IUI
Intrauterine
Insemination

IUI - Intrauterine Insemination... Intrauterine Insemination is the depositing of sperm into the cavity of the uterus using a fine plastic catheter. The technique is used with other infertility treatments in order to maximize the chance of pregnancy for many couples with infertility. Before semen can be injected into the uterine cavity it must be "washed." Sperm washing is the process of separating the sperm from the rest of the seminal fluid which makes up 95% of the volume of the ejaculate. This is usually done by mixing semen with media and spinning the sperm into a pellet, then re-suspending it in media. Once the sperm washing is completed, a small plastic catheter attached to a syringe is used to inject the sample. This is done in an outpatient department. No preparation is required before the procedure is performed. A speculum is place in the vagina (similar to a PAP smear) and the catheter is fed up through the cervix (the opening of the uterus) and into the endometrial cavity. Once the tip of the catheter is in the endometrial cavity, the washed sample is injected. Success Rate: The chance of success can be measured in many different ways. However, the most meaningful method quotes the chance, if treatment is started, that a baby will be taken home. With this treatment the overall "take-home baby rate" is 17% per cycle. The pregnancy rate experienced with this treatment is remarkable considering many couples have already tried Clomid with intercourse. The exact reason for this is not known. It may be the addition of the IUI procedure itself, but may also involve the more intense monitoring of your cycle. (You have to also know that with a healthy couple in the mid-20's only has a 25% chance of conceiving in any given cycle. This makes humans the least reproductive). Monitoring: You would inform the clinic when af arrives...Day 1. Day 3 you would go for blood work which consists of FSH, LH, TSH and Prolactin. (FSH is follicle stimulating hormones; LH is the lutenizing hormone, TSH is thyroid stimulating hormone.) Days 3-7 or 5-9: you would likely take Clomid Day 10-12 - Daily monitoring of blood to watch for the LH surge and estradiol levels. They may also do vaginal u/s. With estradiol levels they are watching for the point at which there is approximately 750-1000 units of estradiol for every mature follicle. A mature follicle is one which measures 1.8-2.3 cm at the time of u/s monitoring. It is important to realize that every woman's blood level and number of follicles will differ. Once the LH surge is detected, you may have an hcg injection (Profasi, Pregnyl) to make the egg release and generally the IUI is scheduled for 36-48 hours after the hcg injection. If not requiring an hcg injection, then typically the IUI will take place 48 hours after the LH surge is detected. Once the insemination is finished, nothing will be done until (this is just what my sheet states) 18 dpiui, when a blood test will be done if af hasn't arrived. A home pregnancy test should not be performed before 14 dpiui due to the hcg injection and you may have a false positive. You can continue with normal daily activites and unless dh has a sperm problem (low counts) you can continue to have intercourse. IUI is extremely safe. When the sperm are injected into the uterine cavity, many women will experience mild, short-duration cramping. However, there can be some side-effects and risks. They are as follows: Occasionally (less than 1 in 2-500 inseminations), a reaction will occur to the semen when it is placed in the uterine cavity. Believed to occur because small amounts of "prostaglandins" remain with the sperm despite the washing process and is referred to as a "prostaglandin reaction." Some women may also be more sensitive to small traces of these prostaglandins. If this reaction occurs it can be easily treated and steps can be taken with the next insemination to minimize the chance of recurrence. Rarely (less than 1 in 3-10,000 inseminations), an infection can be introduced into the uterine cavity during the insemination. This will present and increasing pelvic pain in the day or two after the insemination. It is sometimes accompanied by a vaginal discharge, fever or chills. If any of these symptoms occur after an IUI, you should contact the clinic immediately. Prompt treatment will usually lead to an uneventful recovery. Sometimes spotting will occur after the insemination. This happens because of an injury to a small blood vessel on the cervix at the time of the IUI. It will resolve by itself and does not decrease the chance of pregnancy. Ovarian hyperstimulation syndrome (OHSS) may occur after treatment has been completed and reaches its maximum on the seventh to tenth day after hcg administration. (Incidence is low.) Symptoms may progress rapidly. Early warning signs are: severe pelvic pain, nausea, vomiting, weight gain, and may progress to abdominal distension, diarrhea, severe ovarian enlargement, shortness of breath and decreased urine output. Patients with any of the above symptoms should call the clinic right away. If more than one follicle ovulates, a multiple pregnancy may occur. (Chances of twins are only 5%-10% and more than two is even lower). In addition an embryo may implant in the fallopian tube. The resulting ectopic pregnancy requires medical or surgical removal, since it can neither remain in the tube nor be transferred back into the uterus. Ovarian Cancer - A casual relationship between use of Clomid and ovarian cancer has NOT been established. There has been a very small number of stuides that have reported ovarian cancer after treatment with fertility drugs. Usually treatment is reviewed after 3 cycles of IUI even if everything appears perfect. If a cycle doesn't result in a pregnancy, this is disappointing, but doesn't mean that the treatment needs to be chanced. Costs: I cannot cover this because too many states and provinces have different insurance coverages and also prices. However, it seems quite reasonable as a next step into "medium technology treatment. If I've forgotten anything, please forgive me. I have a stack of papers and tried to compile them into one and hopefully it makes sense. I have used Clomid as an example and does not necessarily mean that will be the medication they use for everyone. As a general rule, I believe they start with Clomid. Lynn aka Lexi

