Intrauterine insemination (IUI) is the process of injecting concentrated sperm directly into the uterus at the time of ovulation. The use of clomiphene citrate or injectable medications, called gonadotropins, combined with IUI, increases the chance of conception. We time the intrauterine insemination with the use of ovulation predictor kits or with an ultrasound. This is an important aspect of treatment because it enables us to predict ovulation before it occurs.
How do I prepare for an IUI cycle?
Prior to beginning an IUI cycle, you will need to have had a basic fertility workup, including lab work, semen analysis and an HSG to be sure your fallopian tubes are open. You will be asked to call the office on day 1 or 2 of your menstrual cycle, and depending on the type of medication to be used, you may need an ultrasound. Medications will be prescribed and you will be advised when you need to schedule an appointment. Please check your calendar to make sure you and your partner will be in town and available during the treatment process. Our nurse will help you determine which days it will be necessary for you to come into the office.
What is the process of intrauterine insemination?
The sperm can be collected at home and brought within 45 minutes to our office. Our lab will then prepare the sperm for insemination and perform a sperm count and motility evaluation. Using a small catheter, the sperm concentrate is then placed into the uterus through the cervix. In the majority of cases, IUI is a completely painless process. Some inseminations are accompanied by cramping, but this is usually very mild and transient. It is necessary to remain lying down for approximately 10 minutes after which time you can resume your usual activities. Couples are encouraged to have intercourse later in the day or evening of insemination to further increase chances for conception.
How do you assess ovulation after treatment?
Progesterone blood testing is performed during the first cycle of treatment to verify ovulation. This occurs approximately 7 days following the insemination and will be scheduled by our nurse. If you have not started your period 14-16 days after the IUI, please do a home pregnancy test and call the nurse with the results.
What is the probability of pregnancy with IUI?
With natural conception in couples without fertility issues, the probability of achieving a pregnancy in any given cycle is approximately 15-20%. In couples undergoing infertility treatment, the chances of pregnancy vary depending on the individual fertility problems and type of medication used. IUI increases pregnancy rates by controlling the timing of exposure of the eggs to sperm and by increasing the numbers of sperm that reach proximity to the egg. Fertility medications increase the probability of pregnancy by increasing the number of follicles on the ovary. In general, the pregnancy rate with clomid is 6-8% per month. Injectable gonadotropins 15-20%. So gonadotropins with IUI can raise the pregnancy rate to the level experienced by couples without fertility problems. We therefore typically recommend that a couple undergo at least 3 cycles of treatment before we can evaluate the effectiveness of the therapy.
How many treatment cycles will be needed?
Some couples conceive with only 1 or 2 treatment cycles. If no conception occurs after 3 cycles, an appointment is made to discuss other treatment options. We understand that there is a certain physical and emotional toll that fertility treatment takes on patients, and we prefer not to continue with a plan that has been unsuccessful after 3 attempts. We will review your response to what has been done and make recommendations as to what should be the next step. Some treatments have a higher probability of success but require more time, effort and cost, so these factors must be taken into consideration in helping you decide on a new plan.
What is the risk from an IUI?
The main risk for IUI is the risk of multiple gestations, especially those which are high-order multiple (triplets or more). The probability of multiples depends on the type of medications you are taking. For example, the risk of multiples with clomid is 6-8%, however, with injectable gonadotropins the risk increased to 15-20%. Your physician will discuss these risks with you prior to beginning a treatment cycle. However, it is important to note that physicians do not have absolute control over how many eggs are released at the time of ovulation and how many of those eggs are fertilized.
Physicians at Fertility Specialists of Texas try to strike the right balance between good pregnancy chance and a low risk for multiple gestations, but even in best of hands, high-order multiples will happen. With this in mind, the number of IUI cycles worldwide has decreased while the number of IVF cycles has increased worldwide in an attempt to decrease the risk of multiple gestations since the risk of multiples with IVF is far less than that for IUI.
Multiples, especially high-order multiples, carry an elevated risk especially premature delivery. Our goal is to achieve pregnancy with as low a risk as possible to mother and newborn child.
Should I choose IUI or IVF?
