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FAQ Frequently Asked
Questions :
1- How would I know when to pursue more advanced fertility treatments?
2- What is the difference (if any) between intrauterine insemination and artificial insemination?
3- How do I know if IUI is an option for me?
4- Which fertility drugs are used with IUI, and why are they used if I already have normal periods?
5- What are typical pregnancy tares for IUI?
6- How many office visits are required during a typical cycle using fertility drugs and IUI?
7- I read on the internet that two inseminations are better than one. Is this true?
8- Can we have sex during a treatment cycle?
9- My doctor wants to use Lupron or Antagon during my IUI cycle. What are these drugs, and why do I need them? I thought they were only for IVF.
10- What complications can occur after IUI?
How would I know when to pursue more advanced fertility treatments?
The decision to seek out more advanced fertility treatments is a complex question, For most couples undergoing treatment with IUI (either alone or with fertility drugs), the best chances for success usually occur within the first four treatment cycles.
After that, the likelihood for pregnancy decreases.
In many of our patients, we recommend only one or two IUI treatments. If these efforts are unsuccessful, we suggest that the couple proceed with other more aggressive treatments including both natural cycle IVF and traditional IVF using injectable fertility medications.
For some patients, IUI should rarely be utilized. For example, those couples with severe tubal disease, pelvic adhesions, or severe male factor infertility may do best by directly proceeding with IVF as their first treatment option. If an age factor is present or if the couple has prolonged infertility (infertility lasting more than 5 years), we may recommend IVF first, as well.
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The difference (if any) between intrauterine insemination and artificial insemination :
Artificial insemination (AI) is a historical term that encompasses any technique involving the introduction of sperm into the female reproductive tract without sexual intercourse. Semen can be placed into the vagina (intravaginal insemination) or into the cervix (intracervical insemination) without any special preparation of the specimen. However, if unprepared semen is placed directly into the uterus [intrauterine insemination (IUI)], then severe spasmodic uterine cramping can occur.
Thus, when performing an IUI, the sperm must first be washed and prepared prior to placement inside the uterus. Washing the sperm removes prostaglandins, the hormones that cause the violent uterine contractions. Washing also eliminates substances that might lower the sperm quality, thereby leading to improved sperm motility. Generally, the IUI specimen is prepared in the doctor's office just prior to insemination.
The actual IUI is a painless, simple, in office procedure that is often performed by a nurse. It usually takes just a minute to perform. Physicians typically ask patients to come in with a full bladder so that the angle between the uterus and cervix is altered, which allows for easy passage of the catheter into the uterine cavity.
Today, it is rare for patients to undergo other forms of insemination besides IUI because the pregnancy rates with IUI are better than those obtained by intravaginal insemination or intracervical insemination.
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How do I know if IUI is an option for me?
IUI is a good option for many infertile couples. It can be performed in conjunction with a woman's natural cycle or can be combined with the use of fertility drugs. IUI can also be effectively used in couples who have sexual dysfunction or infrequent coitus for either medical or nonmedical reasons. For example, some couples may have busy work schedules such that one or the other partner is frequently out of town around the time of ovulation. If the male partner's sperm is obtained and crypreserved (frozen) in advance of ovulation, the physician (or nurse) can perform an IUI and, ideally, facilitate pregnancy without the woman missing a menstrual cycle.
The best candidates for IUI are those couples without tubal disease (female partner) or severe male factor infertility (male partner). Women with severe endometriosis or a history of pelvic adhesions are fairly low in such cases, and prompt consideration should be given to IVF (and ICSI) if pregnancy fails to occur after three or four attempts.
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Which fertility drugs are used with IUI, and why are they used if I already have normal periods?
IUI can produce fair success rates when combined with fertility drugs. Many studies show superior pregnancy rates when IUI is combined with either Clomid or injectable gonadotropins, as compared to using these medications alone. For this reason, most infertility experts will recommend IUI to their patients when treating them with fertility drugs.
In women who fail to ovulate regularly, the goal of drugs therapy is to induce the growth and release of a single mature egg. This treatment is known as ovulation induction. In contrast, the treatment goal for women with regular menstrual cycles is to induce the growth of multiple follicles with the subsequent release of multiple eggs. Hence the term superovulation (also called controlled ovarian hyperstimulation) is used to describe this situation. During a cycle of superovulation and IUI, the goal is to develop 3 to 5 mature follicles, whereas the goal in an IVF cycle is to produce more.