Well I’m still trying to wrap my mind around a positive pregnancy test!! I come to this site occasionally for inspiration, so I thought I would post my story for someone to get a bit of hope! I stopped using BC when I was about 17 I’m now 30. My husband and I have been together since 2001 and never used protection. I’ve never had a miscarriage or never really even thought I was pregnant. AF has always been right on time!! In 2006 shortly after we were married I went to my OB/GYN and he put me on Chlomid for about 6months, nothing! Time for more tests, had my plumbing checked and … all open and flows properly. In March of 2007 I was sent to a fertility specialist. I had surgery, an adhesion of scar tissue holding my ovary down but nothing not even a spec of endometriosis! It was official I became “unexplained!” I took some time thinking there is nothing wrong with me, nothing wrong with my husband, maybe it just wasn’t the right time for us….it will happen when the time is right. Once December 2008 came around I’m now 30 and still nothing! Time to bring out the big guns!! In January we started “super ovulation therapy” which consisted of shots of Gonal-F, a trigger shot on day 12 and IUI on day 14. The day before I was suppose to take my pregnancy test I got my visitor! We took the month off and started round 2 in March, same ammo. This time we increased the doses toward the end then dropped it back down on day 11 and 12, trigger shot on day 13 and IUI on day 15. I’m now about 6 weeks pregnant and due sometime around the 15th of December!! We have our first ultra sound on April 28th. My HcG levels were 241 on April 9th and 539 on April 11th! Doc says its possible we might have twins in there!! Good Luck..and don’t give up on your dream! ~ DJ. A ~

Posted By: Liz F. My IUI was today! I am looking for IUI success stories to keep me optimistic I have 3 mature eggs and one egg that may have matured by today's IUI. DH's post wash count was 44 million with 96% rapid motility! The docs said everything looks great for this cycle, except that I am at high risk for OHSS due to extremely high levels of estrogen. The good news there is that women who develop OHSS also tend to get PG!! So, who wants to tell me how they got PG with an IUI, or tell me about a friend who did??? Thanks, LizF Liz, I'll tell ya. I'm an IUI success! The cycle I got pg I was on 100 mg of clomid. My RE did blood draws to watch for a natural LH surge. We got it on CD 14 and I had the IUI on CD 15. I was crampy that day and a little the next and then I felt fine. The next few days DH and I were out of town so I didn't temp but when we got back I did and my temp was the highest ever for me--98.8. I don't remember any implantation spotting and I felt exactly like I did every other month-- a little crampy, bloaty, sore boobs--just like AF was coming. I tested about 10dpIUI and got a negative. On 13dpIUI I had a tiny bit of spotting so I figured AF was definitely here. The next day I wasn't flowing so I decided to get it out of the way and test. I did an hpt and then got in the shower. When I got out I looked and saw a very definite +!! This was the only IUI I had. Is this your first? I'm hoping that it will definitely mean success for you Liz!! I'm hoping you'll be on the alumni board very soon!!! Extra big good luck wishes to you!!! CK Posted By: CK - 13w4d EDD 5/16 Liz, I am one of those... (m) Posted By: Regina, 24w 2d, edd 03-02 who got pg with IUI. It happened on the 3rd try with 100 Mg of Clomid. I did not feel physically anyhow different that month, except I had that voice "IT IS THE MONTH!" in me :))) LOL I'll keep my fingers crossed for you! And a little piece of advice, if I may - start taking prenatal vitamins (Folic acid is important) if you didn't yet. I wish this month to be the month for you!!!!!! Take care, R ~~~~~~~~~~~~~~~~~~~~~~~

I got great results from my HSG and lap so now it's on to an IUI and Pergonal Clinic in Kingston, Ontario. Has anyone taken Pergonal and/or had an IUI?? Specifically anyone in Canada. I was wondering what to expect from it and how much it will cost us. Thanks for your help! Erika Hi Erika.... I'm a Canadian too (living not too far from you - about 4 or 5 hours LOL). Anyways, the information I have is this: For Pergonal it would cost about $46.20 (plus dispensing fee) and the IUI itself generally runs about $150 (which should include sperm washing and insemination). I am not experienced with pergonal but I would assume it would be similar to iui with clomid... so read the IUI section (this page).... if you have any more questions, feel free to post them... I'm usually around here LOL! Lots of luck to you. Lexi ~~~~~~~~~~~~~~~~~~~~~~~

Toronto Centre for Advanced Reproductive Technology (TCART)