IUI is one of the oldest fertility treatments known to man.  We know today that IUI must only be conducted with specially washed and prepared sperm to avoid severe uterine cramping and potentially serious allergic reactions.

For IUI, the sperm are collected from the husband and prepared by our specially trained andrology laboratory staff. The female usually receives ovulation induction or enhancement drugs, such as Clomid® (clomiphene citrate), and/or FSH injections to improve her chances of achieving pregnancy. 

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 (vaginal ultrasound to evaluate follicle size as well as estradiol, progesterone and luteinizing hormone (LH) to evaluate the hormonal response and confirm timing) may be performed.  This is usually 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. If it appears the OPK was accurate (confirms) then IUI is usually scheduled for the afternoon of the next day.

If pregnancy is still not achieved after confirmatory monitoring and IUI, 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 insemination(s) can be scheduled 34-42 hours later. Serial monitoring is the most accurate, usually predicts the optimal time for IUI 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.

Usually a single insemination is performed each month that ovulation can be reliably predicted. This has been shown to be the most cost effective approach. Two inseminations 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 is transported past the cervix and into the uterus.

In the intermountain region, IUI is offered by several general OB/GYN physicians when it is combined with oral ovulation enhancing agents for the woman.  But with the easy availability of specialized fertility clinics most general OB/GYN physicians do not provide IUI in conjunction with FSH injectable medications.  One reason for this is that the risk of multiple births is high as a result of IUI cycles when FSH is given.  When monitoring is performed at a center with IVF capabilities a planned IUI cycle will usually be cancelled or, if preferred, converted into an IVF cycle if too many mature follicles are produced.

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” in IVF.
 
In the past, many women underwent from 6-12 or more cycles of IUI.  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 than IUI.