Intrauterine insemination (IUI) is one of the simpler, “low-tech” treatments for infertility and the starting point for many individuals and couples who are having difficulty with conception on their own. Patients who have been diagnosed with unexplained infertility, mild male factor infertility, a cervical factor, or irregular or absent ovulation are often good candidates for IUI.
The goal of this treatment is to increase the number of sperm that reach the Fallopian tube and subsequently increase the chance of fertilization. IUI provides the sperm an advantage by giving it a head start, but still requires the sperm to reach and fertilize the egg on its own. Depending on your fertility diagnosis, IUI can be coordinated with your normal cycle or with fertility medications.
A physician may also recommend IUI in cases where a woman or couple needs donor sperm. Before you and your doctor make the decision about whether or not IUI is right for you, you will undergo standard infertility testing.
Monitoring of egg development is usually done with E2 and LH blood hormone tests and ultrasound scans of the ovaries to determine when the egg is mature. The ultrasound allows the physician to visualize the thickness of the uterine lining and the ovaries, more specifically the number of follicles within them. The bloodwork shows the trend of pre- to post-stimulation hormone levels; increased levels of estrogen indicate follicular development.
Our specialized team of andrologists prepare each sperm sample with a procedure commonly known as “sperm washing” in our andrology laboratory. Sperm washing involves placing the sperm sample in a test tube and then a centrifuge, which results in the sperm collecting in a “pellet” at the bottom of the test tube. The andrologist removes the seminal fluid and places the fluid (media) above the sperm. The most active sperm will then swim up into the media. The final sample consists of the most active sperm concentrated in a small volume of media.
Donor sperm is commonly needed by:
- Single women
- Same-sex female couples
- Heterosexual couples with severe male factor infertility
Donor Sperm, from the cryobank, can be ordered one of two ways:
- IUI Prep (preferred) – this sample type has been washed by the sperm bank prior to cryopreservation and therefor the sample only needs thawed, by our internal laboratory prior to IUI.
- ICI (Intracervical Insemination) Prep – this sample type was not washed prior to cryopreservation, therefor our internal laboratory will wash and prepare, prior to IUI.
You will select your sperm donor using the cryobank’s website. Sperm donors are anonymous, but the donors usually provide a childhood picture. The donor database offers personal demographics (i.e., hair color, height, race, etc.), as well as essays written by the donor. Some cryobanks even offer voice recordings of interviews with the donor and information on what celebrity the donor looks like. In some cases, recipients can view if previous pregnancies have resulted from that donor’s sperm.
Intrauterine insemination is the process whereby a clinician will place a concentrated specimen of sperm in your uterus. For this procedure, he or she will insert a speculum into your vagina in order to better visualize your cervix. They will then pass a soft, thin catheter through the cervix opening and into the uterus. The clinician will introduce the washed sperm into the uterus through this catheter. The procedure is done in our office and takes 1 to 2 minutes. It is not painful and does not require anesthesia. You can return to normal daily activities immediately after an IUI.
You will be asked to return to confirm that ovulation has occurred, and blood tests will be performed at later dates to measure hormone levels. Progesterone may be prescribed, in suppository form, to provide luteal support. This medication helps prepare the lining of the uterus to accept and support the embryo throughout pregnancy.
You will be scheduled to return to our office for a pregnancy test approximately 14 days after the procedure. Progesterone, if prescribed, will be taken for 6 or 7 weeks if the test is positive. If you are pregnant, we will continue to monitor you until approximately 10 weeks. If the procedure is not successful, a nurse will call to discuss the next steps.
DIRM is truly a place where dreams, through science, become reality.