IUI is offered as the first line of treatment to couples with unexplained, immunologic, mild male factor infertility as well as to those with early stages of endometriosis. For couples with the above-mentioned problems when the woman is over 40 years of age we recommend standard IVF treatment.
IUI, or intrauterine insemination, is a relatively simple fertility treatment. It may be done with or without fertility drugs. The procedure itself involves transferring specially washed semen directly into the uterus via a thin catheter.
You may know of IUI by the more commonly used term artificial insemination (AI). IUI and AI are one and the same.
INDICATIONS
IUI TREATMENT MAY BE RECOMMENDED FOR ANY OF THE FOLLOWING SITUATIONS:
- Unexplained infertility
- Mild male factor
- Hostile cervical mucus
- Donor semen
- If sexual pain makes intercourse not possible
IUI IS NOT RECOMMENDED FOR THOSE WITH:
- Blocked fallopian tubes
- Severe endometriosis
- Previous pelvic infection
- Severe male factor infertility
TREATMENT CYCLES
Usually fertility drugs are given to patients undergoing IUI cycles to enhance ovulatory process.
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Clomiphene or Letrozole with IUI: IUI may be added to a clomiphene or letrozole treatment cycle.In this situation, as soon as your next period starts, you’ll have an ultrasound and a blood test. Assuming everything looks good, you’ll start taking the oral fertility drugs on the days prescribed. You will have ultrasound monitoring and may need blood work as the cycle progresses.
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Gonadotropins with IUI: Gonadotropins are injectable fertility drugs, including FSH, LH, hMG, and hCG. When you get your period, you’ll visit your doctor to schedule a baseline ultrasound and blood work. You’ll start giving yourself injections according to your doctor’s instructions. Every few days, you’ll have transvaginal ultrasounds and/or blood work.The transvaginal ultrasounds will look for developing follicles. The ultrasound will look to see how many are there, how quickly they are growing, and whether they are nearing maturity.The blood work will measure estradiol (E2), LH, and progesterone.
Your medications may be adjusted based on your hormone levels and the size and number of follicles growing on your ovaries.
When one or more follicles reach maturity, your doctor will schedule a trigger shot of hCG and schedule the IUI procedure.
THE PROCEDURE
The procedure is pretty simple, though it’s normal to feel nervous about it. It will be done in your fertility clinic.Your partner will come into the clinic that day with you and give a semen sample. The semen sample is achieved via masturbation. (Similar to how a semen analysis is done.)
If your partner will be out of town—or, if he had difficulty providing a sample in the past—your partner may provide the semen sample before IUI day. In this case, if the sample is frozen, it will be thawed and prepared
If you’re using a sperm donor, the donor sperm will be thawed and prepared which would be coming from registered semen banks.
Semen contains more than just sperm. Semen is put through a special “washing” procedure. This takes out the impurities and leaves only what’s needed for conception.
For the procedure itself, you will lie down on a gynecological table, similar to the ones used for your exam.
A catheter—a small, thin tube—will be placed in your cervix (mouth of uterus). You may have some mild cramping.
The specially washed semen will then be transferred into your uterus via the catheter.
The catheter is removed, and you’re done!
Your doctor may suggest you remain lying horizontally for a short while after the procedure, or you may be able to get up right away.
In either case, you don’t need to worry about the sperm falling out when you stand up. The sperm are transferred directly into your uterus. They aren’t going anywhere but up, to a (hopefully) waiting egg!
WHAT TO EXPECT POST-PROCEDURE
After the IUI procedure, you may be prescribed progesterone. This is usually taken via a vaginal suppository.
About 14 days post IUI, you would be asked for either home urine pregnancy test or blood test beta hCG for pregnancy.
Waiting to find out if the treatment was successful can be very stressful. Take good care of yourself!
RISKS
- IUI is a relatively low risk procedure.
- There is a very small risk of infection.
- Some of the biggest risks come from the fertility drugs used.
- If you’re using gonadotropins (fertility injections), you may be at risk for developing ovarian hyperstimulation syndrome (OHSS).
- Your risk of conceiving multiples (twins, triplets, or even more) is higher when taking gonadotropins. This is why monitoring is important.
- If there are too many potential follicles, the cycle may be cancelled and tried again another time.
- If your doctor cancels your cycle because there are too many follicles, she will also likely tell you to abstain from sexual intercourse. It is important you take this instruction seriously.
- Some couples are hesitant to “throw away” the cycle. However, if you have sex and conceive, you put yourself and your future babies at risk. Don’t do it.
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