IUI: Why to Try, When to Try & What to Expect?
Artificial Insemination also called Intrauterine Insemination (IUI) is a non–invasive and low–cost Fertility Treatment consisting in placing the partner’s or donor’s semen inside the uterus. It is performed in singles and couples with mild factor infertility. For Singles and Lesbian couples, there is an IUI with Sperm Donor. The couples can do IUI using the partner’s/husband’s sperm or use the Donor’s Sperm for Insemination if the partner has severe male factor infertility.
When to try IUI?
- If you have ovulation problems and are undergoing stimulation, especially when timed intercourse has not succeeded.
- If you have unexplained infertility
- If you have mild endometriosis
- If you have mild male factor infertility (such as low sperm count or low sperm motility)
What Steps Does IUI include?
Any IUI cycle standardly includes 10 Steps following each other. For Natural cycles, Step 4 is avoided as the medication is not used. For IUI with 2 Inseminations in 1 cycle Inseminations are performed the day before ovulation and the day of ovulation.
Step 1 – Interview
Any IUI cycle starts with a detailed interview. It can be an online or a face–to–face appointment. Your fertility specialist will study your personal, gynecological and/or andrological history. All tests you have done earlier will be also reviewed. If you have undergone any Fertility Treatments in the past, their results will be discussed. The doctor may request additional tests if necessary and may prepare a Pre–Treatment Screening & Testing Protocol Blueprint.
Step 2 – Offline Consultation
Once you have all the results, you will be offered an offline consultation at a second meeting. Both appointments are included, and both are the initial ones. You will have the follow–up, in which your Treatment plan will be discussed. During the second appointment and the follow–up you will have some basic fertility tests such as:
- Semen Analysis
- Sperm Morphology Test
- Pap smear
- AMH test
- 3D ultrasound scan.
Step 3 – Fertility Testing before IUI
Before any IUI cycle, you will undergo a fertility assessment. It involves a series of tests and a follow–up consult with a fertility specialist.
Step 4 – Ovarian Stimulation
Usually, the Ovarian Stimulation is started on Day 3 of the menstrual period. You will take a fertility medication or injectable hormones that stimulate ovarian follicle growth or a combination of medication and injectable hormones. The whole process lasts approximately between 8 and 12 days, depending on each case. Together with medication and injectable hormones you will be given one more medication to prevent spontaneous ovulation.
Step 5 – Monitoring and Testing
Ovarian response to medication is monitored through 2–3 ultrasound scans performed during 8–10 days and blood tests. Ultrasound scans are done to know when ovulation is taking place.
Step 6 – Trigger Shot
When an ultrasound scan confirms the existence of a follicle sized 18 to 20 millimeters and the uterine lining is at least 7mm, Ovulation is induced by injecting hCG hormone. It is called a Trigger Shot and it is given to trigger Ovulation. In 36 hours after injecting hCG (human Chorionic Gonadotropin), Insemination will be performed.
Step 7 – Sperm Preparation
On the Day of insemination, 2–3 hours earlier, the husband or partner should provide a sperm sample to the laboratory. Before being used, sperm needs to go through a semen capacitation process to enhance its quality. Capacitation consists of selecting the spermatozoa with the greatest fertilizing potential.
In case of IUI using the Donor’s Sperm, the donor’s sperm samples are selected according to a woman’s blood type, Rh, and phenotype (physical characteristics) and thawed before IUI.
Step 8 – Insemination
Insemination is done in 10 minutes maximum. IUI catheter will be positioned inside the uterus before introducing the sperm–loaded inner. Once the sperm sample is ready, it is deposited in the IUI catheter and transferred into the uterus. If you selected IUI with 2 Inseminations in 1 cycle: the one insemination will be done the day before ovulation and the second one on the day of ovulation.
Step 9 – Fertilization
After Insemination, Fertilization occurs naturally, in the Fallopian Tube. Once released, the oocyte is directed through the Fallopian tube towards the uterus with the mission of being fertilized by the sperm. The sperm sample deposited into the uterus remains there until the oocyte that has just ovulated joins the strongest spermatozoa in the fallopian tubes. And if sperm penetrates the oocyte successfully, the magic of fertilization occurs.
Step 10 – Pregnancy Test & Ultrasound Scan
A urine pregnancy test is done 2 weeks after Insemination. B–hCG pregnancy test is done from the following day of the expected first day of your period. And if the B–hCG pregnancy test is positive, an early pregnancy ultrasound scan will be scheduled on week 6 to determine the heartbeat.
5 Side–Effects of IUI to Know
From Hot Splashes to Ovarian Cysts. And Yeah, this may happen.
The most common side–effects of taking fertility drugs include Hot flushes, Dizziness, Nausea, headaches or visual disturbances, Bloating, Breast tenderness, Pelvic discomfort, Mood swings, Depression, Swollen and painful ovaries, indicating Ovarian Hyperstimulation Syndrome (OHSS), Ovarian cysts, and Swelling or a rash around the injection site for injectable hormones.
Cramping.
Cramping before IUI may indicate Ovulation. If you are ovulating multiple follicles, usually from taking medication to induce ovulation, this may worsen ovulation pain or/and cramping. Cramping during Insemination usually happens while the IUI catheter is being passed through the cervix inside the uterus, and while the sperm is being injected. Cramping after Insemination happens if the uterine catheter irritated the uterus. Cramping a few days after IUI may signal embryo implantation or you will have your period.
Spotting.
Spotting may happen while the catheter is placed in the uterus. And Spotting may happen a week or two after undergoing the IUI procedure. Post–IUI Light Spotting may indicate embryo implantation. And Post–IUI Heavy Spotting may indicate a miscarriage.
Infection.
There is a small risk of introducing bacteria or a virus into the uterus which can cause infection following IUI — less than 1 percent per 10,000 IUI cycles. Infection is introduced in two ways: first, in passing the IUI catheter through, the bacteria might be picked up and introduced into the uterus, and second, the semen may carry an infectious agent. To prevent introduction of the infection, many Fertility Clinics typically administer a prophylactic antibiotic at the time of the Insemination.
Multiples, Multiples, Multiples. Twins, Triplets, Quads, and even more...
Multiple pregnancies are the most common risk associated with IUI Treatment as taking fertility drugs increases the risk of multiple ovulation (hyperovulation). In case of hyperovulation, two or more oocytes are released during the single ovulation cycle. And if fertilized successfully, this may lead to multiple gestations. So, IUI may result in Singleton, Twins, Trips, Quads, and even more...