Intra-uterine insemination (IUI)
IUI is recommended for patients who suffer from:
- Unexplained infertility, usually of more than 3 years duration
- Problems with ovulation (release of the egg)
- Poor/hostile cervical mucus at the time of ovulation. (i.e. poor mucus quality or anti-sperm antibodies in the mucus)
The aims of the treatment are:
- To increase the number and quality of eggs produced in a cycle to 2 or 3 by the use of gonadotrophins (i.e. Menopur, Metrodin, Puregon, Gonal-F)
- To prepare and use the best sperm available for treatment
- To place sperm directly into the womb thereby bringing the sperm and eggs closer together (intra-uterine insemination) and also bypassing the cervical mucus
IUI Treatment schedule
The fertility sister or fertility nurse on duty will ensure that you understand the treatment and provide guidance on and teach you how to perform the simple injections.
This is always offered before you begin your fertility treatment. It is not compulsory but we do strongly encourage couples to have some form of counselling as treatment can be very stressful and emotional. The stresses and strains of the treatment and ways of coping are explored and discussed.
More information is available on the Counselling page.
This will be worked out at a clinic appointment with your specialist in infertility. The treatment will be explained again and you will be informed of your initial drug dosages.
A letter concerning your medication will be sent to your GP.
This term is used to describe the whole process of controlling a woman’s hormones and therefore her egg production during treatment.
It consists of the following steps:
a. Down regulation or de-sensitisation
Nasal spray (GnRH-agonist, usually Nafarelin) to stop the body interfering with the artificial stimulation of the ovaries. This process is often referred to as down-regulation or de-sensitisation. The side effects of this drug are hot flushes, mood swings, breast tenderness and vaginal dryness. You may also take a pill initially or have a large injection instead of sniffing.
b. Ovary stimulation
The ovaries are then stimulated to produce follicles (which contain the eggs) using drugs known as gonadotrophins (i.e. Menopur, Metrodin, Puregon, Gonal-F). The drug is provided in powder form and dissolves when mixed with sterile water. The resulting solution is injected just under the skin. A special injection gun is provided. Injections of these drugs continue until the right number of follicles have been produced.
c. Monitoring egg development.
Monitoring of the development of the follicles (and therefore eggs) is an extremely important part of ovulation induction and is done in two ways:
These are carried out in the Fertility Unit both to assess the development of the follicles and check the thickening of the lining of the womb (endometrium). The scan uses a small plastic probe which is inserted into the vagina to get the best possible picture of the ovaries and follicles. The number of follicles and their size is measured, usually on days 8,10 and 12, although the exact day varies depending on how the follicles are developing. For most women vaginal ultrasound tests are not uncomfortable and only take a few minutes. A baseline scan is also required at the beginning of each cycle to ensure proper down-regulation.
These measure the concentrations of a hormone known as Oestradiol (an oestrogen) in the blood. This is another way of measuring the level of stimulation and helps us to avoid a condition known as Ovarian Hyperstimulation Syndrome (OHSS) which can be an unpleasant side effect of treatment. These blood tests are carried out before stimulation injections start, usually after sniffing Nafarelin or Buserelin for three weeks; this is known as the baseline blood test. There are usually blood tests on the 8th and 12th days and the day before the hCG booster. Patients are asked to have blood tests before 10am so that the results can be acted upon on the same day.
d. HCG booster injection
This injection of HCG (Human Chorionic Gonadotrophin- Profasi or Pregnyl) is given when sufficient follicles reach a size of about 16 millimetres. It causes the eggs in the follicles to mature and the follicles to rupture and release the eggs (ovulation), approximately 40 hours after injection.
This takes place approximately 40 hours after the HCG injection. The insemination technique is very quick and painless and needs no anaesthetic. The male partner is asked to produce a sample at the unit about two hours before the insemination. This is then prepared by the swim-up method. The most active sperm are removed and prepared. The sperm preparation is then gently injected directly into the womb using a fine tube (catheter) passed through the vagina. You will be asked to rest for 10-15 minutes following the insemination.
This comes in the form of Cyclogest pessaries or Gestone injections of progesterone. This hormonal support is necessary because of the previous down regulation (sniffing) which stopped hormone production. Other than using the pessaries or injections, there is no need to do anything differently after insemination. We do advise a couple to have intercourse regularly following the IUI because this maximises the chances of a pregnancy occurring.
What do I do now?
Following the IUI the patient should quite simply wait and try not to worry. If you haven’t had a period after 2 weeks you should perform a urinary pregnancy test. Similarly, if you start to bleed you should inform the Unit and still have a pregnancy test. If a pregnancy test is positive an ultrasound scan will be booked for you one month later.
Pregnancy following insemination
The progress and outcome of any pregnancy following IUI is no different from natural conception. There is no higher risk of abnormality; in fact the risk is no greater than that found in the general population. If you become pregnant you will go into the mainstream of antenatal care.