We recommend that patients pursue an intrauterine insemination (IUI) cycle when timed intercourse in conjunction with the use of fertility medication has a low likelihood for success, or has failed. Findings that support the use of IUI include the presence of physical barriers such as cervical scarring, poor cervical mucus, or chronic cervical inflammation (cervicitis). Erectile dysfunction, problems with ejaculation, or mild sperm abnormalities would also would make IUI an ideal treatment option. For couples who have completed medicated cycles with timed intercourse without success, or have unexplained infertility, IUI is often the next step. Pregnancy success via IUI may range from 10-15% per cycle.
An IUI cycle is not considered for patients with blocked fallopian tubes and may not be a fit for women with severe endometriosis or a history of pelvic infections. If a male partner has an extremely low sperm count, the chances of success are diminished and IVF would often be recommended as an initial step.
Before starting treatment, we do a medical evaluation of both the female and male partner. For men, this primarily involves obtaining a semen analysis. For women, hormone levels such as Anti-Mullerian Hormone (AMH) and Follicle Stimulating Hormone (FSH) are checked, which offer indirect information about egg supply and ovarian function. A physical evaluation and vaginal ultrasound are also performed and any relevant medical history (previous pregnancies, medical diagnoses) are discussed. Many times an assessment of the uterine cavity and fallopian tubes is completed through a sonohysterogram (ultrasound) or hysterosalpingogram (X-Ray).
Undergoing an intrauterine insemination cycle often includes taking medication to stimulate the ovaries to produce eggs, then through a simple technique, directly injecting processed sperm into the uterus at the time of ovulation. We’d like to take you through the entire process, step by step, so you know what to expect.
- Stimulate Egg Growth: The woman begins taking oral or injectable medication to stimulate the growth and maturation of her eggs. The injections are just beneath the skin (subcutaneous) and recommended in an area of the body with fat, such your stomach or the top of the thigh. Oral medication is taken for 5 days and injectable medication is usually taken for 8-12 days based on how the ovaries respond.
- Ultrasound & Blood Monitoring: While on injectable medication, brief ultrasound appointments are needed every 2-3 days to monitor the ovaries and egg development. Blood tests are also completed to assess hormone levels related to egg growth and ovarian function. Through this testing and monitoring, we ensure everything is progressing safely.
- Ovulation Induced: Once a “ripe” egg is present, a patient receives a “trigger shot” that causes ovulation within about 36 hours. The shot is given by a nurse at the clinic or self-administered at home.Sperm Sample Processed: The male partner provides a sperm sample or a donor sperm sample is thawed, then processed by the laboratory. During preparation, the sperm sample is “washed” to remove debris, immobile sperm and substances in semen that could cause severe cramping and the sperm cells are highly concentrated into a small volume.
- Insemination Procedure: Just like a routine pelvic exam, a woman lies on an exam table. The sperm sample is injected into the uterus through a thin, long, flexible catheter. The entire process is virtually painless and takes seconds to complete. Getting up shortly after the procedure will not impact chances of pregnancy. On some occasions, insemination will be recommended two days in a row, but in most cases, a single well-timed insemination is all that is needed in each cycle.
- Follow-Up: A week after ovulation, progesterone levels are often tested. For some patients, additional hormone support (such as progesterone) may be suggested to help prepare the uterine lining for pregnancy. Progesterone support is often used for women with recurrent miscarriage.
Additional Testing: About two weeks after insemination, follow up blood testing determines if pregnancy has resulted.
Author Bio: Dr. John J. Rapisarda, Fertility Centers of Illinois
Dr. Rapisarda has been with FCI for nearly 20 years and is currently one of the managing partners. After graduating with honors from the University of Michigan Medical School, Dr. Rapisarda completed both his residency in Obstetrics and Gynecology and fellowship in Reproductive Endocrinology in Chicago. He has also served as an Assistant Professor of OB/GYN at the University of Chicago before joining FCI. Dr. Rapisarda has been deemed a “Top Doctor” by Castle Connolly, U.S. News & World Report and Chicago Magazine for several years. His compassionate, personalized and understanding approach to care has made Dr. Rapisarda an annual recipient of the Patients’ Choice Award since its inception. His professional interests include management of Polycystic Ovary Syndrome (PCOS), recurrent miscarriage, and IVF.