Ok, you have seen the doctor and have had your results reviewed. The doctor has made the recommendation that you proceed with “IUI” intrauterine insemination. For an IUI, the processed sperm are deposited in the uterine cavity using a small tube (insemination catheter). By doing an IUI, we bypass the vagina (which is acidic and where most of the sperm are destroyed) and the cervical mucus (which can be thick and can prevent upward progress of the sperm). The IUI thus ensures that the sperm are in the “right place at the right time” and therefore increases the chance of conception.
In an IUI cycle, you will usually be placed on oral (e.g. clomiphine citrate, letrazole, tamoxifen) or an injectable medication (e.g. Gonal F®, Follistim®, Menopur®, Bravelle®). The choice of medication depends on several factors (age, diagnosis, FSH level etc.). Cycle monitoring is usually done with blood tests or ovulation monitoring kits and ultrasounds; these are scheduled for specific points in your menstrual cycle.
During treatment, intercourse can become mechanical and goal oriented. You may come to feel that there are other people sharing your bedroom. After all, you have been told what days to have intercourse or you may have been instructed to have intercourse after taking a trigger injection, (hCG, Ovidrel®, Novarel®, Pregnyl®) this causes the final maturation of the oocytes “eggs” and “triggers ovulation” about 38 hours later.
Why do we want you to have timed intercourse and then an insemination or schedule you for 2 inseminations?
Sperm can live for 72 hours, and the numbers of sperm in an ejaculate vary on a daily basis. We want there to be sperm in the uterus, and fallopian tubes when you ovulate, waiting for that “egg” to give you the best chance for fertilization to occur.
On the day of your scheduled insemination, your husband will need to produce a semen specimen either here at the clinic (preferably) or at home. If he produces at home, he will need to get a kit from us to collect in and will have to bring the sperm specimen in himself. It should not be longer than 30 minutes from the time of producing until it is in our possession. He needs to keep it warm (body temperature) so have him tuck it under his arm and bring his picture ID. You will be scheduled for your insemination about 2 hours after he produces his specimen. Your husband is welcome to accompany you to your appointment.
The IUI itself is fairly simple. Prior to the procedure, we will explain his test numbers (total motile sperm count), check your ID and then verify the specimen with you (your husband’s name, social security number.) You will be asked to lie down and place your feet in stirrups (just like when you have a pap smear). A speculum will be inserted in the vagina to expose the cervix. The insemination catheter will then be inserted through your vagina, up through your cervix and the sperm will be injected through that tube into your uterus.
A commonly asked question is “Why is there so little fluid in the test tube?” The answer is quite simple. Most of the semen volume (2 – 5 cc) comes from seminal plasma, which also contains unnecessary particulate matter and inactive sperm. The seminal plasma contains prostaglandins (which can make you cramp) and therefore needs to be removed prior to IUI. We thus make sure that only the “best of the best” is going to be used.
You can get off the table immediately; you don’t have to stand on your head or cross your legs. We will ask you not to soak in a tub or go swimming until your pregnancy test.
Now go out and do something together as a couple -- go out to dinner, see a movie, after all it is “Date Night!”
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