Intrauterine insemination (IUI) is a procedure which places washed sperm into the uterine cavity by passing a small plastic tube through the cervical opening. IUI is performed just prior to ovulation. The indications for IUI include: an abnormal post coital test (mild male factor infertility), low sperm count, or unexplained infertility. The initial sperm sample submitted for IUI will be tested for sperm antibodies.
The timing of IUI may be determined in one of several ways. An ovulation predictor kit is the most useful method and we recommend “Clear Blue Easy”. The kit instructions are easy to follow and this simple urine test will forecast ovulation to occur one or two days after the “kit change”. IUI may be performed on the initial day of kit change or the following day and in our experience the resultant pregnancy rates are the same.
In a small percentage of people, the predictor kits do not provide clear information on ovulation timing. These patients are instructed to come to our office at mid-cycle for an ultrasound evaluation of the ovaries (to visualize the ovarian follicles) and possible administration of a drug to stimulate egg release (HCG) and IUI will be timed accordingly.
The third method of timing is controlled by gonadotropin (FSH, HMG) therapy. Patients receiving gonadotropins for ovulation induction will also receive an HCG injection to stimulate egg release and time the IUI.
There is no advantage to prolonged abstinence from ejaculation prior to IUI. Abstinence for long periods may actually lower specimen quality. Two to four days of abstinence is ideal. The husband will collect a sterile semen sample in our collection suite at the Outpatient Care Center.
The semen specimen for IUI is washed with a physiologic solution and concentrated, a process which takes approximately one hour. The insemination only takes a few minutes and involves a speculum being placed into the vagina in order to visualize the cervix. The sperm sample is drawn up into a thin tube, which is then passed through the cervical opening and placed in the uterine cavity where the sperm are deposited.
A few IUI patients may experience cramping during the IUI procedure. Once the IUI is completed, patients rest for approximately 20 minutes and are then free to go about their usual activities.
Sperm antibodies are an uncommon, but real, problem affecting some men. The first time our lab washes and analyzes a man’s sperm sample, a screening test for sperm antibodies is performed (ASAT test). There is an additional charge for this test and it is done only once.
Prior to beginning IUI, we recommend (but do not require) the husband be tested for the presence of HIV and also Hepatitis B and C. The purpose of these tests is to reduce the risk of disease transmission since IUI is different from intercourse in this regard. We recommend that the husband have these tests repeated yearly, or more often, if medical treatments like blood transfusion or high-risk behaviors are engaged in, such as intravenous drug use or a new sexual partner, that increase the risk of acquiring these diseases. Carrying out this additional testing is the patient’s responsibility. Please notify us at least one week prior to an IUI that testing is requested and we will make arrangements for it to be completed.
There is an extremely low risk (<1%) of uterine-tubal infection following IUI. Sterile physiologic solutions are used to wash the sperm prior to IUI. The presence of protein in these solutions improves the yield of motile, useful sperm. The protein used for this purpose in our laboratory is human serum albumin (HSA). HSA is derived from the non cellular component of human blood, which has been sterilized and purified based on current state-of-the-art-knowledge. Blood donors are screened in accordance with current Centers for Disease Control Guidelines including points of medical history related to the possible risk of Creutzfeldt-Jakob disease transmission. There has never been a documented case of disease transmission related to the use of HSA.
The IUI appointment secretary can be reached at (434) 982-8520. If an ovulation detector kit is used to pinpoint ovulation, call the appointment secretary when the kit shows a color change. It is best to call between 8:00 am and 9:00 am. IUI will be scheduled for that day, or the following day, depending upon the number of IUIs already scheduled. When HMG ovulation induction is done, other medications are used so that urinary testing is not necessary. The physician will recommend the best day for the IUI based upon several factors including the appearance of the ovarian follicles on ultrasound.
IUI is available 362 days a year. IUI is not available on Thanksgiving Day, Christmas day or New Year’s Day. Since the chance for pregnancy is the same with IUI performed on the first day of ovulation predictor kit change or the day after, we can work around these three holidays without any problem.
If the kit changes by 8:00am on Saturday morning, IUI will be performed that day. Call our usual appointment number (434) 982-8520 between 7:00am and 8:00am to have the IUI done that day. Our answering service will take the message and notify the doctor who will return the call. Patients calling after 8:00am will usually have their IUI scheduled for the following day.
If the kit changes on Sunday, IUI can be performed on Sunday or Monday with equivalent pregnancy rates. To have the IUI done on Sunday, phone in as above, or if Monday is a better day call in at 8:00am on Monday.
There may be a higher pregnancy rate with more than one IUI per cycle. We suggest starting out with one IUI. If pregnancy has not occurred after 2 or 3 treatment cycles we can go to two inseminations or we can start with 2 IUIs. If an ovulation predictor kit is used, the inseminations are done on the first day of kit change and the following day. Patients undergoing drug therapy, such as FSH ovulation induction, will be advised of IUI timing by the physician or nurse.
We realize that producing a sperm specimen for IUI may be difficult due to the environment. We do have a collection suite that is quiet and has photographic materials to assist. If you prefer to collect at home it is possible. Collection kits are available at our office and must be used to collect the sample. The sample should be collected exclusively by masturbation (not interrupted intercourse). If you collect at home the specimen must arrive at our lab within 60 minutes and must be kept at body temperature (placed between legs or held in hands, etc.). If the only possible way to collect is through interrupted intercourse, the lab will provide a special condom for this purpose. However, it is more difficult for the lab to work with a sample from a condom.
When planning to collect at the office, the personnel at the desk will know that a collection is scheduled and all that is required is the patient’s name. No one other than our staff needs to know the purpose of this visit.
After sample collection, patients are asked to provide several pieces of information to ensure that your sample is correctly identified and processed by the laboratory.
First fill out the provided sticky label with the patient’s name and collection information. Attach the label to the sample cup holding the specimen and place it UPRIGHT in the small brown bag that is provided in the kit. From this point forward, the sample must be maintained between room and body temperature.
Second, submit the sample to room 1056 on the first floor of the Outpatient Care Center. The lab staff will ask for a photo ID and for a signature on an identity verification document. This can be done in person or the spouse may deliver the sample. If a partner delivers the sample to the lab, her photo ID and signature will be required.
Bring a photo ID. The IUI semen specimen will be processed and be ready for pickup in 60-90 minutes after sample submission. Specimens for IUI will be transported by the patient from the laboratory to the physician offices. A picture ID must be shown by the patient or partner in order to receive the IUI specimen. The IUI sample must be maintained between room and body temperature during transit.
