The IUI Cycle

The IUI Cycle

Who's a Candidate?

Doctors often recommend intrauterine insemination (IUI) for couples with unexplained infertility or mild male-factor infertility. Doctors generally suggest IUI for women who are younger than 43, except for those with:

• Blocked fallopian tubes
• Severe fallopian tube damage
• Very poor egg quality
• Menopause
• Male partners who have severe infertility, such as total motile sperm count less than 5 million

Getting Ready for the Cycle

Because the insemination is timed with ovulation, and eggs can only be fertilized for 12 to 24 hours after ovulation, timing is everything. To make sure sperm meet the egg at the right time, several steps have to be taken.

Prior to IUI, a woman is often screened for hormonal imbalances, infections, or structural problems. These conditions would make the IUI less likely to succeed.

Around day six of the woman’s cycle, her doctor will begin watching for signs of ovulation. Doctors often use transvaginal ultrasound to view the ovaries and egg growth. This is called ultrasound follicular monitoring, because the doctor is checking to make sure that mature follicles (which develop into eggs) have been produced. Doctors might also do urinary luteinizing hormone (LH) surge testing. LH is produced by the pituitary gland in the brain, and when its levels increase at midcycle, it triggers ovulation. IUI is usually scheduled for the morning after an LH surge, as ovulation will occur one to two days following the surge.

IUI is often done in conjunction with ovulation stimulation. In this case, at the beginning of the woman’s menstrual cycle, she will begin using medication to stimulate her body to develop multiple eggs. (This is sometimes called superovulation; generally, a woman only releases one egg a month.) Logically, having more eggs available seems to provide higher pregnancy rates. The drugs that are given to induce ovulation include clomophine citrate (such as Clomid) and gonadotropins (such as hMG). Sometimes these drugs prevent the natural LH surge from occurring. If this is the case, the woman will receive an injection of human chorionic gonadrotropin (hCG) in the evening. The shot will trigger ovulation within 36 to 40 hours, so the IUI is usually scheduled approximately 36 hours after that.

Up until ovulation, the woman’s partner is kind of on the sidelines. In fact, men need to abstain from ejaculation for two to five days prior to ovulation. Once the woman ovulates, the man will produce a semen sample at home or in the doctors office by masturbation. (Donor sperm is used in some instances.)

Twice-a-Cycle IUI

Traditionally, IUI is performed once a menstrual cycle. However, some studies show much improved pregnancy rates when two inseminations are done in a cycle. Perhaps two inseminations double the chances for timing it right.

Here’s how a twice-a-cycle approach might work: A woman triggers ovulation with an hCG shot. The first IUI is done the next day. The second IUI is done the following day, around 36 hours after the hCG shot.