Intra-Uterine Insemination (IUI)
Marissa prepares sperm for IUI by centrifugation
What Is an IUI?
Intrauterine insemination, or IUI, is a first-line infertility treatment which consists of placing prepared sperm within the uterus around the time of ovulation. IUI is used to treat infertility due to low sperm concentration or motility, poor cervical mucus, anti-sperm antibodies and unexplained infertility. IUI can be done with partner’s fresh or frozen sperm or with frozen donor sperm.
The live birth rate per cycle is about 8-12%. The likelihood of success with IUIs depends on the type and severity of the infertility problem and the woman’s age. According to California Health and Safety Code Section 1644.5, male partners must be checked for the following infectious diseases before IUI can be performed: HIV (causative agent of AIDS), Hepatitis B & C, HTLV and syphilis (RPR). Sperm donors, whether directed or anonymous, undergo a much more rigorous screening and testing process.
Why Is the IUI Sperm Prep Necessary?
The processing of sperm by gentle centrifugation accomplishes: 1. Removal of the seminal fluid which contains white cells, bacteria and prostaglandin hormones which can cause painful uterine contractions and allergic reaction; 2. Selection of sperm which are most active and vigorous. The active sperm are then suspended in a small volume for placement within the uterus.
How Is the IUI Performed?
The IUI is an office procedure. A small tube or catheter with the sperm is passed through the cervix into the uterus, and the sperm are deposited in the uterine cavity. Most of the time, this is a simple procedure that causes minimal, if any, discomfort. Occasionally, it can be technically difficult and uncomfortable.
IUIs are very safe, but they do carry a small risk of introducing infection into the uterus and tubes. Please do not empty your bladder 30-60 minutes before IUI to facilitate the passage of the catheter through the cervix.
When Is the IUI Performed?
IUI is timed as closely as possible to the day of ovulation. The sperm preparation takes about 1-1/2 hours after collection. On weekdays, the semen collection is usually scheduled in our office at 8:30 am or 1 pm. The IUI is scheduled either at about 10:15 am or 3:15 pm. On Saturday, the semen collection is usually at 8:30 am and the IUI is at 10:15 am. We do not perform IUIs on Sundays.
Semen is usually collected by masturbation in the office. Men who reside close to the office may bring the semen after collection at home in a receptacle provided by our office with proper labeling. We must have specimen within 30 minutes of collection. It is best not to use a lubricant for collection. The man and woman are scheduled separately, so there is no need to wait in the office during the semen preparation. Please remember to bring a photo ID for sperm collection and release.
How Is the Day of IUI Determined?
Urine LH-detection kits and monitors are available without a prescription. A rise in urine LH signals that ovulation will generally occur on the following day. It is better to do an IUI a bit earlier than too late. An LH test is considered positive when the test dot/line is close to, equal to or darker than the reference dot/line.
Ovulation usually occurs 14 days before menses. For example, if you have a regular 28 day cycle, ovulation occurs around day 14 (28 minus 14 = 14). If you have a 30 day cycle ovulation occurs around day 16 (30 minus 14 = 16). We recommend that you start testing about 3-4 days before anticipated ovulation, e.g. day 10 for a 28 day cycle or day 12 for a 30 day cycle. If you are not certain when to begin testing, please ask us when you call to let us know that your period began and that you wish to have an IUI in this cycle.
What if My LH Kit Does Not Turn Positive?
If the kit is still not positive after four days of testing or around the expected time of ovulation, please call the office to schedule an ultrasound to check whether there is a mature follicle in the ovary in which case ovulation can be induced with an injection.
If your reference dot/line does not appear or if it is streaked, you probably need a new kit. Sometimes there is a question whether or not the kit is defective, in which case you need to call the manufacturer. A toll-free number is provided on your kit.
How Do I Schedule an IUI?
Please call us on the first business day after your period begins to let us know that you will be testing for an IUI. On Sunday through Friday you should test between 10 am and 2 pm so that you can call us no later than 2 pm when your test is positive. Arrangements will be made for the IUI the following day. On Saturdays only, you should test by 7 am; if the test is positive leave a message on the answering machine and have your partner come for collection at 8:30 am the same Saturday; your IUI will be done about 10 am.
Please ring the doorbell to the right of door (under plastic case). If no one answers, please wait, we will be with you as soon as possible. If the IUI cannot be done on Saturday, you should have intercourse that day. Please do not empty bladder 30-60 minutes before the IUI.
How Do I Know if the IUI Was Successful?
You can expect a period of two weeks after the IUI if you are not pregnant. If two weeks have passed and you have not started bleeding, please call the office to schedule a blood pregnancy test. HCG tests are usually done in our office on Mondays, Wednesdays and Fridays and blood needs to be drawn between 8:30 AM and 10:00 AM. If you start a period, please call the office, so that we know whether or not to expect you for another IUI. Generally, 3 to 5 IUIs are done before moving on to another treatment.