Intrauterine Insemination (IUI)
Intrauterine insemination (IUI), also sometimes called “artificial insemination’, involves placement of sperm following separation from seminal fluid into the uterine cavity. An IUI is useful for women who have structural problems, when the cervical mucus is unreceptive, when donor sperm are required, when the male partner’s semen contains very low numbers of sperm, or when unexplained infertility exists in both partners. In the comfort of our clinical setting and under ultrasound surveillance, millions of sperm are placed directly into the uterus via a special catheter when the woman is most fertile.
Candidates for IUI include:
- Couples with no known cause of infertility but have been trying for more than one year
- Women with ovulatory disorders, such as PCOS
- Women using donor sperm due to male factor infertility (MFI)
- Women with mild endometriosis
- Women without a male partner who use donor sperm
The IUI may be performed with or without the aid of fertility drugs. When drugs are used, the cycle is referred to as “controlled ovarian hyperstimulation” or COH. Both IUI and COH generally result in higher pregnancy rates.
Depending on the age of the patient, up to four IUI cycles are recommended by our center before moving on to the more advanced method, IVF.
How An IUI Is Performed At Our Center
In order to prepare for intrauterine insemination, a woman usually takes fertility drugs in advance. The goal is to increase the number of eggs that the patient ovulates in order to increase the chances that she will ovulate a good egg.
- Clomid Induction Cycle With IUI
If the patient under 35 years the treatments may begin with Clomiphene Citrate or as many know it: Clomid. A patient is not automatically placed on Clomid without finding the root cause of their infertility. Patients come to our clinic after having had multiple IUI’s with Clomid without success. It is not a magic drug and can cause infertility if misused.
The purpose of Clomid is to get the ovaries to function normally. It will regulate a woman’s ovulatory cycles and a patient will ovulate by cycle day # 14. Clomid often shortens the follicular phase (first two weeks), if an appropriate dose is used. Clomid can be given in doses from 50 mg to 250 mg. It is up to the physician to find what the lowest appropriate dose is and that is done by trial and error. By checking diligently with the ultrasound, Dr. Ramirez will know exactly how the patient is responding. Ideally, in Clomid cycles a physician does not want to see more than 5 ovulatory sized follicles. The patient will not be allowed to do consecutive months with Clomid because it blocks estrogen receptors and can lead to poor endometrial lining and poor cervical mucous. Clomid is one of the most misused drugs in the United States.
- Superovulation With IUI
Superovulation with fertility drugs are recommended for those women with PCOS (polycystic ovarian syndrome), since the ovary does not function correctly and therefore does not ovulate on a regular basis. Also, for those patients over 35, Dr. Ramirez’s goal is to have them to ovulate 3-5 eggs per cycle, so superovulation with injectable fertility medications is also a reasonable first step. Because of declining fertility after 35 years, we strongly advise our patients pursue an aggressive treatment plan. We usually do not recommend more than 4 IUI cycles as part of an aggressive treatment plan because studies have shown that most patients will get pregnant within four attempts and pregnancy rates decrease dramatically after four. After 35, a woman’s pregnancy rate per IUI cycle is only 12%.
The IUI Procedure
Since with IUI the goal is to get the patient to ovulate three eggs per month (that is what increases the pregnancy chances) it is important to monitor a patient’s progress. The doctor uses an ultrasound machine to gauge the woman’s progress and time when the insemination should be performed. When the ovulatory follicles reach appropriate ovulatory size (18-24 mms), then a hormone injection such as HCG is given to trigger ovulation. The couple is scheduled to come in for two consecutive days at this time. One hour prior to the IUI, if there is a male partner, he will be required to provide a semen sample. This can be done in our private, comfortable collection room. (If donor sperm is being considered, please see the Donor Sperm IUI & IVF page for more information.) The semen sample is “washed”, using precise laboratory procedures, and then inserted through the cervix and into the uterus by way of a long, thin catheter. The procedure is quite painless and quick, similar to a PAP exam.
Most clinics and Ob/GYN’s will only do 1 IUI at 32-26 hrs. Dr. Ramirez is unique in his belief that he can achieve greater success in doing two IUI’s at 24 and 48 hrs from trigger. He will also come in to do IUI’s on weekends, so as not to “cancel” the cycle. As a result, his success rates with IUI’s are very high. For the patient, the IUI cost tends to be much, much less than IVF because there is less technology used. Yet, one must keep in mind that doing too many IUI’s can be equivalent to the cost of one successful IVF cycle. If the patient does not achieve pregnancy by four attempts, studies have shown that the pregnancy rates decrease dramatically so it is recommended to proceed to IVF from there.
Success rates for IUI depend largely on the cause of infertility and the woman’s age. Dr. Ramirez does not believe in denying any of his patients the right to at least try this procedure, even if the woman is of advanced reproductive years. If the woman is under 35, her husband’s sperm count optimal and the woman’s fallopian tubes are healthy, then pregnancy rates for IUI with COH can be as high as 24% per cycle. Over the age of 35 rates will go down because of the age of the eggs.