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Intrauterine Insemination (IUI)

 
Intrauterine insemination (IUI) is a form of therapeutic insemination (TI) using the husbandís (AIH) or donor (AID) sperm. Therapeutic insemination has been used as treatment for infertile couples for many years. More recently, IUI has become an option for many couples prior to considering more complicated and expensive assisted reproductive treatment such as in vitro fertilization (IVF).
IUI involves bypassing the cervical mucus barrier and depositing a concentrated population of motile spermatozoa, washed free of seminal plasma, directly into the uterus. This is performed as close to the time of ovulation as possible. Many different sperm washing techniques can be used, e.g., Percoll separation, chymotrypsin treatment, buffered wash, ìsoftî wash, etc. The choice of technique will depend on the quality of semen to be processed.
 
INDICATIONS FOR IUI:

Male Factor: Indications

  1. Decreased sperm counts
  2. Decreased sperm motility when sperm processing appears to correct the defect
  3.  Decreased sperm quality, e.g., clumping or hyperviscosity
  4. Disorders of sperm function, e.g., defective egg penetrating ability as determined by laboratory testing (sperm penetration test), where increasing sperm concentration or special processing of the sperm (Percoll separation) appears beneficial
  5. Defects of the penis, e.g., hypospadias or severe penile curvature.
  6. Retrograde ejaculation or other forms of ejaculatory dysfunction, e.g., spinal cord injury patients who need electroejaculation.

Female Factor: Indications

  1. Scant or unreceptive mucus
  2. Persistent cervicitis.
  3. Cervical stenosis
 
Unexplained Infertility

Donor Insemination
IUI is now being used in infertile couples demonstrating abnormal male or female factors, or both. 
Since government guidelines recommend the use of only frozen sperm for insemination, we must act accordingly. In addition, we have found that using IUI results in an increased pregnancy rate and requires fewer sperm per insemination.
SUCCESS RATE:
Data from several programs has indicated success rates for IUI with husbandís sperm ranging between 5%-40%. Most agree that there should be a period of at least six months with documented ovulation and accurately timed IUI before treatment is considered a failure and an alternate therapy is considered. IUI with donor sperm has a range of success between 40%-70%.

SPERM PROCESSING:
  1. The goal of sperm processing is to select a fraction of highly motile, morphologically normal sperm, as free of inflammatory cells (white blood cells), debris, and seminal fluid as possible.
  2. Several methods exist for processing spermatozoa from the ejaculate, e.g., swim-up, buffered washing and Percoll gradient separation.
  3. Seminal plasma contains prostaglandins which may cause uterine cramping when placed directly into the uterus; processing markedly decreases these contaminants.
  4. The method for processing the sperm will be decided by your doctor prior to the time of insemination.

TESTING:
Certain testing is required for patients undergoing both husband insemination and donor insemination. All couples will be required to have an HIV drawn before insemination can begin. This can be done in our office. For donor insemination, there will be other tests performed, and those are detailed on a separate attachment.

 
SCHEDULING SEMEN PROCESSING AND IUI:
Accurate timing of ovulation is crucial to achieving a pregnancy with IUI. Several methods can be used to determine the time of ovulation: basal body temperature monitoring (BBT), ovulation predictor kits (e.g., Ovuquick™), and follicular ultrasounds. It is highly recommended to use follicular ultrasounds and an additional ìat homeî method to help determine the time of ovulation. Your gynecologist most commonly will decide how ovarian monitoring will take place.
 Ultrasounds and a tentative date for the IUI will be scheduled. Depending on the ultrasound reports, the IUI may need to be rescheduled within a day or so of the tentative date. Working closely with our office will help alleviate any misunderstanding and allow for accurate timing of the insemination.
Semen processing takes at least one hour. Due to the fact that several couples may need IUIs on the same day, it is essential to be as prompt as possible and to keep your scheduled time for processing and IUI unless otherwise pre-arranged.
The semen specimen is collected in a sterile container at home or in the office. If you need to transport the specimen, it should be kept warm (e.g., in your pocket) and transported as quickly as possible (within an hour). Sterile containers are available from our office if needed.
If the IUI is to be performed in our office and the reason for IUI includes a female factor, we will work closely with your gynecologist. He may recommend medical treatment, e.g., Clomid and/or human chorionic gonadotropin (hCG). Any other problem which may be identified at the time of the procedure will be promptly related to him for his evaluation or treatment.

THE PROCEDURE:
It is usually painless, simple, and quick. After the specimen has been processed, it will be placed directly into the uterus using a small catheter which passes the cervical canal. A special sponge will be placed in the vagina and will be removed by you after five hours. You will remain in the procedure room on your back for about 15 minutes; you will then leave and can resume normal activity. It is recommended that you not perform high-impact aerobic activities or heavy lifting until pregnancy has been determined.
On rare occasions, slight bleeding may be noted and some abdominal cramping. Very rarely, infections or allergic reactions may result from an IUI. Allergic reactions in response to insemination, although exceedingly infrequent, may range from vaginal itching to generalized anaphylaxis.

 
INSTRUCTIONS FOR IUI
  1. When you show a positive color change on your ovulation predictor kit, plan on coming in that day or the next for the first of your two inseminations. This timing will depend on your individual situation, and the nurse will indicate which day.
  2. If you are going to receive a human chorionic gonadotropin (hCG) injection, we usually time your inseminations at 24-48 hours after the injection.

IUI PROCEDURE:

  • The IUI procedure is usually painless and of short duration. After the specimen has been processed (e.g., washed), it is placed directly into the uterus using a small catheter. You will be asked to stay on your back in the procedure room for about 10-15 minutes. Afterward, you may resume normal activity. We do recommend that you keep activity at a low impact level and maintain a healthy lifestyle.
  • On some occasions, slight bleeding and abdominal cramping may be noted. This is normal and should cause no alarm.
 
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