IUI is often a “first line” treatment if you have
male factor,
or unexplained infertility. This is “couple specific” and depends upon many factors including age, cause(s) of infertility, previous treatments, and others. IUI cycles are usually “stimulated” meaning
ovulation induction drugs ,are employed.
In the past, OB/GYN’s often administered IUI with
Clomid. Most now refer patients to a specialist because of the complexities of monitoring, including monitoring for injectable gonadotropins, with dosage adjustments, and potential side effects. In fact, most high order (>2) multiple births come from IUI cycles and great care must be taken to minimize this risk and the risk of ovarian hyperstimulation syndrome. Specialists undergo years of advanced training in the safe use of ovulation induction drugs.
If you are undergoing an IUI cycle, you will administer subcutaneous gonadotropin injections during your ovulatory cycle. The amount and times of your FSH injections, and other medications, depends upon your “patient specific” protocol.
Injections of gonadotropins augment your natural follicle-stimulating hormone (FSH) production and cause your ovaries to “recruit” more follicles, each of which contains an egg. FSH supports follicles as they develop during the ovulatory cycle.
Your cycle will be monitored using estradiol hormone measurements and ultrasound. As healthy eggs develop, they produce increasing amounts of estrogen and the follicles can be visualized on
ultrasound.
In a normal cycle, the body produces a surge of leutinizing hormone (LH), which initiates ovulation. In a stimulated IUI cycle, ovulation is induced by an injection of human chorionic gonadotropin (hCG), which is a longer acting version of LH. The insemination is scheduled for 36 hours later, close to the time of ovulation.
If you are using your partner’s sperm, he will provide a semen sample on the day of the insemination that is washed and specially prepared by our andrologists. “Unwashed” sperm is not introduced into the uterus as allergic reactions can result. The prepared sperm are introduced directly into the uterus using a small catheter in a brief, relatively painless procedure. Depending upon your protocol, you may also receive progesterone.
If you are using a donor’s sperm, the frozen sample will be available on the day of your insemination. All of our sperm donors are carefully screened for sexually transmitted diseases, and for familial or genetic diseases, mental health problems, and for general medical health. Since the test for the AIDS virus often does not turn positive until one to three months after a person is infected, all donor semen is frozen and stored for at least six months. The donor is then re-tested for the AIDS virus. If he is still negative, the semen is released for use.
When you are undergoing intrauterine insemination, please follow these instructions.
- You need to purchase an ovulation predictor kit. Although a number of kits are commercially available, we recommend Clear Plan Easy. This particular kit is simple, accurate, and takes less than five minutes to perform the test.
- On cycle day 10, call your nurse in Birmingham at 1-800-282-1847 or 1-205-801-8225. She will review your instructions, answer any questions you have, and let you know how to contact someone should you detect an LH surge over a weekend. You must contact your nurse on day 10 of every insemination cycle. If day 10 falls on a weekend or holiday, call the day before.
- You will also begin testing your urine on day 10. It is very important that you test your urine between 11:00 am and 2:00 pm. Although this may seem inconvenient, it is the most accurate time to detect the beginning of the LH surge.
- On the day of the LH surge, call your nurse by 3:00 pm to schedule your intrauterine insemination (IUI). Unfortunately, we will not be able to do your insemination if you do not contact us by 3:00 pm. Abstain from intercourse that day.
- On the day of your insemination, your husband must collect his sample in our office or personally bring his sample in with him. We do not allow the wife to bring the sample in for him. He must show a government-issued photo ID (such as a driver's license) and sign the laboratory request form.
- Processing the semen sample will take one to two hours. When the sample is ready, you will be required to pay the $220 fee prior to the procedure. If you are using donor sperm you will be required to pay $395 before the procedure. The nurse will then will request to see your government-issued photo identification, show you the labeled vial of processed sperm, and ask you to initial that you correctly identified the sample. She will give you information about the results of your husband's semen analysis at that time.
The insemination is relatively painless and will be performed by a nurse. The procedure itself takes about 5 minutes, and then you will be asked to lie down for 10 minutes after the insemination.
- One week after your first IUI, your physician might measure a serum progesterone level. You may have this blood test performed in Birmingham, or we will make arrangements to have the test done locally. This test is not necessary if you are taking gonadotropin injections.
- Your doctor will want to see you 1 to 2 weeks after your first insemination to review your cycle with you and make recommendations for further evaluation and treatment.
Per cycle success rates using IUI are similar to those for reproductively healthy couples, approximately 10-15%. IVF success rates are higher, but the number of cycle attempts is often limited by cost. Depending upon numerous patient specific variables, if you are not pregnant after 4 IUI cycle attempts, IVF is the next option.
If you have any questions, please do not hesitate to contact our office.