical Insemination: An Introduction to ICI

When we think of fertility treatments, most of us probably jump to artificial insemination, IVF, IUI, or maybe even a turkey baster. Few would think of ICI, intracervical insemination, but that is changing. ICI offers similar efficacy rates at a fraction of the cost of in-clinic treatments. Read on to learn how Béa Fertility’s at-home insemination kit is changing the way we approach fertility treatments.

Intracervical insemination (ICI) is a form of artificial insemination that involves keeping semen held against the cervix for an extended amount of time (usually 4-12 hours).

This is usually done using a small silicone cup, something like a menstrual cup (often called a ‘cervical cap’). The cervical cap holds semen in place. This is why you’ll sometimes see ICI – intracervical insemination – referred to as CCI, Cervical Cup Insemination, or Cervical Cap Insemination.

Graph showing the female reproductive system and the placement of a cervical cap

Whatever it’s called, the goal of intracervical insemination is to concentrate semen in the cervical mucus, to increase the number of sperm which make it through and into the uterus, towards the egg.

As fertility treatments go, ICI is natural, non-invasive, and proven through decades of clinical research. Scientific papers and records from physicians show that ICI used to be the de facto clinical treatment from as early as 1940, to around 1980.

What happened to ICI?

In the 1970’s there was a significant technological advancement that allowed scientists to ‘wash’ semen – separating out healthy sperm cells to be injected directly into the uterus. With this technology came IVF and Intrauterine Insemination – IUI – now the most popular fertility treatment worldwide.

ICI involves waiting in the clinic for upwards of 4 hours, until a physician can remove the cervical cap for you. With IUI, you can get up and go. It’s a lot more time efficient, which is good. It’s also a lot more invasive and expensive, which is not so good.

Graph comparing ICI and IUI: ICI is affordable, non-invasive, effective but not time efficient whereas IUI is effective and time efficient..

Efficacy rates

According to a number of studies, the differences in efficacy between ICI and IUI both treatment types, over 3 and 6 cycles, are marginal.

A 2015 study involving 1843 women, each undergoing multiple cycles of either IUI or ICI, found pregnancy rates of 20.1% after 3 cycles in the ICI group, and 22.4% after 3 cycles in the IUI group. The same study found a pregnancy rate of 40.5% after 6 cycles in the IUI group, and 37.9% after 6 cycles in the ICI group.

Visualisation of efficacy comparison of IUI and ICI. Both are approximately 20% atfter 3 cycles and both are approximately 30% after 6 cycles, in both cases IUI is around 3 per cent higher.

Affordability

Over 3 cycles, IUI has shown to be 2.3% more effective than ICI. This 2.3% gain in effectiveness will cost more than 4x what you might have paid for ICI. London clinics will offer a single round of IUI for £800-£1500. The increase in efficacy does not correlate to the significant increase in treatment cost.

When it comes to conception, cumulative success rates are the key to success. The lower cost of ICI, reduces the financial restrictions that often prevent those trying to conceive from accessing multiple cycles of treatment.

Put simply: lower cost = more cycles and a higher chance of success.

Visualization of the cost comparison of IUI and ICI. Tex reads "The cost of IUI is approximately 4 times the cost of ICI."

The true power of fertility treatments comes from cumulative success rates: the longer you try for, the higher the chance of success.

A visualization of average cumulative success of IVF, IUI and ICI over 1, 3 and 6 cycles. IVF after 1 cycle is 25-30%, 3 cycles is 45-53% and 6 cycles is 65%. IUI after 1 cycle is n/a, 3 cycles is 22.4% and 6 cycles is 40.5%. ICI after 1 cycle is n/a, 3 cycles is 20.1% and 6 cycles is 37.9%.

This sounds obvious, but the economics of this break down when each IVF treatment round costs well over £3000 – very few people can afford multiple rounds of fertility treatment. Today, the average spend per couple on treatment in the UK is £12,000. The average spend on fertility treatment in the US is $61,000 per couple. That kind of expense is beyond the reach of most. It is simply not fair, and this is why we need to bring affordable, gateway treatments into the market so people can take advantage of cumulative success rates without breaking the bank on IUI and IVF.

Visualisation of cost vs efficacy of intracervical insemiantion, IUI and IVF. ICI is around 38% for approximately £1500, IUI is around 41% for approximately £6,000-£7,000 and IVF is around 50% for approximately £8,000.

Wait a second, isn’t this just the syringe method?

The syringe or straw method of insemination is not the same as intracervical insemination. You’ll sometimes hear people talking about ‘intracervical insemination by straw’, ‘syringe insemination’ or the ‘syringe method’.

ICI mechanically holds semen against the cervix for extended periods of time, whereas the straw or syringe method injects semen into the vagina, essentially mimicking intercourse.

Can you get pregnant if you inject sperm with a syringe?

In one study comparing syringe insemination with cervical cap insemination, the pregnancy rate in the straw insemination group was 5.9% after one cycle. The pregnancy rate in the cervical cap insemination group was 15.2%. Nearly three times higher.

Image of two sperm

How can I access ICI at home?

We are developing the first complete, clinical grade, at-home ICI kit in the UK. In each kit, you’ll get 2x insemination devices, which will help you easily place a cervical cap to perform ICI at home. You’ll also get LH (ovulation) tests, hCG (pregnancy) tests, and everything you need to support you on your conception journey.

To get notified when the kit launches, sign up to our mailing list.