IUI

Before initiating an IUI cycle, your fertility doctor will first review your medical history and discuss your family-building goals. They will also perform a thorough fertility diagnostic evaluation to ensure that IUI is the best option for your specific fertility care needs. For women, this typically includes blood tests to measure hormone levels, a pelvic exam, and a transvaginal ultrasound exam to assess ovarian reserve. For men, fertility is evaluated through a semen analysis.

For insemination to be successful, it must be performed before ovulation. To detect ovulation, urine ovulation predictor kits (OPK) are recommended, which detect the surge in luteinizing hormone (LH), which is one of the primary hormones responsible for ovulation. These kits are available at PCRM, as well as most pharmacies without a prescription. Electronic fertility computers or monitors are not recommended while using fertility medication as the higher hormone levels may give a false reading.

IUI is typically performed alongside superovulation, also known as Controlled Ovarian Hyperstimulation (COH), which involves using medications to stimulate the ovaries into producing more eggs within a single cycle. Combined with IUI, this technique has been demonstrated to be an effective method of treatment for patients where less invasive therapies have not been successful in achieving a pregnancy.

The goal of superovulation is to increase the number of eggs released (3-4 per cycle) during ovulation to help offset the normal age-related decline in egg quality. Multiple eggs are generated with the administration of follicle-stimulating hormone (FSH), which is the same hormone that the female brain naturally produces to make eggs. Given the potential for the production of an excessive number of eggs, patients undergoing IUI require close supervision through a fertility centre to monitor ovarian follicle numbers and estradiol levels.

Once the follicles have reached the optimum size (18-20 mm), an injection of a hormone called human chorionic gonadotrophin hCG is given to “trigger” ovulation. HCG is sometimes referred to as “the pregnancy hormone” because it’s produced by the placenta during pregnancy. It’s also structurally very similar to the LH hormone that naturally causes ovulation. Intrauterine inseminations are typically performed 24 to 36 hours after the trigger shot has been administered. Superovulation is generally always recommended with IUI, as it has been shown to optimize the likelihood of conception.

The most common side effects of superovulation are lower abdominal fullness and bloating. The most significant risks are high-order multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). The majority of multiple pregnancies are twins, however, more than two fetuses can sometimes develop. The risk of high-order multiples is actually greater with superovulation cycles compared to IVF since the number of eggs ovulated cannot be precisely controlled in IUI, unlike IVF where eggs are retrieved and a select number of embryos are created and transferred to the uterus. Typically with ovulation pills, these risks are minimal, all patients will require is ovulation kit testing.

The process of sperm collection and preparation largely depends on whether the female patient is trying to conceive with a male or if the aspiring parents are using donated sperm. If conceiving with a male partner, he will be required to produce a semen sample by ejaculating into a sterile container. Generally, this is done in a private room at our clinic, but can also be done at home with an off-site collection kit. However, the collected sample must be delivered promptly to the clinic within one hour of ejaculation.

The lab will then prepare the semen sample by putting it through a process called sperm washing, a procedure designed to ensure only the healthiest, most motile sperm are used for the IUI procedure. Sperm washing uses a specialized solution and centrifugal spinning to separate the strongest sperm from the seminal fluid, as well as any dead or non-motile sperm. The result is a highly concentrated sample of healthy sperm.

If you’re trying to conceive with donated sperm from an anonymous donor (the most common type of sperm donation arrangement), a big benefit is that the semen sample has already been tested and prepared for use. Anonymous donor sperm must be obtained from an accredited sperm bank, which ensures that the semen has been thoroughly screened for infectious diseases and more. While PCRM does not operate a sperm bank for donation purposes, we will help you facilitate the process of sourcing donor sperm from a sperm bank.

Insemination is typically performed by the nursing staff and is similar to having a Pap test. Using a thin catheter inserted through the vagina, the concentrated sample of sperm is deposited into the uterus so that they are closer to the fallopian tubes where the eggs are. There is typically little or no discomfort experienced during the IUI procedure.

Generally, insemination is done each month until pregnancy is achieved or sufficient inseminations have been done to suggest that more advanced treatments may be necessary. We will recommend a consultation with your physician after 3-4 inseminations have been completed to evaluate your treatment plan. For various reasons (e.g., vacations, illness) it may not be possible for you to have consecutive inseminations performed. This is not a problem and does not affect your chances of success.