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7400 Fannin St., Suite 1180
Houston, Texas 77054 Phone (713) 790-9900 Fax (713)-790-9901 |
Robert
B. McWilliams, MD
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INFERTILITY MALE
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Intrauterine insemination (IUI)Intrauterine insemination is often the next treatment step if therapies such as oral medications (three cycles of Clomid) are not effective. Women 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. Patients 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. The 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. IUI 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. IUI 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. IUI 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. In
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.
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