Clomid is the fertility drug of first choice for both ovulation induction and superovulation with IUI. Women who fail to respond to Clomid or who fail to conceive may be candidates for treatment with injectable fertility medications (gonadotropins) combined with IUI. In some cases, it is best to skip the treatment with Clomid and instead proceed directly with gonadotropin therapy; this decision depends on the severity of the couple's infertility situation.
In women who have normal menstrual cycle, it would appear on the surface that IUI alone without fertility drugs would be as successful as IUI with fertility drugs. Unfortunately, this simply is not the case. Instead, the combination of IUI and fertility drugs to induce superovulation yields a synergistic benefit over either treatment alone.
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What are typical pregnancy tares for IUI?
The pregnancy rates for IUI vary widely, depending mostly on the female partner's age and the presence or absence of any other infertility factors. In patients younger than 35 years old, an estimated one-third to one –half of patients will achieve pregnancy within 1 to 4 treatments. In patients with unexplained infertility, most studies demonstrate a per-cycle pregnancy rate of 6% for the Clomid/IUI combination and 9% to 12% for the gonadotropin/IUI combination, compared with a spontaneous pregnancy rate of less than 5% per month. Many fertility doctors will try 1 to 4 cycles of Clomid/IUI and then 1 to 4 cycles of gonadotropin/IUI. If pregnancy has not occurred after the fourth treatment, most experts would abandon these treatments and proceed with more aggressive therapy such as in vitro fertilization. The optimal number of IUI treatment cycles should be individually determined by the patient and her infertility specialist.
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How many office visits are required during a typical cycle using fertility drugs and IUI?
For treatments using Clomid and IUI, only a couple of office visits per month are required. At a typical office visits, the patient has her blood drawn for hormone analysis, and a pelvic ultrasound is performed to measure the size of the follicles. The doctor uses this information to determine optimal timing of the HCG trigger shot and the subsequent IUI.
For treatment using gonadotropins and IUI, closer monitoring is necessary, perhaps requiring 4 to 6 office visits per treatment cycle. The actual IUI takes only minutes to perform and is usually painless. We routinely ask our patients to lie on their backs for about 10 to 15 minutes following the IUI procedure. The women may then return to her normal activities.
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I read on the internet that two inseminations are better than one. Is this true?
This is not true. In general, one well-timed IUI is as good as two, and no advantages are obtained by performing a second IUI (providing ovulation was well monitored using blood hormone determinations and follicle ultrasound measurements). However, in patients who chose not to monitor their ovulation at all, two inseminations may be a better option.
Using basal body temperatures as the basis for an IUI's timing is not recommended, because this method cannot prospectively pinpoint the optimal timing of ovulation for an IUI treatment. The rise in basal body temperature increase would not help in scheduling an IUI procedure.
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Can we have sex during a treatment cycle?
In general, the answer is yes. Many experts, however, recommend no coitus for 2 to 3 days prior to an anticipated IUI to "build up" the male partner's sperm count and volume. Also, some men may experience difficulty producing a specimen if they have recently had coitus. For men who have a low sperm count or motility, it is recommended that they abstain from sexual relations for 3 to 5 days prior to a planned IUI.
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My doctor wants to use Lupron or Antagon during my IUI cycle. What are these drugs, and why do I need them? I thought they were only for IVF.
These medications can be used to prevent premature ovulation that is, they can delay ovulation during an IUI cycle can be dealt with by simply adjusting the timing of IUI. These medications are primarily used in patients undergoing IVF rather than IUI. For most patients undergoing treatment with IUI, Lupron and Antagon are rarely necessary. These drugs are not routinely used unless a patient repeatedly experiences a premature LH surge during the treatment cycle. In such cases, these medications can allow for a more optimal stimulation.
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What complications can occur after IUI?
It is very rare for any complications to occur after IUI, because it is a simple, in office, nonsurgical procedure, usually performed by nurses. Some patients may experience mild to moderate uterine cramps usually last 10 to 15 minutes. Infection rarely occurs (its incidence is less than 1%). Many infertility specialists routinely obtain cervical culture prior to initiating an IUI cycle, and the culture media used to prepare the IUI specimen commonly contains antibiotics. Occasionally, patients may note some light spotting after placement of the IUI catheter, but this is not an indication of a complication or problem. Multiple pregnancy can occur in any situation when two or more mature follicles are present at the time of HCG. Your physician should discuss with you the risk of multiple pregnancy in cycles using fertility medication to induce the growth of multiple follicles.
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