Intrauterine insemination (IUI)

Many people assume that infertility treatment always leads to in vitro fertilization (IVF). In reality, the most advanced fertility interventions are reserved for only a relatively small number of patients and are rarely the first course of treatment. With fertility care, most patients will begin with low-tech treatment and a plan that is individualized according to the underlying cause of their disorder.   

“At Shady Grove Fertility, we believe in a stepped-care approach to treatment, starting with the simplest, most affordable low-tech fertility treatment options first and moving up to more advanced treatments only if needed,” shares SGF physician Dr. Grace W. Graham.  

For the following common infertility diagnoses, it is often best to start with low-tech fertility treatment.   

Ovulatory disorder 

One common cause of infertility is ovulatory dysfunction. It affects as many as 40% of infertile women and the disorder has a spectrum ranging from irregular ovulatory cycles to complete lack of ovulation. The treatment for this common disorder involves medication, taken orally for 5 to 7 days, or injected. We typically use oral Clomiphene Citrate (Clomid) or Letrozole for ovulation induction, or injectable gonadotropins when indicated. The goal of these medications is to stimulate the growth and maturation of eggs which culminates in the ovulatory event.   

A fertility specialist will advise the couple on the optimal time for sexual intercourse, to increase the chances of pregnancy. For this, a variety of means are used, ranging from intercourse on alternate days around the expected day of ovulation, to monitoring the progression of the cycle with vaginal ultrasounds and blood tests for more precise timing.   

Many women with ovulatory dysfunction will respond to treatment and the chances of pregnancy will approach those of the standard population. 

Male factor

Another relatively common cause of infertility is that due to male factor infertility, meaning that the sperm count or motility (the number of actively moving sperm) may be decreased or the morphology (the shape of the sperm) could be abnormal.   

Male factor is a cause of infertility in 40 to 50 percent of couples. The Center for Male Fertility at Shady Grove Fertility offers a range of services including basic evaluation and testing to help determine the best treatment options.  

Many times, it is quite possible to use low-tech treatment to address male factor infertility, such as intrauterine insemination (IUI). This simple procedure introduces the sperm inside of the uterus at the time of ovulation. The process is quick and painless. It is done in the office and patients may resume their normal activities immediately after. 

Unexplained infertility 

About 30 percent of infertility diagnoses are unexplained, meaning the underlying cause cannot be precisely determined with the tests available. These patients are said to have unexplained infertility. In these cases, the initial stages of treatment are also relatively simple and are a combination of Clomiphene Citrate (or an injectable medication) to help eggs grow, along with IUI.  By increasing the number of eggs available for fertilization, and increasing the concentration of sperm that encounter eggs, the chances of pregnancy can be increased.

When to schedule an appointment with a fertility specialist 

“Rarely are two cases of infertility exactly the same,” shares Dr. Graham. “That’s why it’s important to undergo a consultation with a fertility specialist and complete a comprehensive infertility evaluation before making any assumptions on the type of treatment necessary.”  

For women younger than 35 with regular periods, we recommend scheduling an appointment when you’ve had 12 months of unprotected intercourse without conception.  For women ages 35 to 39, we recommend seeing a fertility specialist after 6 months of unprotected intercourse without conception. For women 40 and older, we recommend seeing a specialist right away if pregnancy is desired. 

Medical contribution by Grace W. Graham, D.O. 

Grace W. Graham, D.O., is board certified in obstetrics and gynecology (OB/GYN). Dr. Graham completed her residency in OB/GYN at Vanderbilt University Medical Center in Nashville, Tennessee. From there, she trained in Reproductive Endocrinology (REI) at the National Institutes of Health in Bethesda, Maryland.  

Popular website, Parents.com, featured SGF patient’s journey of getting pregnant with IUI treatment.

SGF patients Sarah and Jay Hudson looked forward to starting a family. But after several unsuccessful months of trying to conceive, Sarah was diagnosed with polycystic ovary syndrome (PCOS), a common ovulatory disorder that affects many women of reproductive age.

