Fertility 101: Treatment
Artificial Insemination: Intrauterine Insemination (IUI)
(Male partner or husband)
Definition:
Insemination is the process of the direct transfer of washed sperm by a thin spaghetti-like catheter into the intrauterine space thus bypassing potential vaginal-cervical sperm barriers and increasing sperm concentration near the site of fertilization (in the fallopian tubes). IUI is almost always combined with superovulation with gonadotropins and less frequently with clomiphene citrate and letrozole. Intracervical inseminations are no longer performed due to higher pregnancy rates with IUI.
FREQUENTLY ASKED QUESTIONS (FAQ):
For the male, why should you do this?
IUI may be helpful in two main respects. First our andrology lab will perform an analysis on your specimen. Although a morphological analysis is not done at this time we will be able to comment on several aspects of your sample. Secondly the pregnancy rates are higher with this technique than with sexual intercourse. The increased pregnancy rates may be the result of improved timing, a result of placement of millions of washed motile sperm into the uterine cavity, or another undetermined factor that may activate the sperm.
Please don’t “store up” for several weeks or days to produce a “super specimen”. If ejaculation does not occur on a regular basis then the quality of the specimen likely will deteriorate. This may be due to the consumption of glycogen and other nutrients by the sperm in your genital tract. In fact we recommend that you have intercourse the night your wife takes her HCG to trigger ovulation. If, as a couple, you have decided to undergo two inseminations it is best to refrain from ejaculation on this day and instead do the insemination approximately 12 and 36 hours after HCG. In the case of a single IUI see timing instructions below.
In most cases you can collect at home by engaging in intercourse with use of a special condom (ask us for one) or from ejaculation into a sterile container. If your wife brings in your specimen please give her a note signed by you stating that this is your specimen and that you are aware that it is to be used to inseminate her. This is for your protection. If you live over 30 minutes away we encourage you to use one of our collection rooms. These are private and away from the main activities of the clinic.
Why don’t you combine insemination with ultrasound monitoring in a non medicated cycle?
It does not significantly increase pregnancy rates and its expense and low pregnancy rates in this setting do not warrant it to be done. We will occasionally combine insemination with a clomid cycle especially if we note more than one mature follicle on ultrasound.
When is the best time to do insemination?
When doing a single insemination it is best to take the trigger dose of HCG approximately 36 hours before the insemination. If you are going to do two inseminations please do the IUI 12 and 36 hours after the trigger dose of HCG.
What happens if the IUI catheter will not go into my uterine cavity?
Rarely can the nurse or doctor not pass the catheter. If they have difficulty but are able to pass the catheter and you fail to conceive, then you should consider having your cervix dilated in the office between day 4 and 10 of your next cycle. We will often prescribe misoprostol (to dilate your cervix) and pain medication to facilitate the dilation process.
Should I do one or two inseminations?
It is most common to perform one insemination per cycle at approximately 36 hours after trigger HCG. While pregnancy rates are higher with two inseminations the rate is not significantly higher. If you elect to do two inseminations please alert our staff so that we will be prepared for your two visits to the office.
Should I have intercourse after having done an insemination?
Please engage in normal sexual activity during the course of the medicated cycle. If doing one insemination, we recommend that you have intercourse on the trigger day of HCG. If two inseminations are planned then it is best to not undergo coitus the night of trigger HCG since the male partner will be producing two specimens over the next two days.
Should I take any medications after my insemination?
We usually recommend that you take progesterone starting two days after your insemination. This will be prescribed as a 50 mg vaginal suppository (PVS) and should be used at night for 14 days. If you do not experience a period then check a pregnancy test. If negative then stop the progesterone and wait a cycle. If positive please continue PVS and obtain a blood pregnancy test to confirm the HCG level.
Are there any side effects or risks associated with insemination?
At the time of insemination you may note an efflux of some of the specimen out of the vagina. The uterine cavity will only hold certain amounts of specimen so don’t worry if this occurs. Some women will experience cramping after insemination. This is due to some of the prostaglandins that remain in the sample despite washing. Do not use aspirin or Motrin like products for cramping as this may affect ovulation or implantation. Instead use Tylenol for cramping. If you experience a sustained fever after insemination then you should be seen in the office or emergency room.