Ovulation Induction and Intrauterine Insemination Program
OI is often used in conjunction with another treatment called Intrauterine Insemination (IUI). Intrauterine Insemination (IUI) is an office procedure in which the sperm is carefully placed in the woman’s uterus, bypassing the cervix and allowing more sperm to reach the egg. For a woman, having an IUI is something similar to undergoing a PAP smear. The process involves the use of a very thin flexible catheter that facilitates passage of sperm. The procedure takes just a few minutes, and patients are able to return to regular activities immediately after the procedure. IUI may be recommended to increase the probability of pregnancy if a patient has unexplained infertility, male factor infertility (low sperm), problems with cervical mucous, or difficulty with intercourse.
Various IUI treatment options include the following:
- Natural Cycle (using no medications)
- Oral Medication for ovulation induction (e.g.Clomiphene or Letrozole)
- Injectable Gonadotropin Medications for ovulation induction (Follistim, Gonal-F, Menopur, Bravelle)
Your physician will recommend the treatment cycle most appropriate for you. Before proceeding with any of these treatments, it is important that you attend an orientation class lead by one of our Nurse Coordinators where the logistics of the treatment cycle are covered in detail. During the orientation class, you will also be taught how to administer injections which may be necessary to time the IUI and/or to develop the eggs.
Requirements to undergo insemination include:
- Male virology testing.
- Consent for the procedure which must be signed by one or both partners and witnessed by either our clinic staff or a certified notary public.
- A waiver of second or repeat test for Infectious Disease as needed.
It is required that all necessary paperwork be completed and the results of laboratory tests received before the treatment cycle can begin.
Please see below overview of the various IUI treatment options:
1. Natural Cycle
With a Natural Cycle, no fertility drugs are taken. You will begin treatment by calling us on your first day of menstruation (Cycle Day 1) On Cycle Day 9 (CD 9), you will be instructed to begin checking for ovulation using an over-the-counter Ovulation Predictor Kit. When ovulation is detected, you must call to schedule the IUI. Generally the IUI is scheduled the day after a positive ovulation. A pregnancy test is done two weeks later to determine if the IUI was successful.
2. Oral Medicated Cycle
This is the simplest and most common form of treatment used in women who do not ovulate or who ovulate infrequently. It is also a very common initial treatment for couples with unexplained infertility. These medications are in the form of tablets which are taken daily by mouth for five days. Clomiphene and Letrozole are the two more commonly used oral medications. Your physician will determine the medication most suitable for you. Most women do not suffer any side effects with these medications. However, some women may have side effects such as mood changes, bloating, breast tenderness, or hot flashes. Risk of multiple pregnancies depends on the number of oocytes released (which can be predicted by ultrasound) and age.
Baseline ultrasound is performed before starting oral medications. Occasionally there may be an ovarian cyst detected at this time. If a cyst is detected, you will be instructed not begin treatment. If there are no cysts present, you will be asked to take your medication.
A decision making ultrasound will be performed mid-cycle to check for follicular development. When the ultrasound examination suggests that the eggs are mature (usually when the lead follicle size is about 20 mm or greater in diameter), you will be instructed to take an injection of human chorionic gonadotropin (HCG). The timing of the HCG is critical, so it is crucial that you take it at the time instructed. This injection is administered subcutaneously similar to the one used to administer insulin and the method to administer the injection is covered in the Orientation class. Approximately 36 to 41 hours after the HCG injection, an IUI will be performed.
Two weeks following the IUI a pregnancy test is performed to determine if the IUI was successful.
3. Injectable Gonadotropin Medication Cycle
Injectable gonadotropin (FSH) may be the third treatment option recommended by your doctor. To begin this treatment you are requested to call us on the first day of full menstrual flow (cycle day 1). A baseline ultrasound must be scheduled by cycle day 3 to check for possible ovarian cysts in the ovaries. If there are no cysts detected on ultrasound, you will be instructed to begin your gonadotropin injections the evening of CD3. We will teach you to administer these medications yourself or you may choose to have your partner administer them to you. The medications are to be injected subcutaneously (into fatty tissue injection sites) every night until instructed to discontinue.
The next ultrasound performed will usually fall on cycle day 7; this is to monitor the response of the ovaries to the first few days of injections. The physicians will then determine if the dose is appropriate based on the number and size of the follicles seen on ultrasound. The dose may be increased, decreased or maintained. An ultrasound may be performed every 2-3 days later to monitor the growth of the follicles. Once the lead follicle(s) measure at least 16-18 mm in diameter, another set of instructions will be provided as to the timing of the HCG injection to coordinate ovulation induction and the IUI appointment. Ovulation typically occurs 40 hours after administration of the HCG injection.
Similar to oral medications, most women do not suffer any side effects. But it is possible to have bloating, breast tenderness, and other side effects commonly associated with the oral medications. Risk of multiple pregnancies depends on the number of oocytes developing and your age. We may ask you to restrict your activities in order to maintain a pulse rate below 140bpm and avoid exercise activities such as aerobics, running, jogging or cycling. These activities may cause discomfort due to the enlarged ovaries.
We recommend that patients arrive with a full bladder on the day of the scheduled IUI. The IUI procedure is comparable to a PAP smear. Please plan on resting for about 10 minutes after the insemination. You can then return to your usual activities.
Instructions to the Male partner: If using fresh semen, your partner should be available on the day of the insemination. It is recommended that he abstain from ejaculation 2 to 5 days before giving the semen sample. On the morning of the IUI appointment your sample should arrive in the REI lab by 8am to allow adequate time for processing. The semen sample must be received in the REI Lab within 45 minutes of collection. There is a collection room available in the REI Lab if your partner prefers to collect in our clinic. Your partner must be prepared to provide picture identification as well as a legal document verifying name and DOB when he drops off the sample.
Two weeks following the IUI, a pregnancy test will be performed to determine if the treatment was successful. Following two consecutive positive pregnancy tests, two ultrasounds will be performed at approximately 6 weeks of gestation and at 8 weeks of gestation. As the pregnancy progresses, your will be recommended to follow up with your Obstetrician.