Anxious to make their dreams of having children a reality, the couple consulted with SGF’s own Joseph Doyle, M.D., in the Rockville, MD office. Dr. Doyle conducted a complete infertility work up to check if other factors, in addition to PCOS, may be impacting their infertility. What many people don’t realize is that male factor infertility accounts for nearly 40 to 50 percent of all infertility cases, which is why SGF tests both the male and female during an infertility work-up. Once a diagnosis is determined, the physician can devise an individualized treatment plan unique to your situation.

“He started me on Clomid and timed intercourse because he wanted to try the least invasive protocol, but one that he still thought could be successful,” says Sarah, 31.

Clomid is a commonly prescribed fertility medication that helps stimulate ovulation. The couple tried this method for 3 months without success. SGF believes in a stepped approach to treatment starting with the least invasive treatments first and then only moving on to more advanced treatment options if necessary.

The next step for the Hudsons was intrauterine insemination (IUI). Intrauterine insemination is the process whereby your physician will place a concentrated specimen of sperm in your uterus. IUI is commonly used for patients who have been diagnosed with unexplained infertility, mild male factor infertility, a cervical factor, or irregular or absent ovulation.

How does an IUI treatment cycle work?

“The treatment is stacked right on top of the patient’s regular cycle,” Dr. Doyle says. “They should be able to have one try each month.”

To help your physician time the IUI with when you will be ovulating, you’ll visit your local office every few days for monitoring appointments. At these appointments, bloodwork and ultrasound will help to monitor your estrogen levels, uterine lining, and egg (follicle) growth. The goal of these appointments is to make adjustments to your protocol and to determine the best timing for ovulation and the subsequent intrauterine insemination.

Do IUI treatment cycles require medication?

Clomid is also used in conjunction with IUI. Sometimes, in addition to Clomid, an injection of Ovidrel is recommended prior to the IUI to trigger the release of your egg to increase the ability to correctly time the insemination.

“We [use medication to] try to push the ovaries to produce more like two to three eggs. Our first thought there is that if the first egg doesn’t fertilize, maybe the second or third one will,” Dr. Doyle says. “Part of this is just a numbers game. We’re increasing the number of eggs and getting more sperm close to those eggs.”

“It felt like light cramping. It took maybe 5 minutes, plus the 10 minutes you lay down afterward. Like any doctor’s appointment, it’s the waiting in the waiting room that took longer,” Sarah says.

Dr. Doyle, who rarely does unmedicated IUIs, says that of the 15 percent of women who get pregnant via medicated IUI, 92 percent experience single gestation while about 8 percent become pregnant with multiples.

Why is the timing of the IUI so critical?

Our physicians generally perform IUIs 1.5 days after the trigger injection, which sets ovulation in motion. The exact timing of insemination is not critical to the exact time of ovulation. Both the sperm and the egg remain viable in the female genital tract for many hours, so the physician may time the insemination within a window of several hours around the time of ovulation. Following the IUI, you will take daily supplemental 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.

Sarah says the post-IUI wait is the hardest part. “I definitely tried to keep my mind off of it and continue with business as usual because the more I got my hopes up, the sadder it was when it didn’t work.”

Watch: SGF’s New On-Demand Webinar, Low-Tech

IUI vs. IVF

IUI helps patients to achieve pregnancy rates closer to the natural per cycle chance of pregnancy for women in their age group who do not have infertility. If IUI is unsuccessful after a few cycles, it’s generally recommended to move on to more advanced treatment such as IVF.

It took Sarah and Jay Hudson three cycles of IUI to become pregnant. Now that she is expecting her baby’s arrival in June, Sarah says she is happy she started with a low-invasive treatment like IUI.

“I felt like Dr. Doyle made sure my treatment plan was right for me,” Sarah says. “I’m also happy because before starting treatment I had an intense fear of needles so moving right to IVF would have been really hard on me personally.”

While IUI is successful for many couples, IVF is sometimes the better alternative for fertility treatment depending on the age and diagnosis of the patient.

Sarah admits that she was fully prepared to try IVF if the IUI hadn’t worked. “IVF is, of course, more costly, but we could have cut some of the extra things out of the budget to afford treatment,” she says. “At the end of the day, we wanted to be parents and we were going to do whatever was necessary to make that dream a reality.”

To learn more about IUI treatment, or to schedule an appointment with a physician, please contact our New Patient Center at 1-877-971-7755 or click here to complete this brief form.