Intrauterine Insemination (IUI)
An IUI can be performed after taking medication for ovulation induction or controlled ovarian hyperstimulation, or during a natural cycle in cases with mild male factor infertility or when donor sperm is used. When a fresh sample is given, the sperm is “washed” and prepared by an andrologist. This process filters out abnormal sperm and bacteria and selects out motile sperm, which are drawn up into a catheter for insemination. The catheter is guided through the cervical opening directly into the uterine cavity, where the sperm are deposited. A blood pregnancy test is performed 14 days after the insemination.
Ovulation induction involves using medication to cause a woman to mature or release one or more eggs during her cycle. It is used in women who have irregular periods and are anovulatory, or do not regularly release an egg each month, in order to cause them to ovulate so that they have an opportunity to conceive. The same medications may be used to increase the number of mature eggs that develop in a given cycle, in order to increase the probability of becoming pregnant. This is called controlled ovarian stimulation or superovulation.
Either oral medications such as clomiphene citrate or letrozole, or injectable versions of follicle stimulating hormone can be given to promote development of ovarian follicles, which contain eggs. Medication dosages are individualized depending on a woman’s age and history. Women planning to take clomiphene citrate or letrozole come into the office for baseline bloodwork and a vaginal ultrasound during the first few days of the menstrual cycle. These medications are typically given for five days beginning on the third day of the cycle. Patients return for periodic monitoring with blood tests and ultrasounds starting a few days after they finish the medication until the follicles appear mature. At that time, ovulation is often triggered using an injection of human chorionic gonadotropin (hCG). Then, instructions are given regarding when to have intercourse or an Intrauterine Insemination is scheduled.
Injectable fertility agents (medications such as Follistim, Gonal F, Bravelle and Menopur) can be given subcutaneously (under the skin) in order to simulate the growth of ovarian follicles. These are often used for ovulation induction in women who are resistant to the oral medications, or for controlled ovarian stimulation or for in vitro fertilization (IVF). After a baseline ultrasound and blood tests at the beginning of the menstrual cycle, women are started on daily injections of these medications with periodic monitoring in the office every one to three days. As with oral medications, when the follicles appear mature, hCG can be given to trigger ovulation, followed by scheduled intercourse or an intrauterine insemination (IUI).