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Intrauterine Insemination

BASIC OVERVIEW

Indications: IUI is an option for enhancing fertility. It can benefit women with decreased ovulation, men with decreased semen quality, and couples with unknown causes of infertility.  IUI, also known as artificial insemination, can benefit women using donor sperm.  The success rate of IUI is approximately 15-20% per cycle.

Risks: The risks of IUI include cramping and bleeding.  There is a very small chance of infection.  Women using fertility enhancing drugs have a higher chance of multiple pregnancies. On rare occasions, women experience an allergic reaction.

Pre Procedure Preparation: Women taking fertility drugs should take them as directed.  Women should monitor ovulation with an at home ovulation predictor kit (OPK).  When the OPK turns positive, please call our office to coordinate an appointment.  The physicians are available during office hours Monday-Friday and on Saturday and Sunday to perform IUI.  On the day of IUI, the semen is prepped and washed to maximize quality.

Procedure:  The procedure will only take a few minutes and is performed in the office. Similar to a pelvic exam, a speculum will be placed in the vagina to visualize the cervix. A flexible catheter is passed gently through the cervix into the uterus. It some instances, a stabilizer is used to grasp the cervix to aid the passage of the catheter.  The semen is injected slowly. All instruments are then removed and the patient is asked to lay flat for approximately 20 minutes.

Aftercare: After the procedure you can expect a watery, pinkish discharge and mild cramping.  You may resume all activities except heavy exercise for 24 hours.  You may have intercourse, and this may aid in conception.  Tylenol should be used for cramping.  Contact our office if you have any problems such as an odorous discharge or severe lower abdominal pain.

If you miss your next cycle (which would happen approximately 2 weeks after IUI), take a home pregnancy test. If the test is negative or your cycle begins, please contact our office to discuss your plan of care.  If your pregnancy test is positive, congratulations!, and call our office to schedule an appointment.

DETAILED INFORMATION FOR THOSE UNDERGOING IUI AT OBGYN OF ATLANTA

 Your doctor has recommended intrauterine insemination (IUI) to assist you in achieving a successful pregnancy. This procedure is quick and often successful, but requires coordinating the offices of OB Gyn of Atlanta (OBGA), a specialized fertility lab and your menstrual cycle. This summary is meant to assist you in understanding the process in hopes of making this a smooth and successful process while minimizing any inconvenience or frustration you might experience.

IUI Timing- In order to succeed, the "timing" of the IUI procedure is critical. IUI consists of implanting sperm directly into a woman's uterus when she is most fertile in order to increase the chances of fertilization and pregnancy. Typically our physicians will recommend 3 separate attempts in 3 separate cycles. If unsuccessful at 3 attempts then a consult is recommended to reconsider options.

The Best Time for IUI- The usual process involves monitoring a woman's natural ovulation cycle. IUI must take place when ovulation is imminent or shortly afterwards. A woman must keep track of her natural monthly cycle in order to determine when she is ovulating. We recommend that she use a menstrual calendar or one of the many simple and free apps compatible with their smart phone. By convention the first day of a woman's period as called Day 1 of the cycle. A woman’s most fertile window is usually between days 10 and 16.  Ovulation and peak fertility is a more narrow window lasting about 24 hours. In order to pinpoint the time of ovulation more accurately, women are asked to use a commercially available ovulation predictor kit (OPK) which utilizes a urine test to determine the most likely time of ovulation. When the OPK is positive – then ovulation is imminent.  IUI procedures are most successful should when performed 24 to 36 hours following their presumed ovulation. Women are advised to schedule their IUI for the day following their positive OPK test.

Insemination Process Timing-The sperm specimen must be specially prepared for IUI at a specialized fertility lab. OBGA utilizes 2 fertility labs. Without exception every patient must have a requisition signed by an OBGA physician and indicating Semen Prep or IUI prep when they present to the fertility lab. If more than one IUI is necessary then a new requisition is required each time. Once the man's sperm have been processed and prepared by the laboratory, the actual insemination process takes place in an OBGA office and takes only minutes to perform. While it is not painful, some women experience discomfort and cramping during and immediately following the procedure. Once the IUI process is completed, women can go home the same day and resume their normal activities. There is no limitation on sexually activity. In fact, intercourse is recommended during the remainder of the fertile window.

The following summarizes the usual process for IUI at OBGA. Your doctor may recommend other medications or testing, but this is the typical process.

IUI at OBGA step by step-

·      Menstrual calendar to document menstrual dates

·      Days # 3-7 :                   Some patients will take clomid or femara. Dosing may vary.

·      Days #10-15:                 OPK home ovulation testing

·      Day of positive OPK:   Call OBGA office (404.252.1137)  to arrange IUI for the next day (the presumed day of ovulation)

                 Call Fertility lab to arrange sperm washing (will need a signed order from OBGA)

·      Day of Ovulation:        Attend scheduled appointment with Fertility lab to prepare specimen

                 Bring specimen (kept at body temperature) to appointment at OBGA

                 Bring a chaperone (if weekend scheduling)

·      Day #21:                        Progesterone level (drawn at OBGA. Lab appointment must be scheduled >24 hrs in advance.)

·      Day #28:                       If no menses then perform a home Urine Pregnancy Test (UPT)

                                               If positive, then call OBGA to arrange appointment to confirm normal pregnancy

                If negative then wait for next menses or if no menses wait for 7 more days

·      First day of menses:   Call OBGA to arrange scheduling for next IUI cycle

·      Day # 35:                      If no menses then repeat home UPT and contact office to either schedule confirmation of pregnancy appointment or to restart process for next                                                          cycle.

There are many timed steps to this process and because of the usual late notice of scheduling needs OBGA cautions our IUI patients that scheduling at times can be frustrating. OBGA promises to do everything in our power to arrange your procedure as conveniently as possible. Please understand that patients may be required to travel to one of our more remote offices for their IUI in order to coordinate with the appropriate physician at the appropriate timing. IUI can be scheduled most any day that is necessary, whether weekday or weekend. OBGA asks that our patients please understand that scheduling weekend procedures can be especially difficult as the doctor who is on call will need to perform the procedure and their primary responsibility is to manage hospital patients at Northside Hospital in Sandy Springs. Rarely IUIs could be canceled on weekends due to unavoidable and unpredictable demands on the on-call physician. All weekend IUIs are arranged at our Sandy Springs office.