Can’t I just take the meds and have intercourse instead of inseminations?
Doing an insemination around the time you are ovulating will increase your chance of achieving a pregnancy. During intercourse the sperm must travel up the vagina, through the cervix and uterus and up into the fallopian tubes. With an insemination the catheter is placed through the cervix, high up into the uterus close to the tubes.
This technique bypasses the cervical mucus and/or cervical scarring, which can slow down or stop sperm from traveling into the uterus. It also places the sperm close to the tubes to make a shorter trip to fertilization. Inseminations are also very useful when there are male factors such as low sperm count or motility, structural issues such as an abnormal urethra opening or retrograde ejaculation.
Donor sperm can also be used in inseminations. This is frequently used in same-sex couples, when there is severe male-factor infertility, or when the male has a hereditary issue he does not want to pass on to a child.
Cryopreservation of sperm is also an option. This is mostly used when the partner cannot be there for the insemination due to work/travel schedules or before starting treatment for an illness, such as chemotherapy for cancer.
Why does my partner have to come in for a separate appointment that morning?
On the day of your insemination, there will be two appointments made for you and your partner.
The first appointment is for your partner to come to the office to produce a fresh specimen to be used. That specimen is then “washed down” to get rid of any dead sperm, debris and seminal fluid resulting in a more concentrated, high motility specimen. This process can take 1 1⁄2-2 hrs.
The second appointment is made for you, to carry out the actual insemination procedure. Your partner is more than welcome to return to the office with you for that appointment, but it is not required.
How is the date for the insemination decided?
After taking your follicle-stimulating meds, whether it was pills or injections, you will either return to the office for monitoring or begin to use an LH kit. Both methods are used to determine when you are getting close to ovulation. Once it has been determined you are about to ovulate, we have you give yourself the “trigger” injection (HCG).
Depending on your cycle plan you will either have intercourse that evening and return for your insemination 36 hours later, or you will be instructed to return the next two mornings for the insemination procedures.
The purpose of having intercourse on the night of “trigger” or coming the morning after “trigger” for the first IUI is to have sperm waiting in the uterus/tubes before ovulation. Sperm can live in the uterus for 24-72 hrs. The purpose of coming for the IUI 36 hours after “trigger” is to perform the IUI at the approximate time of ovulation (within 6 hours). This will increase the chances of fertilization.
Are inseminations with injections better than inseminations with oral medications?
Not necessarily. The doctor will perform blood tests and other diagnostic tests to find out if you are likely to respond to one medication over the other. If you are just starting with infertility treatment and all tests have come back normal, you may be started on an oral medication like Clomid or Letrazole first.
If you have done oral meds in the past, or tests have determined you have diminished ovarian function, you may be started on injections. Both methods are used frequently and have both been shown to work.
Do I have to stay lying down after or be on bedrest?
No. Contrary to what many people think, the uterus is not a wide open space. The walls normally touch each other enveloping the sperm sample inside. Due to normal cervical flora and the medications you have been on, you may have increased cervical/vaginal mucus so you may feel the specimen “falling out” after you stand, but it is not.
People may opt to take the day off work for their own mental health or relaxation, but it is not necessary.