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
