Programs & Services -

Intra-Uterine Insemination (IUI)

Some causes of infertility can be effectively treated with ovulation induction - or superovulation therapy combined with artificial insemination.

Ovulation induction therapy is focused on achieving a healthy ovulation and depending on the diagnosis, the ovulation of multiple eggs. Since eggs are the most important factor in human reproduction inducing the release of more than one can dramatically increase a woman's per cycle chance of pregnancy. In ovulation induction, the woman is treated with medications that increase the number of eggs she produces each month (normally it is one). At the appropriate time, sperm are introduced into the uterine cavity, a process called artificial insemination

Artificial insemination is usually called intrauterine insemination (IUI) in our office and more commonly we use the acronym IUI. IUI therapy coupled with ovulation induction optimizes sperm delivery to the female reproductive tract. Many people do not realize that the sperm must travel over 12 inches to reach an egg. IUI is a technique to cut that trip in half thereby improving the likelihood of fertilization. Prior to the IUI the sperm sample, either produced by the male partner or received from a donor, are isolated and prepared for insemination by a trained Andrologist. The sample is then highly concentrated for delivery of the healthiest motile sperm into the female reproductive tract.

Ovulation induction with IUI can treat many causes of infertility including:

  • Ovarian dysfunction (inability to ovulate normally on your own)
  • infertility associated with endometriosis (a painful inflammatory condition of the female pelvis)
  • cervical factor infertility (related to prior surgery)
  • unexplained infertility (infertility in which the exact cause cannot be identified).
  • Polycystic ovarian syndrome (a common female endocrine disorder)

How Ovulation Induction Therapy Works

  1. The first step in superovulation therapy is to administer medications which should enhance the development of a mature egg(s) produced by the ovaries.
    • During the normal reproductive cycle, two hormones - follicle stimulating hormone (FSH) and luteinizing hormone (LH) - are required to initiate and complete the process of egg maturation. Medications are administered to women either orally or by injection to increase levels of both LH and FSH.
  2. Fertility is then further enhanced by monitoring the development of eggs in the ovary using an ultrasound. These ultrasounds are most commonly performed transvaginally and allows the doctor to monitor the development of follicles. Follicles are fluid filled sacs within which an egg develops.
  3. Once the follicle or follicles have reached the appropriate size to contain a mature egg a single injection is given to trigger ovulation. This helps us provide optimal timing for fertilization and hopefully a pregnancy.
  4. Intrauterine insemination is then performed the next two days. The semen sample is prepared in a way that allows us to place an enriched, highly motile concentrate of sperm directly into your uterus through the cervix. This procedure involves the use of a very small tube to pass the sperm beyond the cervix to optimize sperm delivery. By performing an appropriately timed intrauterine insemination (IUI) with prepared concentrated semen from your partner or a donor we have optimized timing and sperm delivery to give the best sperm concentration around the egg and the best chance for success.
  5. Following two days of insemination we will confirm adequate hormone concentration to support implantation using a simple blood test 5-7 days later. If these levels are low your Doctor will recommend hormonal supplementation.

As a result of this treatment path there is an increased likelihood that ovulation will occur at the right time and that sperm will reach the egg(s) to complete fertilization and hopefully a pregnancy. For many couples the chances of pregnancy approaches 20% with a single month of therapy.

Medications use in Ovulation Induction and Superovulation Therapy

  • Clomiphene citrate - (Clomid® or Serophene®) is a pill which can be taken orally to promote ovulation and the process of egg maturation. We monitor the effect of this medication on the ovaries using an ultrasound.
  • Gonadotropins - are injectable medications which are taken using a very small needle for injection beneath the skin. These medications are known by the following trade names:
    • Gonal-F®
    • Follistim®
    • Bravelle®
    • Menopur®

These medications are all different forms of Follicle Stimulating Hormone - the most important hormone for the development of healthy eggs. Follicle Stimulating Hormone (FSH) is naturally made by your body in the pituitary gland and by giving yourself additional FSH you can help your own body improve egg production.

These injectable medicines are more powerful than the oral medication and tend to produce a larger number of eggs. To assess the process of egg maturation while you are being treated with these medications, several (2-3) ultrasounds and blood samples are needed to monitor the safety and likelihood of success of these medications.

Medications used to trigger ovulation (egg release)

Your body naturally releases another hormone call Luteinizing hormone to trigger egg release. There are two additional medications we use to do this at the best time in your ovulation induction cycle:

  • hCG (human chorionic gonadotropin) This is a medicine given via injection which can be used to trigger egg release. Commercial brands are known as:
    • Pregnyl®
    • Novarel®
  • Ovidrel® -this is a synthetic human pregnancy hormone which can be used to trigger egg release. It is available as a pre-filled injection on a very small needle.

Medications used to support implantation and an early pregnancy

Your body naturally releases two additional hormones which support implantation and an early pregnancy known as estrogen and progesterone. Some women do not produce enough of these hormones and we recommend supplementation to optimize the chances for a pregnancy. These medications are called:

  • Estrace® This is a form of estrogen which can be taken orally to support implantation and early pregnancy
  • FemTrace® This is another preparation of estrogen which can be taken orally to support implantation and early pregnancy
  • Prometrium® This is a form of progesterone which can be taken orally to support implantation and early pregnancy
  • Endometrin® This is a form of progesterone which can be taken orally to support implantation and early pregnancy