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What does the Treatment Involve?

IUI treatment can be natural (without fertility drugs) or stimulated (with fertility drugs). The most appropriate course will be chosen at your Initial Consultation.

The IUI procedure involves placing sperm directly into the uterus at the fertile period each month, as close to the day of ovulation as possible.

Sperm Preparation

First, the semen sample from the male partner, or donor, is prepared by spinning it in the laboratory. This is done to separate the sperm from the seminal plasma (the liquid which carries the sperm) which is known to irritate the uterus. In normal sexual intercourse the seminal plasma does not enter the uterus, but rather the sperm 'swim' away from it, through the uterus and into the fallopian tube.

Next, the embryologist assesses whether the sample is suitable for IUI. This involves counting the sperm to ensure adequate numbers are present, checking for healthy appearance and assessing motility (the amount of movement they display).

Finally, to minimise the presence of seminal plasma, the embryologist mixes the sperm with a culture medium.

Insemination

The sperm and culture medium are drawn into a very fine plastic catheter, or tube, which is then passed through the cervix (the neck of the womb) into the uterus, where the sperm are released. The procedure is usually painless and takes only a few minutes. About 10% of women experience temporary menstrual-like cramping and, occasionally, a little bleeding. It is usual to lie down afterwards, for 15-20 minutes, after which normal activities can be resumed.

Possible Side-effects

Separating the sperm from the seminal plasma removes most of the bacteria from the ejaculate, but neither the sperm nor the cervix can truly be sterilised. There is always the slight chance that IUI could produce an infection in the uterus, although experience has shown this to be a very uncommon occurrence, with a risk of less than 1%.

Occasionally, even after thorough preparation, some seminal plasma may still be present with the sperm and culture medium. This residual seminal plasma may cause an irritation in the pelvic cavity, resulting in a feeling of discomfort and bloating. Whilst this may feel as if there is an infection present, it is not accompanied by fever nor raised white blood cell count, which are the usual signs of infection.

Stimulated IUI

The chances of pregnancy may be increased by the use of fertility drugs, which can be used to support more than one phase of the reproductive cycle.

Firstly, there are drugs which stimulate the ovaries to produce more than one egg each cycle. Vaginal ultrasound monitors progress by identifying the number and maturity of ovarian follicles (each follicle can produce one egg). The most commonly used drugs for this phase are Clomid tablets, or Menopur, Puregon or Gonal F injections.

The next step involves testing for the LH surge. LH, or Luteinizing Hormone, stimulates the egg to ripen and triggers ovulation (the release of the egg).

Testing for the surge is done from Day 9, using an ovulation predictor kit at home, or by daily urine testing in the clinic. Once the LH surge is detected, an injection of HCG, either Ovitrelle or Pregnyl, may be given (or self-administered) to ensure release of the egg.

Insemination at the clinic is booked for the day following ovulation.

Finally, Cyclogest pessaries (progesterone) may be used after insemination to facilitate implantation (the process of the fertilised egg attaching to the uterine wall).

After the IUI Treatment - Natural or Stimulated

A urine or blood pregnancy test can be done 14 days after the IUI.

When IUI treatment is successful, the pregnancy should follow a normal course. However, there are the same risks of miscarriage and fetal abnormalities as those for the general population.

If a pregnancy does not result, the treatment strategy will be re-evaluated AND a further two cycles may be attempted. If there is no positive result after three cycles, alternative treatment methods will be considered.

IUI cycles do not have to be consecutive to be effective, although recent studies seem to suggest that consecutive cycles are associated with a higher pregnancy rate.