Q: What is an IUI and how is it done?
A: An IUI -- Intrauterine Insemination -- is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn't take very long. It usually requires the insertion of a speculum and then the catheter, a process that maybe takes no more than a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove catheter -- going slowly helps reduce discomfort).
Q: Where is the sperm collected? How long before the IUI?
A: The sample is collected through ejaculation into a sterile collection cup. If you are collecting at home, HFI requires that the semen be delivered to the office within an hour of ejaculation. Otherwise, we provide a collection room in the office for the male to use.
There is a delay between when the semen sample is dropped off and when it is inseminated to allow for washing of the sample. The amount of time depends on the washing technique used, which takes 30 minutes to two hours, as well as on the clinic's scheduling. In most cases, we will perform the IUI as soon after washing is completed as possible.
Q: When is the best timing to an IUI?
A: Ideally an IUI should be performed within 6 hours on either side of ovulation. When timing is based on an hCG injection, the IUI's are usually done between 24 and 48 hours later. If two IUI's are scheduled, they are usually spaced at least 24 hours apart.
Q: What does an IUI feel like?
A: Most women consider IUI to be fairly painless due to the thin flexible cathetar -- along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI.
Q: Do I have to lie down after an IUI?
A: Our doctors recommend patients lie down on the table for 30 minutes after the procedure.
Q: Do I need to take it easy after an IUI?
A: We recommend patients take it easy for a while following IUI. Some people reduce their aerobic activity and heavy lifting during this time in hopes that it will increase the chance of implantation.
Q: How long before an IUI should the male abstain from intercourse or ejaculating?
A: This depends on your individual situation, but it usually should not be more than 72 hours since his last ejaculation in order to ensure the best motility and morphology. If low sperm count is the reason for IUI, it is generally best to wait 48 hours between ejaculation and collecting sperm for the IUI.
Q: How long after IUI should implantation occur?
A: Implantation generally takes place 6-12 days after ovulation -- so 6-12 days after a properly timed IUI.
Q: What kind of monitoring is usually done for an IUI cycle?
A: This depends mostly on how the female is being treated. A natural cycle is often timed with over-the-counter ovulation prediction kits. The use of Clomid can increase the monitoring, but usually only requires a handful of visits. Gonadotropins (injectable medications) increase the necessity of ultrasounds and bloodwork, requiring more frequent office visits.
Q: What does "sperm washing" mean?
A: It is sometimes also called sperm preparation or spinning. It is a laboratory technique for separating sperm cells from other supporting cells and fluid, and the separating motile sperm from non-motile sperm, for use in assisted reproduction (IUI, IVF).
The washing technique for near normal specimens is mixing the ejaculate after liquefaction with the appropriate washing medium followed by centrifugation (a centrifuge is a machine that separates materials with different densities by spinning them at high speed) The supernatant is discarded and the sediment (sperm rich fraction) is re-suspended in more washing medium. This process is repeated 2-3 times maximum. In the final wash, the sediment is re-suspended in 0.5 cc of medium, loaded into a syringe and deposited in the uterus.
Q: Can IUI work after tubal ligation (having "tubes tied")?
A: No. A tubal ligation is effective birth control because it prevents the sperm and egg from meeting. The natural process that leads to pregnancy is having an egg released from a follicle in the ovary and then beginning the journey to the uterus through the fallopian tube. Sperm will travel from the vagina, through the cervix, through the uterus, into the tube where fertilization occurs. IUI bypasses the need for the sperm to travel through the cervix. However it doesn't get the sperm to the other side of the tubal ligation, so fertilization won't take place. The only way to get pregnant after tubal ligation is by having tubal reversal surgery or an assisted reproduction technology that includes egg retrieval, such as in vitro fertilization (IVF).
Q: Can IUI be used for gender selection?
A: Yes, sperm can be washed or spun to increase the odds of having a male or female offspring. For those patients who desire a specific gender, much higher results are generated with using PGD and IVF.