insemination is often the next treatment step if therapies such
as oral medications (three cycles of Clomid)
are not effective.
undergoing IUI cycles usually receive daily injections of FSH
(Gonal-F, Follistim) to stimulate the development of their eggs
within the ovarian follicles. They also receive medications (Lupron,
Antagon or Cetrotide) that suppress the body's natural production
of FSH and LH and prevent the rapid rise in LH that triggers ovulation
in a natural cycle. A premature LH surge could cause the stimulated
cycle to be lost.
are monitored by periodic ultrasound
and estradiol measurements and once the physician judges that the
eggs are mature, an injection of human chorionic gonadotropin (hCG)
is scheduled 36 hours prior to insertion of the sperm. This injection
simulates the body's natural surge that occurs prior to ovulation.
couple arrives at our office on the day of the insemination and
the husband provides his sperm by masturbation. The sperm are specially
washed, concentrated, and prepared for insertion into the uterus.
("Unwashed" or "unprepared" sperm must never
be placed directly into the uterus as severe allergic reactions
can result). The sperm are aspirated into a small catheter and then
transferred to the uterus in a painless procedure.
is often effective in treating mild male factor infertility since
the sperm can be concentrated prior to placing them into the uterus.
More severe male factor infertility requires the use of a sperm
donor or in vitro fertilization with intracytoplasmic sperm injection.
is effective in treating cervical factor infertility because the
sperm are passed through the cervix into the uterus using catheter
thus avoiding poor mucus and/or antisperm antibodies.
is not without risk since the number of eggs that will be ovulated
cannot be directly controlled. This means that there is the potential
for high order (>3) multiple births. In fact, most of the cases
of multiple births seen in the media are the result of IUI cycles.
In an IVF
cycle, the team decides how many embryos to transfer to the uterus
thus reducing the chance of multiple births.
order to manage the risk of multiple births, all IUI cycles must
be monitored by a reproductive endocrinologist thoroughly trained
in the use of gonadotropin medications in order to manage the risk.
Frequent dosage adjustments, based upon each patient's individual
response are required.