IUI: The Basics

IUI is short for intrauterine insemination. I am covering the basics including what IUI is and what types of cycles are used.

BEFORE THE IUI

IUI is exactly what it sounds like. It is putting the sperm inside the uterus. It is not the same as taking ejaculate and putting it inside the uterus. It has to get cleaned. So the vagina is very acidic and the pH of the ejaculate is alkaline in order to protect the sperm in that environment. Most of what you see when someone ejaculates is actually all the protective stuff and not the sperm. The sperm swim out of the protective ejaculate and swim through the narrow and twisty cervix into the uterus and then the fallopian tube. I firmly believe that you should not be doing IUI unless you know for sure that your fallopian tubes are open. You can do this with an x-ray called an HSG. During this test, a speculum gets placed in the vagina and a small catheter goes into the cervix. Then dye gets injected into the uterus and dye will get moved through the fallopian tubes to show they are open or not. It is a very quick test and feels sort of like a period. So I can do a million IUIs and if your fallopian tubes are not open, there is a zero percent chance you can get pregnant. If your tubes are blocked you will need IVF, INVOcell, or something that takes the eggs outside the body, fertilizes them and puts an embryo back inside.

What is IUI?

IUI is a low tech option. It is simply taking your best players and putting them further down the field. I can’t make them score the goal. There is not a guarantee with IUI. Almost always couples think that it’s going to work and are devastated when it does not work the first time. Most of the time IUI does not work. The probabilities are low, so setting appropriate expectations is important. You also need to understand who is a good candidate for IUI and who is not which is helpful when deciding the best treatment for you. The diagnostics are essential to do beforehand. IUI is using a fresh ejaculated sample that is cleaned and the alkaline part is removed. A concentrated sample of the sperm is put into a catheter and injected into the uterus. IUI can also be done with frozen sperm whether it is donor sperm or partner sperm. IUI should not hurt. It feels a like a pap smear. You don’t need to come in expecting it to be painful. Most barely feel anything.

Types of Cycles

You can do IUI in a natural cycle where you ovulate on your own. You can also do it in cycles where there is ovulation induction using Medications like Clomid or Femara. In some cycles we use gonadotropins which are injectable hormones like FSH or LH. Essentially you can combine IUI with a natural cycle or an induced cycle.

Natural Cycle

In a natural cycle you will want to monitor ovulation using OPKs. With an OPK, you pee on a stick and it detects LH, which is the hormone that causes the surge that induces ovulation. LH is release from the brain in the early morning. So the best time of day to test is from 10:00 AM- 2:00 PM. In some cases if you test too early, there is a chance you will miss it, and by the next it may already be excreted. I always recommend doing it in the middle of the day. The surge is LH and not ovulation. So when you are timing based on a natural cycle, you want to have your IUI the day after the positive OPK. This is the day that you are ovulating. Some doctors will want to bring you in for an ultrasound to check how your follicle is growing or they may base it totally on ovulation predictor kits.

OVULATION INDUCTION

If you are doing an induced cycle, you may test with OPKs or do a trigger shot. With a trigger shot you are trying to time things perfectly, and determine when you are going to be ovulating before you naturally surge. The trigger shot is HCG which is similar to LH. It binds to the LH receptors and triggers LH to be released. A IUI should be done about twenty-four to forty-eight hours after the trigger shot. So when the egg is release from the ovary, it is picked up by the fallopian tube. Egg and sperm meet in the fallopian tube, and the egg lives for about twenty-four hours. This means from the time it is released you have about 24 hours for it to be fertilized. You want to time the IUI when the egg is already in route. You will hear people like me say “but the sperm can in the female reproductive tract for more than one day, so you want to be early instead of too late.” That is true. However, sperm can live in the reproductive tract, but we think it lives longer during intercourse. With intercourse, sperm swims out from the ejaculate into the cervix which has a lot of curvy hideout places. Even though it is true that sperm can live up to five days in the reproductive tract, we want to make sure the egg is already release for the best chance of success. Every doctor is different, but I like to use a trigger shot and monitor with ultrasound so we can control as much as possible. Every doctor has a different comfort zone.

PROGESTERONE

During many cycles, progesterone is supplemented to support the pregnancy after the IUI. Some data shows that when you do ovulation induction, you may need extra support from the corpus luteum. When using injectable hormones, you will want to take progesterone after ovulation. I also use it with Femara or Clomid cycles, and do not usually do it when using natural cycles and no trigger.

Next, I will discuss the reasons for IUI and what the chances are based on that reason.