IUI - INTRAUTERINE INSEMINATION
IUI,(Intrauterine insemination) is a procedure, which places washed sperm into the uterine cavity by passage of a small plastic tube through the cervical opening. IUI is performed just prior to ovulation. The indications for IUI include: low sperm count, abnormal sperm movement or shape, or unexplained infertility.
TIME OF INSEMINATION:
The timing of IUI may be determined in one of several ways. An ovulation predictor kit is the most useful method. We recommend “Clear Blue Digital”. The kit instructions are easy to follow and this simple urine test will forecast ovulation - to occur one - two days later. Inseminations may be performed on the initial day of kit change or the following day - in our experience the resultant pregnancy rate is the same. In a small percentage of people, the predictor kits do not provide clear information and then you will be instructed to come in at mid-cycle for an ultrasound evaluation of the ovaries and possible administration of a drug to stimulate egg release (HCG). IUI would be timed accordingly. The third method of timing is controlled by Gonadotropin therapy. Patients receiving Gonadotropins for induction of ovulation will also have HCG given to stimulate egg release and that will determine the time of IUI.
There is no advantage to prolonged abstinence from ejaculation prior to IUI. Abstinence for long periods may actually lower specimen quality. Two to five 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 is washed with a physiologic solution. The sperm processing takes approximately one hour and a half. The insemination only takes a few minutes. A speculum is placed in 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. The sample is deposited there. A few patients experience cramping during the procedure. Once the insemination is completed, you will rest for approximately 20 minutes and then you are free to go about your usual activities.
PRIOR TO STARTING IUI:
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 your 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 other high-risk behaviors (such as intravenous drug use or a new sexual partner) that increase the risk of acquiring these diseases. Let us know if you wish to be tested.
There is a risk of uterine-tubal infection following IUI. In our experience, this risk is extremely low - less than 1%.
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 noncellular 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.
HOW TO SCHEDULE AN IUI APPOINTMENT DURING THE WEEKDAYS:
The appointment secretary can be reached at (434) 654-8520. 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 on the number of IUIs already scheduled. When HMG ovulation induction is done, or other medications are used so that urinary testing is not necessary, the physician will let you know the day best for insemination.
IUI ON HOLIDAYS:
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.
IUI ON WEEKENDS:
If your kit changes by 8:00am on Saturday morning, IUI will be performed that day. Call our usual appointment number (434) 654-8520 between 7:00am and 8:00am to have the IUI done that day. Our answering service will take the message and notify the doctor and the doctor will call you back. If you call in after 8:00am, your IUI will be scheduled for the following day.
If your kit changes Sunday, IUI can be performed on Sunday or Monday with equivalent pregnancy rates. If you want to do IUI on Sunday, phone in as above. If you want IUI on Monday, call in at 8:00am on Monday.
For all weekend appointments, entry is through the Main entrance at the front of the building. There is a call box located to the right of the sliding glass door. You will need to press the number 3 or 6 on the number panel until our name is displayed (Reproductive Medicine). Press the # symbol on the panel to call us. When we answer your call, we will open the door. You will come to our office on the third floor and have a seat in our lobby to wait for an andrologist to direct you to the collection room and lab.
MORE THAN ONE IUI PER CYCLE:
There may be a higher pregnancy rate with more than one IUI per cycle. We suggest starting out with one insemination. If you fail to conceive after 2 or 3 treatment cycles we can go to two inseminations – or – if you prefer we can start with 2 inseminations. If you are using a predictor kit, the inseminations are done on the first day of kit change and the following day. If you are being treated with drug therapy, we will instruct you about IUI timing.
FOR THE HUSBAND:
We realize that producing a sperm specimen 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 (or somewhere else) - that is possible. Collection kits are available at our office and must be used to collect the sample. The sample is preferred to be collected exclusively by masturbation (not interrupted intercourse). If you collect at home the specimen must be to the 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 can provide you with a special condom for this purpose. However, it is more difficult for the lab to work with a sample from a condom. If you are planning to collect at the office, the personnel at the desk should know that you have an appointment for sperm collection and you should simply need to say your name and not need to announce why you are there.
After sample collection, you will be 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 your 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 Suite 304 on the third floor of the Outpatient Care Center. Lab staff will ask you for a photo ID and for your signature on an identity verification document. You can do this in person or your partner can deliver the sample for you. If your partner delivers the sample to the lab, her photo ID and signature will be required.
PICK UP ARRANGEMENTS FOR THE IUI SPECIMENS:
Bring a photo ID. The 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 sample must be maintained between room and body temperature during transit.