Intrauterine Inseminations

What is Intrauterine Insemination?

An intrauterine insemination or IUI is a reproductive technique to facilitate pregnancy by directly introducing sperm into the patient's uterus. The primary goal of IUI is to increase the chances of fertilization and conception.

IUI involves the collection and preparation of sperm from a male partner or a sperm donor. The prepared sperm is then directly introduced into the woman's uterus at the most fertile point in her menstrual cycle. This method is often recommended for couples facing fertility issues, such as low sperm count, sperm motility problems, or unexplained infertility or for patients utilizing donor sperm.

Washed and concentrated sperm (either from a fresh semen sample or frozen sperm vial) is carefully placed directly into the woman's uterus using a thin catheter, bypassing the cervix. This procedure is timed to coincide with the woman's ovulation, increasing the chances of sperm reaching and fertilizing the egg.

IUI is a relatively simple and less invasive fertility treatment compared to other assisted reproductive technologies, such as in vitro fertilization (IVF). It can be an effective option for some couples with specific fertility challenges or for patients using donor sperm. However, the success rates can vary depending on the underlying cause of infertility and other individual factors. Before considering IUI, it is important for prospective patients to be evaluated by a provider who specializes in fertility care to determine if IUI might be a good option.

Schedule an appointment

Intrauterine inseminations are offered at both our San Diego and Tustin office locations. Scheduling an appointment is easy. Please call the office that you will receive treatment at and set up a consultation.

Meeting with your IUI coordinator - what to expect

You can set up an IUI consultation with an IUI coordinator for either an in person visit or a phone consultation. The coordinator will ask you questions about your menstrual cycle, fertility history and goals. You may be instructed to get hormone testing, a hysterosalpingogram (HSG) or other testing prior to beginning a cycle at The Fertility Center of California. Your IUI coordinator will also ask questions about what type of sperm you plan to use to get pregnant (partner sperm, anonymous donor sperm, known donor sperm). If you plan to use your partner’s sperm, it may be recommended that he have a semen analysis (CSA) done to assess if his sperm is of good quality for an IUI. The main goal of this initial consultation is to gather information and create a unique fertility plan for you on your pathway to parenthood.

What is a hysterosalpingogram (HSG)?

A hysterosalpingogram (HSG) is a diagnostic medical procedure used to examine the uterus and fallopian tubes in women. It is a type of X-ray imaging test that helps evaluate the shape and condition of the uterine cavity and the patency (openness) of the fallopian tubes. HSG is commonly performed as part of the infertility evaluation to identify potential causes of fertility issues or recurrent miscarriages.

Natural Unmedicated IUI cycle vs. medicated IUI cycle

When you meet with your IUI coordinator you will go over unmedicated and medicated options for fertility treatment. Your coordinator may have recommendations based on your fertility history, laboratory results or sperm source. It is important to review all options to ensure that you are given the best chance at achieving pregnancy while still keeping in mind your personal preferences.

Unmedicated IUI cycle:
In an unmedicated IUI cycle, a patient’s menstrual cycle is carefully tracked and no hormonal medications are used to regulate/stimulate ovulation.

The timing of the IUI procedure is based on the natural ovulation, determined by ultrasound monitoring and/or ovulation predictor kits. On the day of the IUI procedure a sperm sample is prepared in the laboratory and then directly inserted into the uterus using a thin, flexible catheter. This procedure is relatively painless, similar to a Pap smear procedure. Following the insemination, it is usually recommended that the patient remains lying down for about 15 minutes, and then can carry on with their normal routine. Patients are instructed when and how to test for pregnancy and given additional instructions as needed.

Medicated IUI cycle:
Medicated IUI cycles involve the use of fertility medications to help regulate ovulation, ovarian stimulation and uterine lining development. In medicated IUI cycles, ultrasound monitoring is required to ensure proper medication response and to help pinpoint the ideal timing for the IUI procedure (along with the use of ovulation predictor kits). One the day of the IUI procedure the prepared sperm is introduced directly into the uterus using a thin, flexible catheter. This procedure is relatively painless, similar to a Pap smear procedure. Following the insemination, it is usually recommended that the patient remains lying down for about 15 minutes, and then can carry on with their normal routine. Patients are instructed when and how to test for pregnancy and given additional instructions as needed.

Ultrasounds

Ultrasound monitoring is an extremely useful tool for an IUI cycle and is required for medicated cycles. A minimum of 2 ultrasounds are performed at specific intervals in a cycle. The timing of the ultrasounds is important as each ultrasound is used to gather different types of information.

• Baseline ultrasound: A baseline ultrasound is usually performed on cycle day 2-5 to assess the health and condition of the uterus and the ovaries, ensuring that there are no cysts, fibroids, or other issues that could affect the treatment. This ultrasound is needed at the start of each cycle.
• Monitoring ultrasound: A cycle monitoring ultrasound is usually performed on cycle day 11-14 to assess the growth and maturation of the follicles as well as the thickening of the uterine lining. This ultrasound is helpful in tracking the progress of the cycle and assisting the IUI coordinator and patient in making decisions as they move forward toward IUI day.

