Intrauterine Insemination
IUI does not involve vitrification and is primarily for couples experiencing difficulties conceiving who want to get pregnant now.
Overview
1. Monitor ovulation
During this phase, assessments of the ovaries are conducted by transvaginal ultrasound and the hormones are monitored by blood tests. Fertility medications may or may not be used to stimulate ovulation. This depends on a case-by-case basis.
2. Collect sperm
Once the fertile window is determined, sperm from a male partner or sperm bank is collected, assessed, and processed for insertion.The sperm undergoes a "washing" process to separate the sperm from seminal fluid, which can irritate the uterine lining. This preparation enhances the quality of the sperm for insemination.
3. Inseminate
The sample of processed sperm is inserted through the cervix into the uterus in an outpatient setting or clinic. The procedure takes a few minutes and is relatively non-invasive compared to other fertility treatments.
Wait (and Reassess)
After two weeks, a pregnancy test is administered, either at the clinic as a blood or urine test or an at-home urine test. If the procedure was not successful and pregnancy does not ensue, the fertility specialist may suggest another try or recommend another fertility treatment.
Reference Process and Timeline
- Meet & evaluate your doctor
- Understand procedures & prep needed
The first appointment with the doctor or fertility specialist is for them to explain to you the procedure, process, and risks involved. The doctor also uses this time to review your medical history and assess your overall and reproductive health, such as pre-existing conditions or factors that may affect fertility or the IUI process, previous pregnancies, surgeries, or medical treatments that may impact fertility. Now is the moment to determine whether this doctor and clinic suits your needs and financial situation.
Get an idea of the timeline, i.e. when you will be checked for your ovulation or fertile window and whether the doctor suggests you to use any fertility medications to stimulate ovulation, so that you can plan ahead and take days off work if necessary.
Find out the preparation needed before treatment. Depending on your situation, they may ask women to get on or off birth control pills to regulate your cycle and provide specific dates on when to take your first and last oral contraceptives. Smoking could have an adverse impact on fertility and the doctor may advise you to refrain from smoking before and during your fertility treatment cycle.
- Complete health assessments
- Prepare for treatment
Your healthcare provider may require an x-ray to determine whether the fallopian tubes are open and the uterus appears normal. This test is called saline infusion sonogram (SIS) or hysterosalpingogram (HSG). You will also likely be tested for infectious diseases.
Since IUI utilizes sperm, male partners will provide a semen specimen to be tested for infectious diseases.
Generally, the infectious diseases tested for are: Hepatitis B, Hepatitis C, HIV, Syphilis, Chlamydia, Rubeola, Rubella.
- Take fertility medications by oral route or injections
- Continuous monitoring of ovulation
Time: Usually within Day 1 – 14 of your menstrual cycle
Note the first day of menstruation, which is also day one of the treatment cycle. In the case of fertility medications, these will be started on day 2 to 5 of the treatment cycle. Medications may be orally administered or injections, and the monitoring varies for different medications. The clinic will provide specific instructions on monitoring and medications.
Depending on the doctor or clinic, women either self-monitor the treatment cycle with ovulation predictor kits or are monitored in-clinic with a blood test in the morning or with ultrasounds.
For in-clinic monitoring, the number of times women visit the clinic depends on how the body responds to the medications, therefore, it's advised to keep mornings free and flexible during the treatment cycle's first two weeks.
- Collect for insemination
- Analyze and "wash" for IUI procedure
Time: 1 – 2 hours
This step is all about the male. Once the woman is in her fertile window, the male partner goes to the clinic once again for sperm to be collected. There are different ways to go about this, such as collecting into a special condom during sexual intercourse, extracting from a urine sample in a lab, collecting with vibratory stimulation, or masturbating into a sterile container.
Analysis is then carried out to examine sperm count, motility, and morphology. The collected sperm then undergoes processing, called "sperm washing." This process removes the seminal fluid from the sample as it can cause cramping in women after insemination.
If using donor sperm from a sperm bank, this requires planning and additional fees. Furthermore, the frozen specimens should be at the clinic before treatment begins.
- The big day!
Time: A few minutes
During the procedure, the doctor uses a speculum to view the cervix and then inserts a thin and flexible small tube that's specially designed for IUI to inject the sperm sample into the uterus. The procedure is generally painless.
Side effects may include mild cramping and spotting for one to two days after the IUI procedure. Women usually are able to return to normal life and have sexual intercourse the same day.
- Take a pregnancy test
14 days after the IUI procedure, a positive pregnancy test would signal if fertilization has occurred. A blood test could be required to check the HCG (pregnancy hormone) levels and follow up with the first pregnancy ultrasound. Alternatively, women may take an at-home pregnancy urine test.
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