This is the starting point for many patients who are having difficulty with conception. Patients who have been diagnosed with unexplained infertility, mild male factor infertility, a cervical factor, or irregular ovulation are often good candidates for IUI.
The aim of this treatment is to increase the number of sperm that reach the fallopian tubes which would increase the chances of fertilization. IUI provides the sperm an advantage by giving it a head start but the sperm is still required to reach the egg and fertilize it. Depending on your diagnosis, IUI can be coordinated with your normal cycle or with fertility medicines.
Dr Berios will place a concentrated specimen of sperm in your uterus. This is done by inserting a speculum into your vagina in order to see your cervix. A soft, thin catheter will be passed through the opening of the cervix into the uterus. Dr Berios will then insert the “washed” sperm into the uterus through this catheter. The procedure is done in his rooms and takes approximately 15 minutes. It is not painful and does not require anaesthesia. You can return to normal activities afterwards.
MEDICATIONS
Clomiphene Citrate i.e. Clomid is a medication commonly used for the treatment of women with ovulation disorders e.g. irregular menstrual cycles. It is taken orally for 5 to 7 days and induces ovulation.
Sometimes, in addition to Clomid, an injection of Ovidrel is recommended prior to the IUI to trigger the release of your egg to increase the ability to correctly time the insemination.
Monitoring of the egg development is done with E2 and LH blood hormone tests and ultrasound scans of the ovaries to determine when the egg is mature. The ultrasound allows Dr Berios to see the thickness of the uterus lining and the ovaries especially the number of follicles within them.
The bloodwork shows the trend of pre to post stimulation hormone levels, increased levels of oestrogen indicates follicular development.
SPERM WASHING
The embryologist prepares each sperm sample with a procedure known as “Sperm Washing” in the laboratory. Sperm washing involves placing the sperm sample in a test tube and then into a centrifuge, this removes the hormones and other substances. The sperm then collects as a “pellet” at the bottom of the test tube.
The embryologist then removes the seminal fluid and places the fluid above the sperm. The most active sperm will then swim up into the fluid. The final sample consists of the most active sperm concentrated in a small volume of fluid.
TIMING THE INSEMINATION
Dr Berios will perform IUI’s 1½ days after the trigger injection has been given which sets ovulation in motion. The exact timing of insemination is not critical to the exact time of ovulation. The sperm and the egg remain viable in the female genital tract for many hours.
Following the IUI you may take daily supplemental progesterone – usually in the form of a capsule inserted into your vagina twice a day, which supports the endometrial lining of the uterus and implantation of the embryo.
What are the different types of IUI Cycles?
- Non-Medicated Cycles (Natural Cycle)
This is a non-medicated cycle which is often used by single women or same sex female couples who are not experiencing infertility but rather a lack of sperm. This treatment involves tracking the development of the egg and then inserting the donated sperm. You will see Dr Berios for two to four appointments to track the egg development and cycle timing.
- Ovulation Induction
The aim with ovulation induction is to develop a single egg during the stimulation phase. At the time of ovulating insemination occurs, inserting the sperm directly into the uterus. IUI puts the sperm closer to the egg than possible with intercourse alone. You will see Dr Berios for three to five monitoring appointments to track egg development and cycle timing.
- Injectable Medication
If pregnancy doesn’t result from ovulation induction with oral medications, injectable medications will be used. These medicines stimulate the ovaries to produce more eggs. The sperm is essentially given more targets to hit. For this procedure you will see Dr Berios for four to eight appointments to track egg development and cycle timing.
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