Ovulation Monitoring/Tracking

Timing is key! Tracking ovulation is a vital component to an intrauterine insemination. Most patients have a fertile window of up to 36 hours. If sperm does not reach an egg in that small window, pregnancy is unlikely to occur. But how do you know when your fertile window is occurring? A common misconception is that the moment of ovulation is the best time to introduce sperm. Ovulation refers to the release of an egg by the follicle. It is usually best to give the egg time to travel down the fallopian tube, toward the uterus, where the sperm are waiting. This is why inseminations are usually performed up to 36 hours after ovulation.

There are three main ways to monitor/track ovulation.

1. Tracking your menstrual cycles over time is a very helpful method in determining ovulation patterns. Some people use apps or devices to assist them with this method. Unfortunately, not all people have regular menstrual cycles and this method may only get one so far.
2. At home ovulation predictor kits (opk) are the go to method for ovulation tracking. They are inexpensive and accurate. They measure hormone levels in the urine to let you know when ovulation occurs. Using opk’s is ideal for people with irregular cycles or people who have been unsuccessful in achieving pregnancy on their own. They work similar to a home pregnancy test and give results within minutes. It is important to note that in order to get accurate results; you should follow the specific instructions given by your IUI coordinator, such as when to test each day and when to schedule your IUI after you get a positive ovulation result.
3. Ultrasound monitoring. Ultrasounds can be a helpful tool in predicting ovulation when used in conjunction with ovulation testing kits. Although they show high quality imagery of the female reproductive tract, they do have their limitations. This is why testing kits are still used alongside ultrasound for monitoring ovulation.
4. Trigger shot. A trigger shot may be used prior to ovulation to force the follicle to release a mature egg. This type of medication may be recommended to more accurately pinpoint ovulation or assist patients in ovulation. When a trigger shot is given, the IUI can be scheduled 24 hours after, with little doubt on if the fertile window is occurring.

Tracking ovulation is not as straightforward as one might think. Often, people have irregular menstrual cycles and/or ovulation. This may make it hard to get pregnant without medical intervention. There can be underlying causes to irregular cycles and ovulation. It is important to speak to a medical provider to determine if additional treatments are recommended.

Polycystic Ovarian Syndrome (PCOS) and Fertility

Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that affects women of reproductive age, typically between their late teens and early 40s. It is one of the most common endocrine disorders in women, and its exact cause is not fully understood. PCOS is characterized by a combination of various signs and symptoms, which can vary from woman to woman. The three primary features of PCOS are:

Irregular Menstrual Cycles: Women with PCOS often experience irregular menstrual periods, which may be infrequent, unpredictable, or absent altogether. This irregularity is due to hormonal imbalances that affect the normal ovulation process.

Hyperandrogenism: PCOS is associated with increased levels of androgens, which are male hormones present in both men and women. Elevated androgen levels can lead to symptoms such as acne, excessive facial and body hair growth (hirsutism), and male-pattern baldness.

Polycystic Ovaries: Women with PCOS typically have enlarged ovaries containing numerous small follicles, often described as "cysts." These are not true cysts but are small, undeveloped follicles that have not matured enough to release an egg during the menstrual cycle.

Other common symptoms and characteristics of PCOS may include:

• Weight gain or difficulty losing weight
• Insulin resistance or impaired glucose tolerance
• Fatigue
• Mood swings or depression
• Skin darkening in certain areas (acanthosis nigricans)
• Infertility or difficulty conceiving
• Pelvic pain

The diagnosis of PCOS is made based on a combination of clinical signs, symptoms, and laboratory tests. There is no specific test that definitively confirms PCOS; rather, healthcare providers will evaluate the patient's medical history, perform a physical examination, and order blood tests to check hormone levels, glucose tolerance, and other relevant factors.

PCOS can be a major concern for people who are planning for pregnancy. At The Fertility Center of California, we are well experienced in working with patients suspected of having PCOS. Our approach to PCOS and fertility allows for patients to utilize low cost, minimally invasive medical assistance to help them achieve pregnancy. To learn more or to schedule an appointment to meet with an IUI coordinator, please call our nearest office.

Male requirements for IUI:

Motile sperm counts greater than 5 million with normal progression, 2-5 days of abstinence prior to sample collection, state required infectious disease testing results on file.

Female requirements for IUI:

To ensure the health and safety of our patients, as well as the efficacy of fertility treatment, we require our patients to be 42 years old or younger, participate in a fertility consultation prior to beginning a cycle, have recommended hormone testing, recommended genetic testing and in some cases a recommended HSG.

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