What Is An IUI?
Intrauterine Insemination
Intrauterine insemination involves injecting sperm directly into a woman's uterus (womb). This gives the sperm a helping hand. The goal is to introduce prepared sperm at a high concentration close to the egg in order to increase the chance of fertilisation.
IUI should only be advised after a comprehensive history and fertility work-up. It can be considered in cases of mild male fertility issues or problems of the cervical canal, for example abnormal cervical mucus. A woman must have patent (open) fallopian tubes for an IUI to be successful. The chances of success with IUI are around 10-15% per cycle but also dependent on other factors such as female age and male semen parameters.
There are two options when it comes to IUI cycles, a stimulated or a natural approach.
Stimulated IUI
Here, the doctor will advise hormonal medications to stimulate the growth of more than one follicle in the ovaries and increase the chances of ovulation. You will usually attend the clinic at the beginning of the cycle (cycle day 2-3) for a transvaginal ultrasound to assess the follicles in each ovary and a baseline blood test. Depending on your physician's protocol, hormonal medications will then be prescribed. These may be oral medications such as Clomifene Citrate (Clomid), Letrozole tablets or hormonal injections - Gonadotrophins.
Clomiphene Citrate
Clomiphene Citrate works by blocking estrogen receptors in the brain. It tricks the brain into thinking estrogen levels are low causing an increase in the production of FSH (Follicle Stimulating Hormone) and LH (Leutenizing Hormone). This then encourages follicular growth. 50 mg of Clomid is usually taken for 5 days, commencing on day 3 until day 7.
Benefits: The purpose of Clomid is to encourage follicular development and to induce ovulation. It usually does this more than 80% of the time. It can be taken orally, is inexpensive and has relatively few side effects. As it does have an anti-estrogenic effect on the body, it does reduce the effects estrogen has on preparing the uterine lining (womb) for a pregnancy. Therefore, medication to supplement this will be given to you (progesterone to thicken the endometrial lining).
Your physician may monitor you until you naturally ovulate or they may induce ovulation with an injection of hCG- human chorionic gonadotropin. The IUI procedure is then usually scheduled 32-36 hours later.
Letrozole (Aromatase Inhibitor)
Letrozole works in a different way. It lowers estrogen production by blocking the conversion of androgens to estrogens. Both Clomiphene Citrate and Letrozole are equally safe however letrozole was associated with higher live-birth and ovulation rates among infertile women with the polycystic ovary syndrome. It is taken in a dose of 2.5mg or 5 mg daily.
Benefits: There is a reduced risk of mutiple pregnancy with Letrozole as it promotes mono-ovulation (ovulation of one egg). It has a short half life meaning it leaves the body relatively fast (48 hours) and does not block the estrogen levels in the uterus. This is important for embryo implantation and pregnancy as it improves the thickness of the uterine lining making it more welcoming to an embryo.
Your physician may monitor you until you naturally ovulate or they may induce ovulation with an injection of hCG. The IUI procedure is then usually scheduled 32-36 hours later.
Gonadotrophins
These are medications that contain follicle stimulation hormone (FSH), luteinizing hormone (LH) or a combination of the two. The purpose of these medications is to stimulate the growth of more than one follicle. Injections can either be administered at home if you feel comfortable, or at the clinic by a nurse each day. Your doctor will need to see you in the clinic for blood tests and ultrasounds every 2-3 days for monitoring and tracking of the follicle sizes. Once the follicles are large enough (approx 18-22mm) a hCG injection will be given to induce final follicle maturation and ovulation and the IUI procedure will be scheduled (32-36 hours later). Once the hCG shot has been given, you and your partner will be asked to abstain from sex until the day of the IUI procedure. On the day of the IUI procedure, he will asked to produce a sperm sample at the clinic (usually 2 hours before your IUI is scheduled).
Benefits: Increases stimulation of the ovaies to produce follicles (eggs). It is a more aggressive approach however it brings with it an increased chance of multiple pregnancy. If you hyper-respond to the medication, which is rare but can happen, the cycle may be cancelled and/or changed to an IVF cycle. If you hyper-respond with several eggs and an IUI is performed, you are at a higher chance of a multiple pregnancy. This is what we try to avoid.
Your physician will monitor you more closely when on this medication and will induce ovulation with an injection of hCG. The IUI procedure is then usually scheduled 32-36 hours later.
Natural IUI
In a natural IUI, no medication will be given. The doctor will track the growth of the dominant follicle (egg) in the ovary by transvaginal ultrasound and when it is big enough (18-20 mm) will wait for the natural ovulation process to occur. This will be detected by blood test ot by urine etsts. The IUI will then be scheduled.
If a couple decides to have IUI using their own sperm, the man will be asked to provide a sperm sample at the fertility clinic by masturbating into a specimen cup. This usually happens on the same day that IUI treatment takes place. The sperm sample will be "washed" and filtered to produce a concentrated sample of healthy sperm.
IUI Procedure
The IUI procedure is very quick. You will be asked to arrive in the clinic with a full bladder as this makes visualising the uterus during the IUI procedure easier for the physician. The procedure itself involves the insertion of a very thin catheter into the vagina and up through the cervix. Sperm will then be pushed using a syringe into the catheter and up into the uterus where it should hopefully swim to reach the egg.
Most asked Question? Should I stay lying down all day after the procedure?
No. After the procedure you will be asked to lie down for about 10-15 minutes. After this, you can go about your daily life as normal. Yes, as normal, trust me. It is not advised to stay in bed all day and actually on the contrary, it is advised to keep moving. Avoid strenuous exercise however until you have your first pregnancy test, to be safe.
Pee.... yes you heard me. You can pass urine immediately after the IUI procedure and it is completely safe. The sperm will not 'fall out'. Sperm swim fast. Within minutes they can be swimming up into the fallopian tubes.
Tip: It's advised to have sexual intercourse the day after your IUI procedure
You will be prescribed some luteal support (progesterone supplementation) for after your IUI. This is to help with preparing the uterine lining for implantation. Make sure to follow your doctors advice on the time and dose of this as it is important. Your pregnancy test will then be scheduled for about two weeks after the IUI procedure.
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