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IUI (Intrauterine Insemination)

IUI/Intrauterine Insemination (formerly known as SOURCE Cycle) In this process, the woman receives daily Hormone medications to stimulate the growth of multiple eggs. Once the eggs have reached the right stage, intrauterine inseminations are done using specially treated sperm.

Your physician and you may elect to proceed with Ovulation Induction with injection. Because of the complexity of the program, you will be interacting with a number of different team members. The medical, nursing, laboratory and support staff will help you throughout your cycle.

The Ovulation Induction Program includes the possibility of five steps:

Development of ovarian follicles (the growth and maturation of eggs using medications such as clomiphene citrate, an oral medication, and/or gonadotropins, serial self-administered injections).
Stimulation of ovulation with hCG (Human Chorionic Gonadotropin) injection.
Intrauterine Insemination (IUI) with a partner's or donor prepared sperm.
Hormonal support of the Luteal Phase with progestrone, if recommended by you primary physician.
Follow up blood tests and obstetrical appointments.

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Standard stimulation cycle

Ovarian Follicular Development

You may start using injectable Human Menopausal Gonadotropins or recombinant gonadotropins on day 3 of your cycle and continue for approximately 8 to 10 days until the follicles are mature.Gonadotropins are medications normally used to induce and stimulate ovarian Follicle development so that ovulation can occur.

Gonadotropins are given as a daily injection. The medication is used to stimulate more than one follicle to develop, therefore, increasing your chance of pregnancy but also increasing your chance of a multiple pregnancy.

Ovulation drugs are not associated with increased risk of birth defects or spontaneous miscarriages. When follicles are mature (determined by Ultrasound and blood estradiol levels), another medication will be given by injection, Human Chorionic Gonadotropin (hCG). hCG is like a woman's natural LH and causes the follicle(s) to release the egg(s).

Monitoring Ovarian Follicular Development

A baseline ultrasound is performed soon after your period starts. After several days of gonadotropins, you will have a blood test for estradiol and a Vaginal Ultrasound examination. The estradiol blood levels and ultrasound are used together to assist in determining follicle maturity. Ultrasounds and blood tests will continue daily or at longer intervals until you are ready for hCG. How long you will be on these injections can vary tremendously, depending on your personal medical situation.

Human Chorionic Gonadotropin ( hCG)

When ultrasounds and blood estradiol levels indicate your follicles are mature and ready to ovulate, you will receive hCG.

Intrauterine Insemination (IUI)

If inseminations are recommended for you, 1-2 inseminations will be performed 18-42 hours after hCG administration.

RISKS
There are two inherent risks involved with the use of gonadotropins, namely:

Multiple pregnancies
Enlargement of the ovaries during the second half of the cycle (called hyperstimulation)

These risks are increased when too many follicles mature at once and the estrogen in the blood is too elevated. Therefore, we consider it very important to have the ultrasounds and blood levels performed.

Luteal Phase Support

Your physician may recommend luteal phase support after HCG. You will be given written instructions on type, dosage, and when to administer the medications to supplement the luteal phase. This medication should continue until the result of the pregnancy test is known.

If pregnancy occurs, the medications will continue as directed by your doctor. If the pregnancy test is negative, the luteal support may be discontinued.

Follow-Up Blood Tests and Appointment

To determine the outcome of an ovulation induction cycle, simply await the onset of a normal period. If abnormal or late with your expected menses, return for a blood pregnancy test 17 days after the HCG injection, 2 weeks after timed intercourse or IUI or check a home pregnancy test.

You may arrange a follow-up appointment with your physician after your cycle if you wish. This visit will be to summarize your Ovulation Induction cycle, discuss future plans (prenatal care, future Ovulation Induction cycles, other Infertility options), and to answer questions.

Success with the Ovulation Induction Program

Successful pregnancy occurs in approximately 15-20% of cycles we perform. This statistic may vary and may be higher if you have a ovulatory dysfunction.

Because of the tremendous success we have had with IVF, ovulation induction has become a less popular option.To minimize these risks we have certain criteria above which we will recommend cancellation of the cycle. Should this occur, the hCG will not be given and abstinence recommended.