Intrauterine Insemination (IUI)

Introduction

Intrauterine insemination is a process whereby sperm from the man is processed in the laboratory, concentrated and then placed in the uterine cavity. The cervix is bypassed, thus allowing the best and most motile fraction of sperm to be placed closer to the egg. Intrauterine inseminations are used to treatment a variety of fertility disorders including unexplained infertility, cervical factor, mild male factor, and early stage endometriosis.

Timing of Inseminations

Intrauterine insemination is timed to occur as close to ovulation as possible. One way to determine the time of ovulation is with home ovulation predictor kits. These kits detect the LH surge in the urine, which usually occurs the day before ovulation. Therefore inseminations are scheduled for the day after the LH surge is detected in the urine. We do not recommend any one kit over another, but you should follow the manufacturer’s directions for performing the test. Another way to time ovulation is by administering an injection of the hormone hCG. This injection must be given at the proper time in the cycle in order for ovulation to occur normally. The timing of the hCG injection is based on ultrasound measurements of the ovarian follicles and on hormone levels of estrogen in the blood. Inseminations are performed 36-40 hours after the hCG injection, which is the expected time of ovulation.

If you are using home ovulation predictor kits to time your inseminations we recommend you start checking your urine for the LH surge around cycle day 11. If you are taking clomiphene (clomid), you should not check for the LH surge while you are still on the drug as this can cause a false positive result. When you detect the surge you should call our office at 501-801-1200 and let the nurse know that you have detected the LH surge and need to schedule and insemination for the next day. If you detect the surge at night, on the weekend or a holiday, you should call the medical exchange at 501-663-8400 and the physician on call for our group will call you back with instructions. If you have not detected the LH surge by cycle day 14, you should call our office and let the nurse know. We usually will need to see you the next day in clinic for an ultrasound to determine why you have not had a surge.

Use of Ovulation Induction with Insemination

Intrauterine insemination is often combined with drugs to stimulate ovulation such as clomiphene, tamoxifen, letrozole, and/or injectable gonadotropins. This typically results in an increased number of eggs, which should increase the chance of conception. There is also an increased risk of multiple pregnancy with the use of these drugs. The risk depends on several factors including the drug used, your age and the reason for your infertility. Your doctor will discuss your risk of multiple births prior to the start of your cycle.

Insemination Procedure

Your husband will need to produce a semen sample before the insemination. We have facilities in our clinic for sperm collection. Alternatively, he may collect the sample at home, but he must be able to get the sperm sample to our clinic within an hour of collection. If he would like to collect at home please let the nurse know in advance so she can give you appropriate instructions and a collection container for home collection. You should bring the sperm sample immediately to our clinic. Do not refrigerate it. Keep it at body temperature. The sperm will be processed in our lab, which takes about 45 minutes. You should abstain from intercourse for 3-4 days prior to the insemination to maximize the chance of having a good sperm count on the day of the insemination. The insemination takes just a few minutes to perform. It is generally painless, although mild uterine cramping occasionally occurs. We will have you rest in our clinic for 15 minutes after the insemination. You then may return to home/work without any restrictions of your activities. If you have not started a menstrual period within 2 weeks, a pregnancy test should be performed. If your period does start, you should call the office and inform the nurse. Generally, we like to have you return to our office when your period starts so we can check your ovaries for cysts prior to starting another cycle. We also like to review your last cycle and make adjustments in your cycle stimulation if necessary. If pregnancy is going to occur with inseminations, it usually will do so within 3 cycles. Therefore, if you are not pregnant after 3 cycles of inseminations, you should make an appointment with your doctor to discuss changing your treatment plan.