IUI-- intrauterine insemination -- is performed by threading a flexible, very thin catheter through the cervix and injecting sperm that has been pre-washed directly into the uterus. While the process is short, it can be complicated and should be done by someone with considerable experience in the fertility field. It requires the insertion of a speculum and then the catheter, a process that maybe takes a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove the catheter — going slowly helps reduce discomfort). Sometimes when the cervix is hard to reach, a tenaculum is used to hold the cervix, which can make the process a bit more uncomfortable. As a general rule, no sedation is necessary as the process is usually discomfort-free.
Intrauterine insemination is performed around the time of ovulation. If no fertility drugs are used, ovulation can be predicted by monitoring urinary LH (Luteinizing Hormone). Monitoring of urinary LH can be accomplished through the use of a urine LH kit that can be purchased at your local pharmacy. The IUI may be performed 1 or 2 days after the LH surge, depending upon your physician’s preference. IUI’s in natural cycles have lower success rates than in stimulated cycles and are usually reserved for women with regular cycles undergoing insemination with donor sperm.
Clomiphene is used primarily for ovarian stimulation in IUI (intrauterine insemination) for women who have infrequent or irregular menstrual cycles. Clomiphene is a tablet taken by mouth at bedtime in doses ranging from 50 to 200mg (1 to 4 tablets) per day. Clomiphene is usually taken starting on day 3 to 5 of the menstrual cycle, and continued for 5 days. Upon completion of 5 days of clomiphene, 1.25 mg (2 tablets) Premarin, an estrogen, is taken daily to enhance the thickness of the uterine lining. Serial ultrasound examinations are performed starting about day 10 of the cycle, in order to monitor the growth and number of ovarian follicles (generally 1 to 3 follicles). Approximately day 10 of the cycle, patients begin using a home ovulation predictor kit. When the ovulation predictor kit detects a LH surge, inseminations are performed on the next two subsequent days. If no LH surge is detected, but ovarian follicles appear mature on ultrasound examination, hCG (Profasi or Ovidrel) is administered to assist ovulation. Inseminations are then performed on the two subsequent days. One week after the second insemination, a blood sample is drawn to confirm ovulation. Two weeks after the second insemination, a blood pregnancy test is performed.
The highest success rates with IUI’s are seen when hMG/FSH fertility drugs are used to induce ovulation (approximately 12-15% pregnancy rates). Monitoring of the ovarian stimulation levels will begin with the onset of the cycle. The monitoring will continue until the end of the cycle, similar to an IVF cycle, which includes blood tests and ultrasound examination. The side effects of the fertility drugs ordered by your reproductive endocrinologist are discussed below.
Possible side effects of intrauterine insemination (IUI) include pelvic infection, uterine cramping, bleeding, mild discomfort, and perforation of the uterus (rare). Cancellation of IUI Cycle The IUI or the treatment cycle may be cancelled for any of the following reasons: