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Intrauterine Insemination (IUI) Program
The Center for Advanced Reproductive Medicine & Fertility offers an IUI Program for the treatment of infertility. Intrauterine insemination (IUI) is a treatment that may be used when the female partner does not produce sufficient cervical mucus at the time of ovulation, in couples with male factor infertility, or unexplained infertility. This procedure is also commonly performed as part of a superovulation-IUI (SO-IUI) treatment cycle for infertile couples where adequate numbers of healthy sperm are present in the husband’s ejaculate, and at least one fallopian tube is open. If the sperm parameters are significantly compromised, IUI is unlikely to improve the chance for pregnancy, and these couples are best treated by IVF with ICSI. However if this is not the case, IUI has been shown to increase the pregnancy rates even with mild ovulation induction protocols using (e.g.) clomiphene citrate (Clomid tablets).
What is Superovulation (SO-IUI)?
Superovulation therapy involves ovarian stimulation using medications called gonadotropins. Gonadotropins are fertility medications given by injection. They contain follicle-stimulating hormone (FSH), which is produced naturally by the pituitary gland, alone, or combined with luteinizing hormone (LH), also produced by the pituitary gland. A related medication is human chorionic gonadotropin (hCG) which has a similar structure to LH and which simulates the natural LH surge that causes ovulation at mid-cycle. Gonadotropins are used to stimulate the growth of ovarian follicles which are the individual sacs of fluid in which an egg develops in the ovary. They are used to induce ovulation in women who do not ovulate, and to induce development and ovulation of multiple follicles in women undergoing advanced reproductive therapies such as SO-IUI or in vitro fertilization (IVF). HCG is commonly used to trigger ovulation, or release of the egg(s) once follicles have matured. There are several gonadotropin products available including Gonal-F, Follistim, Bravelle and Menopur.
What are the indications for SO-IUI?
- Unexplained infertility
- Lack of, or infrequent, ovulation (e.g. PCOS)
- Mild male factor infertility
What is involved in SO-IUI?
A SO-IUI cycle involves the following steps:
1) Stimulation Of The Ovaries With Injectable Hormones
Daily FSH injections are given to stimulate the growth of 2-4 ovarian follicles (i.e. the fluid-filled sacs in which an egg develops). Sometimes clomiphene (Clomid)tablets are given for 5 days prior to FSH injections. You will be taught how to give these injections yourself. They are taken daily for about 9-14 days, starting on day 3 of your menstrual cycle.
2) Monitoring Of Treatment With Transvaginal Ultrasound And Blood Work
This is very important to determine how many eggs are developing, and when the eggs are mature and ready to ovulate.
3) Triggering of ovulation
This is done with an injection of hCG (human chorionic gonadotropin) which mimics the body’s LH surge in a natural cycle. The hCG causes final maturation of the eggs, followed by ovulation or release of the eggs approximately 34-40 hours later. The timing of this injection is very important as it allows us to accurately time the insemination to coincide with ovulation.
4) Timed intrauterine insemination (IUI)
A sperm sample is provided on the day of ovulation. It is washed, prepared, and then placed into the uterus through the cervix using a small, flexible catheter. This is a simple procedure, similar to a Pap test, with minimal discomfort. If you are using donor sperm, the sample is thawed on the day of ovulation.
5) Pregnancy testing
Following the IUI, you will start vaginal progesterone supplementation. This is continued until the pregnancy test, which is done 2 weeks following the IUI. If you are pregnant, you will continue the progesterone during the early first trimester.