For most people, when they hear the words fertility treatment, the first thing that comes to mind is In Vitro Fertilization (IVF). Many patients are surprised to learn that less invasive options are available and frequently covered by insurance. At Shady Grove Fertility, 50% of all fertility treatment cycles performed each year are considered “low tech.”
Intrauterine insemination (IUI) cycles are the most common treatments for fertility patients just beginning their journey. During an IUI cycle, medication can help to develop a single egg (or multiple eggs depending on the patient’s history) and upon ovulation, sperm is placed directly into the uterus by a physician.
IUIs can be performed with or without medication, they are not painful and do not require surgery or anesthesia.
Each patient will complete a basic fertility work-up which will help determine a diagnosis and treatment plan. At Shady Grove Fertility, your physician will make recommendations on a treatment plan that fits your comfort level. “We have to look at the entire picture when treating a couple. After having a discussion with the couple and reviewing their history, we can determine if the couple would be a good fit for IUI. Age and duration of trying to conceive are critical components to consider as well,” says Shady Grove Fertility’s Dr. Stephen J. Greenhouse, MD.
Finding the Diagnosis
The following tests will give you and your physician an idea of what treatment plan will be considered:
Day 3 Blood work
- Follicle Stimulating Hormone (FSH)- hormone is released from the brain and stimulates the ovaries to mature an egg.
- Estrodial (E2)- refers to the estrogen level, the main female reproductive hormone which is secreted from the ovary.
- Luteinizing Hormone (LH) – an integral component to the final maturation and release of a mature follicle.
Semen Analysis – A visual test of the male partner’s sperm that measures three distinct indicators – the count, or number of sperm in the sample, the motility, which is the sperms movement, and the morphology referring to the shape and sperm’s ability to penetrate an egg.
Hysterosalpingogram (HSG)– A test that indicates if the uterine cavity is a normal shape, void of any obstructions such as polyps or adhesions that may cause miscarriage and the condition of the fallopian tubes, whether they are blocked or open.
Once the results are complete, the physician will review them with the couple to determine the cause of infertility. Certain diagnoses will lead a patient directly to IVF, as in the case of patients with decreased ovarian reserve, tubal blockages, or sever male factor. Most other causes will lead couples directly to IUI for treatment. The most frequent causes for infertility that can be treated with IUI are ovulatory dysfunctions such as PCOS, borderline male factor, and irregularities in the blood working concerning prolactin, LH, and TSH levels.
What is Involved in an IUI?
An IUI procedure is fairly simple. On the day of an IUI procedure, patients have two appointments. The first is for the male partner to provide a sperm sample. The sample (which is usually collected at home) is delivered directly to the andrology laboratory where it is labeled accurately. The lab will perform a procedure commonly referred to as “sperm washing.” The procedure involves placing the sperm sample in a test tube and then a centrifuge. The centrifuge spins the sample causing a separation of the sperm from the seminal fluid which is then removed and replaced with another fluid. The most active sperm will then swim into the fluid and generate a good sperm sample for insemination.
Approximately an hour and a half later, the second appointment for the female partner occurs. During Intrauterine Insemination, a soft thin catheter is placed through the cervix and into the uterus. The washed sperm is then placed into the uterus through the catheter. The procedure is completed in our local offices and takes only a few minutes. This procedure is not painful and does not require surgery or anesthesia.
Are There Different Types of IUI Cycles?
Yes. Medication plays a big role in the “type” of IUI cycles patients can undergo. Medications can vary between the various types of IUI cycles. Based on the comfort level and medical indication, patients can discuss with their physicians a variety of medications and treatment options.
IUI with No Medication– A less common IUI procedure where patients track their ovulation with predictor kits, recommended by your physician, and upon ovulation, an IUI appointment is scheduled within 36 hours.
Timed Intercourse with Medication– For patients who need help stimulating the growth of an egg but prefer not to undergo a IUI, can choose to have medication with the intention of having planned or timed intercourse at home. During the stimulation process, ultrasounds and blood work are used to monitor the egg as it matures, these appointments are called monitoring and there is usually 2-4 during the cycle. Once the egg has reached maturity, a subcutaneous injection of a hormone called hCG is administered. This is referred to as the “Trigger Shot” which triggers the egg to ovulate which occurs approximiately 36 hours later. Once the trigger shot is given, and ovulation begins, the couple has timed intercourse at home.
IUI with Ovulation Induction– Patients are prescribed an oral medication such as Clomid to mature and ovulate one single egg. Ultrasounds and blood work are then used to monitor the egg as it matures. With ovulation induction, there are usually 2-4 monitoring appointments throughout the cycle. Once the egg is ready the “Trigger Shot” which triggers the egg to ovulate 36 hours later is administered. Two days following the trigger shot, an IUI is scheduled for the patient.
IUI with Superovulation– For women who do not respond as well with Ovulation Induction, superovulation with IUI is an option. Similar to an Ovulation Induction IUI cycle, a superovulation IUI cycle uses injectable medications called gonadatropins to stimulate the growth of 2-4 eggs. In some cycles, patients will start with the oral medication Clomid and move to injectable medication if egg growth is not occurring as anticipated. Once at maturity, these eggs are ovulated with the help of a trigger shot.
Similarly to Ovulation Induction an IUI appointment is schedule for approximately 36 hours following the trigger shot; where insemination occurs.
With all types of IUI treatment, 2 weeks after the IUI or timed intercourse, patients return to Shady Grove Fertility for their pregnancy, or beta, test.
How Successful is IUI Treatment?
With natural conception, the chances of pregnancy for women in their mid 20s, is between 20-25% with every cycle. As the female partner ages, that percentage decreases and by their early 40s, the chance of natural conceptions falls to around 5%. The typical success rates with IUI are between 15% – 20% per cycle in women under the age of 35. Your physician can provide a more specific success rate based on your specific case. Typically the majority of success will occur within the first 3-4 IUI cycles. Due to moderate success rates, it may take patients more than one IUI cycle to conceive.
An Affordable Option
One of the most appealing reasons patients choose to start their fertility treatment with IUI is the cost. This treatment is significantly more affordable than its IVF counterpart and is frequently covered beinsurance. Upon your initial consultation our insurance team will determine your benefit coverage for fertility treatment including IUI and IVF.
For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.
