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Intrauterine Insemination (IUI)

 
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What is IUI?

Intrauterine insemination (IUI) involves inserting the male partner’s (or donor’s) prepared semen through the neck of the womb (cervix) and into the uterus, close to the time of ovulation. It is a simpler, less invasive form of fertility treatment. Intrauterine Insemination (IUI) can be indicated in many situations, for example, if the female carries a lot of sperm antibodies in herself or what is more common, if the condition of low-quality sperm or a low number of sperm cells exist. Couples trying to conceive for a very long time with obviously no success and who then have the problem of unexplained infertility may choose this option as well.

IUI Procedure

Step 1 : Ovarian stimulation

Oral medications: a typical treatment cycle begins with an ultrasound and blood work on the third day of the menstrual cycle. Clomiphene (Clomid) and letrozole (Femara) are oral medications taken between days three and seven of your cycle. A transvaginal ultrasound will be performed on day 10 or 11 (from start taking the medicine) to check for egg development. In the ovaries, each egg is contained within a follicle, or fluid-filled sac, that can be visualized by ultrasound. 

Injectable medications: If oral medications are unsuccessful, injectable medications such as a follicle-stimulating hormone (FSH) are typically the next step. Injectable medications are started on day three or menstruation or added after day 5 of oral medication and are continued for 5 to 10 days, depending on response.

Once the lead follicles measure at least 16 to 18 millimeters in diameter, you will be instructed to take an injection of human chorionic gonadotropin (hCG) which can be injected by a woman when the oocytes developing in her ovaries are mature enough to be released. Ovulation will occur approximately 36 hours later. IUI will be performed around 42 hr after the triggered ovulation according to the timing of oocytes moving to the uterine tubes at the insemination time.

Step 2 : Sperm collection for IUI

The semen sample is collected through ejaculation into a sterile collection cup that we provide in our clinic. The specimen is usually collected in the office in a specially designated private room. The man’s partner may be in the room to help him collect. Occasionally, a man will for several reasons, be unable to collect a sperm specimen in the clinic, even in the special room. In those situations, we will let him collect at home or hotel and bring the specimen within a half hour or so and it should be kept warm.

We will schedule the male for collection approximately 2-3 hours before we schedule the woman for the IUI. This allows time for the sperm to liquefy in our incubator and time for preparation for the IUI.

Step 3 : IUI Procedure 

When the woman arrives at our clinic, she is taken to a procedure room and she undresses from the waist down. She will lie down on an examination table and cover herself with a drape sheet. She will place her legs in stirrups and a speculum is inserted into the vagina. This is the same process she would go through if she were having a pap smear. The physician draws the prepared sperm specimen into a catheter attached to a syringe. The catheter tip is threaded through the vagina and cervix and into the uterus. The plunger on the syringe is pressed and this causes the sperm specimen to flow through the catheter into the uterus. The catheter is then withdrawn and the speculum removed. Then, the patients remove their legs from the stirrups and relax.

After the intrauterine insemination is completed, the patient will bed rest on the bed for 15-20 min. Then the patient can get dressed and resume normal activities that she likes for the rest of that day.

Step 4 : Instructions for after the IUI

As indicated above, there is little that a woman might do after an IUI that will influence the chance for achieving pregnancy. You can return to work or exercise if you like. It is okay for a couple to have intercourse at any point after an IUI is performed. In fact, for men who have very low sperm counts, having intercourse in addition to the IUI on day1 after IUI will increase the total amount of sperm in the uterus and may improve the chance for pregnancy. 

Step 5 : Pregnancy test and success rate

Blood tests can detect a positive pregnancy result 14 days post-IUI procedure. In fact, blood tests are significantly more accurate than a home test. A false negative on home tests are not uncommon. If the blood test is a positive result take another test in a week — hCG levels double about every two days.

Here are the chances of pregnancy after one IUI cycle, by age:

  • Under 35: 10 to 20 percent chance of pregnancy

  • Between 35 and 40: 10 percent chance

  • Women 40 and above: 2 to 5 percent chance
     

The good news is that most people that try IUI will have a good chance of becoming pregnant over time. However, you may need to be willing to try IUI multiple times. It may take between 3 to 6 IUI cycles before pregnancy occurs. If you have tried IUI for 3 to 6 cycles and have not gotten pregnant yet, it is time to discuss other options with a fertility specialist (reproductive endocrinologist).

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