Our precious boys...

Our precious boys...

Friday, June 5, 2009

WHAT IS AN IUI - INTRA UTERINE INSEMINATION?

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 only requires the insertion of a speculum and then the catheter, a process that maybe takes a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove the catheter — going slowly helps reduce discomfort). Sometimes when the cervix is hard to reach, a tenaculum is used to hold the cervix, which makes the process a bit more uncomfortable.



An IUI has 5 basics steps. This information is from www.advancedfertility.com

1. The woman usually is given medications to stimulate development of multiple eggs and the insemination is timed to coincide with ovulation - release of the eggs.

Many doctors monitor follicle development during IUI cycles. Most trigger when the dominant follicle is within a certain size range. While there is always some difference in doctor preference, the norms are unmedicated 20-24mm, clomiphene citrate 20-24mm, FSH-only meds 17 or 18mm minimum, and FSH+LH would be 16 or 17mm minimum. It is possible for slightly smaller follicles, 14-15mm, to contain a viable egg. Also, follicles continue to grow until they release, usually at a rate of about 1-2 mm per day. A woman may ovulate more than one follicle in a cycle, but the releases will occur within 24 hours. When hCG is not used, only follicles close in size are likely to release. The use of hCG induces ovulation in about 95 percent of women, and will get most mature follicles to rupture.

2. A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.

Usually the semen sample is collected through ejaculation into a sterile collection cup, but it is also possible to obtain collection condoms for this purpose. Most clinics want the semen to be delivered within a half hour of ejaculation, around the time of liquefaction, so if one lives close enough the sample can be collected at home. If not, one has to make do with a room at the clinic, a bathroom, or any private setting.

3. The semen is "washed" in the laboratory (called sperm processing or sperm washing). The sperm is separated from the other components of the semen and concentrated in a small volume. Various media and techniques can be used for the washing and separation. Sperm processing takes about 30-60 minutes.

There is a delay between when the semen sample is dropped off for washing and when it is inseminated. 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. Most will perform the IUI as soon after washing is completed as possible.

4. A speculum is placed in the vagina and the cervical area is gently cleaned.

5. The washed specimen of highly motile sperm is placed through the cervix into the uterine cavity using a sterile, flexible catheter.

The intrauterine insemination procedure, if done properly, should seem similar to a pap smear for the woman. There should be little or no discomfort. Most clinics offer for the woman to remain lying down for a at least 15 minutes after the procedure.

Ideally an IUI should be performed within 6 hours either side of ovulation — for male factor infertility some doctors believe after ovulation is better, otherwise chances of success are higher with insemination before ovulation with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG, though some do it at 24 hours, and some clinics are reporting better results when doing the IUI at 40-42 hours post-hCG.

Some doctors will base timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm, but doing them at 24 hours is also pretty common since ovulation may be a bit earlier. The egg is only viable for a maximum of 24 hours after it is released.

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