Intrauterine Insemination (IUI)
Generations Fertility Care in Madison, Wisconsin offers intrauterine insemination (IUI) with ovulation induction (OI), both of which are medical techniques that can help a woman become pregnant.
Approaches to Infertility Therapy
For couples for who need some assistance in conceiving, generally there is a stepwise approach to determining the assertiveness of therapy:
- Natural conception
- Intrauterine insemination (IUI) with oral medication
- Intrauterine insemination (IUI) with injectible medication
- In vitro fertilization (IVF)
Intrauterine Insemination (IUI) with Ovulation Induction (OI)
Though some patients prefer either IUI or oral medication without combining the two, there is evidence that they are more cost effective in combination. In other words, for comparable cost, on average, a woman is more likely to have a live birth after a single cycle of oral medication combined with a single IUI than she would with either two cycles of oral medication with ultrasound or two cycles of IUI. This is why we generally proceed from natural conception directly to oral medication with IUI.
Reasons Why Intrauterine Insemination (IUI) Can Increase Pregnancy
The reason intrauterine inseminations increase pregnancy rates is twofold.
First, they bypass cervical causes of infertility, caused either by problems in the cervical mucus or the cervix itself.
Second, inseminations dramatically increase the number of sperm that reach the egg. This increase can be as high as twenty fold. For this reason, couples should not feel pressured (unless instructed to do so) to have intercourse before or after an insemination because the additional number of sperm that will reach the egg from intercourse in addition to the IUI is relatively minimal.
How Ovulation Induction (OI) Helps During Intrauterine Insemination (IUI)
Medicines, commonly called fertility drugs, are given to the woman to enhance her oocyte ("egg") production beginning approximately two weeks prior to the actual procedure.
Normally, a woman releases one oocyte per month (or none if she is anovulatory). Oral fertility medications generally increase this number to one to three oocytes, and injectable medications can further increase the number of oocytes recruited.
More oocytes in a cycle will increase the likelihood of pregnancy. However, when more than two or three oocytes are recruited for an IUI cycle, there is a minimal benefit to the overall likelihood of pregnancy, but the risk of multiples, especially high order multiples (three or more) dramatically increases.
This is why fertility care can be as much an art as a science, since the goal is to maximize pregnancy rates, but simultaneously minimize the risk for multiple pregnancies.
Another risk with ovarian stimulation is ovarian hyperstimulation syndrome (OHSS), though this relatively rare with insemination cycles (and still uncommon, but not as rare with in vitro fertilization (IVF)).
To help guide the delicate balance between under- and over-stimulation, we use ultrasounds to tell us how many oocytes are developing and when would be the optimal time for IUI.
To further optimize timing for an IUI, we often will use an injection called "hCG," which is an abbreviation for human chorionic gonadotropin. This is the same hormone that is detected in a pregnancy test, but in this context it simulates/supplements a woman's LH surge. This causes oocyte maturation so that the "egg" has the greatest likelihood of being fertilized by a sperm.
The Intrauterine Insemination (IUI) Procedure
On the day of the insemination, the patient's partner will come in to the office (at a scheduled time) and produce a sperm sample in a private collection room. Though the sample can be produced at home, the faster the laboratory can process the fresh sample, the better it is for the sperm. Ideally, the sample should be processed within 30 minute to 1 hour of collection.
After the sperm sample is processed by our lab, the gynecologic setup is comparable to that of a Pap smear.
After cleaning the cervix with Betadyne (which is an iodine based cleaning solution, so tell your doctor if you have an allergy to iodine or shellfish), a small catheter (the diameter of a coffee straw) will be placed past the cervix and the sperm sample will be advanced in to the uterus.
After removal of the catheter and the speculum, you will then recline on the exam table for ten to fifteen minutes, which actually improves pregnancy rates. However, prolonged rest past this time has not been shown to have additional benefit, so you can feel free to resume routine activities afterwards. You (and our team) then wait for two weeks to take a pregnancy test and hopefully it's positive!