For many fertility patients, IUI is the gateway to infertility treatment. IUI can be the first treatment option if:
- The female partner is young — under age 35
- Ovarian reserve is normal for your age
- Fallopian tubes have been documented to be patent bilaterally
IVF is more reasonable if:
- The female partner is over age 35
- Ovarian reserve is low (indicated by high FSH and/or low AMH)
- Cause of your infertility is a severe male factor
- History is consistent with tubal disease
For example, in severe male-factor infertility, IUI may not allow for fertilization because the sperm concentration is too low. Through IVF sperm can be microsurgically injected into the eggs, in a procedure called intracytoplasmic sperm injection (ICSI). Even when there is no sperm in the ejaculate, in about 80-85% of cases, a urologist can extract sperm from the testicles, which can then be used in ICSI (but not in IUI). Our team of physicians work closely with urologists in North Texas to facilitate this procedure which requires detailed coordination during the IVF process. For couples with severe male-factor infertility, IVF combined with ICSI is often a better (and sometimes the only) option.
Is IUI less costly than IVF?
Many patients choose IUI over IVF, thinking that IUI is more cost-effective than IVF. Insurance policies tend to offer more generous coverage for IUI than IVF, for the same reason. Although IUI cycles, indeed, are less costly on a per-cycle basis, IUI cycles may be less cost-effective overall, because of IUI’s much lower pregnancy rates. Indeed, a number of recent studies concluded that, at least in many patients, going straight to IVF, skipping the interim step of up to 3 IUI cycles that may be used to attempt pregnancy beforehand, represents a more cost-effective approach.
Is IUI less invasive than IVF?
There are a lot of fears circulating when it comes to IVF. One important aspect that concerned patients often overlook is that at least once they reach ovarian stimulation with gonadotropins, IUI and IVF cycles are very similar: Both require daily self-injections; both require monitoring with ultrasound and blood testing; both take between 2-4 weeks. It is true that higher doses of medication are used for IVF than IUI and the ovaries are stimulated to be larger from more dominant follicles with IVF compared to IUI, but the main difference is that the IVF cycle requires egg retrieval under intravenous sedation.
Egg retrieval is a minor surgical procedure. While performed while the patient is asleep (IV sedation administered by an anesthesiologist), egg retrieval involves no incisions. Egg retrieval involves the aspiration of follicles through the vagina with a long needle using ultrasound guidance.
Number of IUIs per cycle:
There may be a higher pregnancy rate with more than one IUI per cycle. We suggest starting out with 1 insemination. If you fail to conceive after 2 or 3 treatment cycles we can go to 2 inseminations – or – if you prefer we can start with 2 inseminations. If you are using a predictor kit, the inseminations are done on the first day of kit change and the following day. If you are being treated with drug therapy, we will instruct you about IUI timing.
IUI is recommended for the following problems:
- Ovulation problems
- Mild male factor infertility
- Unexplained infertility
- Failed treatment with clomiphene without inseminations
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For the Husband
We realize that producing a sperm specimen may be difficult due to the environment. We have collection suites that are quiet and have photographic materials to assist in our Frisco and Dallas offices. If you prefer to collect at home (or somewhere else) – that is possible. Collection kits are available at our office and must be used to collect the sample. The sample is preferred to be collected exclusively by masturbation (not interrupted intercourse). If you collect at home the specimen must be delivered to the lab within 45 minutes and must be kept at body temperature (placed between legs or held in hands, etc.). If the only possible way to collect is through interrupted intercourse, the lab can provide you with a special condom for this purpose. However, it is more difficult for the lab to work with a sample from a condom. If you are planning to collect at the office, the personnel at the desk should know that you have an appointment for sperm collection and you should simply need to say your name and not need to announce why you are here.
After sample collection, you will be asked to provide several pieces of information to ensure that your sample is correctly identified and processed by the laboratory:
First , fill out the provided sticky label with your name and collection information. Attach the label to the sample cup holding the specimen and place it UPRIGHT in the small bag that is provided in the kit. From this point forward, the sample must be maintained between room and body temperature.
Second, bring the sample to our facility. Our lab staff will ask you for a photo ID and for your signature on an identity verification document. You can do this in person or your partner can deliver the sample for you. If your partner delivers the sample to the lab, her photo ID and signature will be required.