IUI Indications and Processes
IUI (intrauterine insemination) is one of the oldest fertility treatments known to man. IUI employs the sperm that are collected from the husband and prepared by our specially trained andrology laboratory staff. A sperm donor may be used for the IUI cycle in cases of moderate to severe male infertility. Many couples with male factor infertility opt for IVF with ICSI, which is often successful even when only one viable sperm can be isolated.
IUI usually requires that the female receive ovulation induction, or enhancement, drugs, such as Clomid® (clomiphene citrate), and/or FSH injections to improve her chances of achieving pregnancy. IUI must only be conducted with specially washed and prepared sperm to avoid severe uterine cramping and potentially serious allergic reactions. IUI has been offered at our Salt Lake City, UT fertility clinic since we opened in 1996.
IUI must be timed properly and follicular development is usually initially monitored using urinary ovulation predictor kits (OPK). This is considered accurate more than 90% of the time. If pregnancy is not quickly achieved, then confirmatory monitoring such as vaginal ultrasound to evaluate follicle size,estradiol, progesterone and luteinizing hormone (LH) measurements to evaluate the hormonal response and confirm timing may be performed. This is accurate more than 95% of the time. Confirmatory monitoring is done the morning the OPK turns positive or the next morning if the kit turns positive in the evening after being negative that morning.
Typically the LH will be elevated (greater than 20 or 3 x the baseline value) the day the OPK test turns positive. IUI is usually scheduled for the afternoon of the next day if it appears the OPK was accurate (confirms).
If IUI does not result in pregnancy after confirmatory monitoring, then serial monitoring may be considered. This is usually started 2-3 days prior to the anticipated LH surge. Once the physician judges that the follicles have reached maturity and appropriate hormone levels are achieved, an injection of hCG is given so that the IUI(s) can be scheduled 34-42 hours later. Timing is most accurately predicted by serial monitoring and achieves the best pregnancy rates. However this high level of monitoring is usually not required nor is it typically recommended initially due to the additional cost.
IUI is usually performed each month that ovulation can be reliably predicted. This has been shown to be the most cost effective approach. Two procedures 24- 48 hours apart may be considered in certain circumstances if ovulation timing has been unpredictable.The insemination involves the painless insertion of a small catheter so that the sperm are transported past the cervix and into the uterus.
IUI is offered by several general OB/GYN physicians in the intermountain region, where it is combined with oral ovulation enhancing agents. But with the easy availability of specialized fertility clinics most general OB/GYN physicians offering IUI do not provide it in conjunction with FSH injectable medications. One reason for this is that the risk of multiple births is high as a result of these cycles when FSH is given. An IUI cycle will usually be cancelled or, if preferred, converted into an IVF cycle if too many mature follicles are produced when monitoring is performed at a center with IVF capabilities, like our Salt Lake City fertility clinic,
IUI is converted into an IVF cycle before the eggs can be ovulated, the eggs are withdrawn from the follicles using transvaginal guided ultrasound . Once the eggs are withdrawn, they are combined with the husbands sperm and fertilization occurs. After incubation, a set number of embryos are transferred to the uterus and the number varies dependent upon patient specific characteristics. The incidence of multiples is much lower if only 2-3 embryos are transferred.
IUI patients who are receiving injectable medications must be carefully monitored to try and limit the occurrence of high order multiples (triplets and above). Essentially, the fertility specialist cannot always control how many mature follicles are produced, nor can they always accurately predict how many eggs will be released (ovulated). A major advantage of IVF over IUI is that the number of embryos placed into the uterus can be “controlled”.
IUI was administered as many as 6-12 cycles in the past. Most specialists agree that if IUI has not worked in 4-6 treatment cycles other therapies, such as IVF should be tried. IVF success rates are usually significantly higher.
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