Artificial Insemination (AI) / Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is the same as artificial insemination (AI). This technique consists of placing sperm into the uterine cavity of the patient around ovulation time. It means that instead of the sperm having to swim up the cervix and uterus to get to the egg, which is located in the fallopian tube, it only has to swim from the uterine cavity and into the fallopian tube.
A doctor may recommend IUI/Al in cases where the male has a mild to moderate-low sperm count. IUI/AI is also preformed where the couple may need to use a sperm donor. IUI/AI has become a commonly used treatment for same sex female couples and single women.
WHAT TO EXPECT?
The IUI/Al procedure is performed as close to the day of ovulation as possible. IUI can be carried out with or without stimulation drugs – this is down to personal preference and the doctor’s recommendations based on your gynaecology and fertility history. A sperm sample is produced and our specialised team of andrologists prepare each sperm sample. This is known as “sperm washing”. Sperm washing involves:
• Removal of the seminal fluid, which contains proteins and hormones that cause painful uterine contractions and allergic reactions in women.
• Isolation of the sperm that are the most motile and most fertile.
• Concentration of the sperm into a small volume comparable to the volume of the uterine cavity.
After the sperm is washed it is placed into a soft, thin catheter that will be passed through the opening of the cervix into the uterus. The procedure only takes about 10 minutes and is does not require anaesthesia. The patient will lay down for about 30 minutes and then can resume normal activity.
Following the IUI/Al, you will take daily supplements progesterone – usually in the form of a capsule inserted into your vagina twice a day – to support the endometrial lining of the uterus and implantation of the embryo.
HOW IS IUI/AI PREFORMED?
There are four different ways the doctor may choose to conduct IUI depending on your individual situation:
Without hormonal medications
1. In a natural cycle
With hormonal medications
3. Follicle stimulating hormone – FSH
4. Follicle stimulating hormone with human chorionic gonadotrophin – FSH/hCG
IUI/AI done without hormonal medication
1. In a natural cycle
If the woman has a regular menstrual cycle, IUI/AI will be performed about day 12 to day 15 of the cycle when ovulation – release of the egg – is taking place. It is also suitable for those who cannot have natural intercourse (e.g. spinal cord injuries). You will be asked to work out when ovulation will occur by tracking basal body temperature (your temperature increases during ovulation) and changes in vaginal mucus, or by using ovulation kits. Alternatively, you may be monitored through regular ultrasounds or blood tests administered by your medical team or clinic.
IUI/AI done in conjunction with hormonal medications
Depending on your particular situation, your doctor may recommend that you take hormonal medication (also known as ‘fertility drugs’) to help stimulate ovulation. Your doctor may refer to this part of treatment as ‘ovulation induction’, ‘ovarian stimulation’ or ‘stimulated cycle’.
At the beginning of your menstrual cycle, the hypothalamus (the part of the brain that controls a large number of bodily functions) releases a hormone called gonadotrophin-releasing hormone (GnRH). GnRH in turn causes the pituitary gland (at the base of your brain) to release a hormone called follicle stimulating hormone (FSH) to prepare one egg for release. When the egg is mature, the pituitary gland produces another hormone called luteinising hormone (LH). This prompts the follicle to release this one egg into the fallopian tube in the process known as ovulation. Follicles are the fluid-filled sacs in which eggs grow to maturity. Fertility medication (often either clomiphene citrate or a gonadotrophin – see information below) can increase the number of mature eggs and regulate ovulation timing to improve your chances of becoming pregnant.
2. Clomiphene/IUI cycle
Typically, a doctor will start you on the medication clomiphene citrate. Clomiphene citrate stimulates the release of GnRH, which in turn causes the pituitary gland to release more FSH and LH, causing growth of the follicles containing the eggs.
How is it taken?: Clomiphene citrate comes in an oral tablet form and is usually taken daily for five days. Your doctor will advise you on which day of your cycle to begin taking clomiphene citrate
3. Follicle stimulating hormone/IUI cycle
If clomiphene citrate is unsuccessful, gonadotrophins may be used. Gonadotrophins may be in the synthetic form of the naturally occurring hormone follicle stimulating hormone (FSH) or can be purified human menopausal gonadotrophin (HMG). You may hear this medication commonly referred to as ‘FSH’. FSH is also available in combination with LH.
Often couples prefer to proceed directly to FSH medications without first trying clomiphene/IUI. FSH acts directly on the ovary, promoting follicular development.
How is it taken?: These medications are taken by a self-administered injection under the skin (subcutaneous) of the tummy or thigh, usually via an easy to use pen-like device. The length of treatment varies with each patient. Your doctor will decide the length of your treatment and your dose.
Gonadotrophin-releasing hormone (GnRH) agonists or GnRH antagonists
IUI treatments can sometimes be compromised if ovulation does not occur at just the right time. When used in combination with injected FSH, gonadotrophin releasing hormone (GnRH) agonists allow for more reliable timing of the egg collection and usually an increased number of eggs. They include the medications nafarelin acetate and leuprorelin acetate. Nafarelin acetate is given by nasal spray morning and night and leuprorelin acetate is given by a daily subcutaneous (under the skin) injection.
GnRH antagonists – cetrorelix acetate and ganirelix acetate – can be given for a shorter period of time than GnRH agonists. As with GnRH agonists, using this medication allows the continued stimulation of follicle growth whilst preventing the risk of premature egg release.
4. Follicle stimulating hormone with human chorionic gonadotrophin – FSH/hCG/IUI
Human chorionic gonadotrophin (hCG) causes the final maturation and release of the egg and is usually given by injection one to two days after the last dose of FSH.