IUI Intrauterine insemination

• Introduction

  Intrauterine insemination is the process whereby your doctor or nurse will place a concentrated specimen of sperm in your uterus. For this procedure, they will insert a speculum into your vagina in order to better visualize your cervix. He or she will then pass a soft, thin catheter through the cervix opening and into the uterus. The doctor will introduce the washed sperm into the uterus through this catheter. The procedure is carried out in our clinic and takes 1 to 2 minutes. It is not painful and does not require anesthesia. You can return to normal daily activities immediately after an IUI.

• Step one: Medications for Intrauterine Insemination

  Clomiphene citrate (Clomid) is a medication commonly used for the treatment of women with ovulation disorders as reflected by infrequent or irregular menstrual cycles. Clomid is a pill taken orally for 5 days, typically starting on day 2 of a woman’s menstrual cycle to induce ovulation. Clomid works at the level of the brain and pituitary gland and facilitates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH, in turn, stimulate the ovaries to produce eggs and the ovarian hormones estradiol (E2) and progesterone (P4). The initial prescribed dosage of Clomid is 50 to 100 mg (one or two tables) daily at bedtime, or as prescribed by your doctor. Clomid is also used in conjunction with IUI. Sometimes, in addition to Clomid, an injection of hCG (Ovitrelle) is recommended prior to the IUI to trigger the release of your egg to increase the ability to correctly time the insemination. Monitoring of egg development is usually done with oestrogen and luteinising hormone blood hormone tests and ultrasound scans of the ovaries to determine when the egg is mature. The ultrasound allows the physician to visualize the thickness of the uterine lining and the ovaries, more specifically the number of follicles within them. The blood tests shows the trend of pre- to post-stimulation hormone levels; increased levels of estrogen indicate follicular development.

• Step two: Sperm washing

  Our specialized team of embryologists prepare each sperm sample with a procedure commonly known as "sperm washing" in our andrology laboratory. Sperm washing involves placing the sperm sample in a test tube and then a centrifuge, which results in the sperm collecting in a "pellet" at the bottom of the test tube. The embryologist removes the seminal fluid and places the fluid (media) above the sperm. The most active sperm will then swim up into the media. The final sample consists of the most active sperm concentrated in a small volume of media. A single IUI is usually performed from a single fresh semen sample or one vial of frozen sperm. 

• Step three: Timing the insemination

  Our doctors generally perform IUIs 1 and a 1/2 days after the trigger injection, which sets ovulation in motion. The exact timing of insemination is not critical to the exact time of ovulation. Both the sperm and the egg remain viable in the female genital tract for many hours, so the doctor may time the insemination within a window of several hours around the time of ovulation. Following the IUI, you will take daily supplemental progesterone, usually in the form of a capsule inserted into your vagina twice a day, to support the endometrial lining of the uterus and implantation of the embryo.

• Step four: The pregnancy test

  Two weeks after the embryo transfer, you will perform a pregnancy test. This test is frequently called a "beta" because it measures the beta chain portion of the hCG hormone emitted by the developing embryo. We let you do this test in the privacy of your own home using a urinary pregnancy test and you then let us know the outcome so we can plan the next steps.

1. Are there different types of IUI cycles?

   There are three different types of IUI cycles based on your individual diagnosis and your response to treatment:

   Non-medicated cycle with IUI: Also known as natural cycle IUI, a non-medicated cycle with IUI is often used by single women or same-sex female couples who are not directly experiencing infertility, but rather a lack of sperm. This treatment involves tracking the development of the egg that is naturally recruited during a menstrual cycle and then introducing the donated sperm. You will come into the clinic for two to four monitoring appointments to track egg development and cycle timing.

   Ovulation induction with IUI: The goal with ovulation induction is to recruit and develop a single egg during the stimulation phase. At the time of ovulation, insemination occurs, placing the sperm directly into the uterus. IUI puts the sperm closer to the egg than possible with intercourse alone. You will come into the clinic for three to five monitoring appointments to track egg development and cycle timing.

   Injectable medication cycle with IUI: If pregnancy doesn't result from ovulation induction with oral medications, the next step is to use injectable medications. These medications stimulate the ovaries to produce two to three eggs; when combined with IUI, you have an increased possibility of conception. Essentially, the sperm is given more targets to hit. You will come into the clinic for four to eight monitoring appointments to track egg development and cycle timing.

2. Can I have intercourse during an IUI treatment cycle?

   You may have protected intercourse at any time during your treatment cycle. Unprotected intercourse is advised only when instructed by your doctor.

3. How often do I need to come in for monitoring?

   This will vary between treatment cycle types. Generally patients have an average of two to four appointments before the IUI if they are not using ovulation stimulating medications, and three to eight appointments if they are using medications. Closer monitoring and more appointments are required if you are using injectable medications vs oral medications only.

4. When does my husband/partner produce a sample for the IUI?

   He will need to produce sperm sample the same day as your IUI. Drop-off is scheduled 1.5 hours before the IUI. The specimen should not be produced longer than 2 hours from appointment time. Patients are provided with a specimen cup so he can produce in the comfort of his home. If he chooses to use a collection room, that is also available.

5. Do I need to lie down after an IUI?

   It is not a requirement to lie down after an IUI but if you choose, you can lie in the recovery room for 5 to 10 minutes after procedure and then resume with your normal activities.

6. Do I need to take it easy after an IUI?

   Most people can return to regular activity following the procedure, but it is suggested during this time that you refrain from high impact activity. If you start to feel any type of cramping, we recommend you take it easy.

7. How long after an IUI should implantation occur?

   Implantation usually occurs within 36 to 48 hours after the procedure.

8. When will I find out if I am pregnant?

   Approximately 2 weeks after the insemination, you will perform your urinary pregnancy test. We will provide you with the exact date to perform the pregnancy test.

Fees

We are delighted to be able to offer Ovulation Induction (OI) and Intrauterine Insemination (IUI) as a treatment package with a single cost from the moment you decide to pursue treatment. Our full price list can be found here for download, but below is a summary of what the OI and IUI package includes. At any time, if you have any questions about the fees, please contact us as soon as possible on 0141 956 0509 to speak to a member of staff.