intrauterine insemination

This visit is scheduled when menstruation begins. The first day of full flow is to find a cycle day one. Normally around cycle day 2-4 we will schedule an appointment for your “baseline” ultrasound. The purpose of this ultrasound is to verify that the ovaries are not “active” (no new cysts or large follicles) while you are on your period.

The baseline appointment is the only appointment that you are responsible to make. After the baseline ultrasound, we will tell you when to make your first monitoring appointment

Typical appearance of ovary at baseline

A monitoring appointment refers to the ultrasound performed to confirm follicular development and/or ascertain your response to the ovarian stimulation medication (if using during your IUI cycle). Normally this is done around cycle day 10.

During this ultrasound your doctor will measure any follicles that are growing. In a natural cycle only one follicle will typically grow. In a medicated cycle, a typical goal would be 2-3 growing follicles. When the follicles are fully mature (measuring 14-20 mm in average diameter) you will be instructed to self administer a “trigger shot”. A trigger shot is an injectable medication that signals the eggs to release from the follicles. You will typically take this in the evening and the insemination will be scheduled for 24-36 hours later.

Typical appearance of ovary during monitoring

Sperm preparation

For patients with a male partner, semen will be collected on the day of your insemination. Your partner should abstain for 2-4 days prior to the insemination date.

The sperm preparation begins with the collection of ejaculated semen by masturbation. We offer a dedicated, on-site collection room in our office. If this is an extreme hardship for your partner accommodations can be made for home collections

The sperm, now concentrated into a pellet, are loaded into an insemination catheter and stored in an incubator. It takes approximately 90 minutes to process the semen.

If you are using frozen partner sperm, in lieu of the collection step above, the sperm will be thawed the morning of your insemination

If you are using frozen donor sperm, the specimen needs to be shipped to our office from the sperm bank of your choice.

The insemination procedure

The insemination is a very simple and most often comfortable office procedure. No anesthesia is required. Much like a common pap smear, the cervix is visualized and a very small and soft catheter specially designed for comfort is used to introduce the sperm to the upper uterus. After a waiting period of about 5 minutes, you can leave the office and, unless otherwise instructed by your physician, resume your normal day without restrictions.

After ovulation, the released egg’s follicle turns into what’s called the “corpus luteum” which is responsible for making a key pregnancy hormone called progesterone. Progesterone prepares the uterus for receiving the embryo and provides support to the uterus after the embryo implants. We commonly will suggest that you take vaginal progesterone supplementation after the insemination to support a pregnancy. Progesterone is administered vaginally (either a capsule or ovule).

The first pregnancy test is done 14 days after the insemination. On this day you would be considered exactly “4 weeks and 0 days” pregnant. Serial ultrasounds will be scheduled starting with the week following the positive pregnancy test (this is considered “week 5” of pregnancy). The first ultrasound will attempt to establish that the pregnancy is in the right location. Subsequent ultrasounds (about every 2 weeks) will identify developmental milestones which tell us that the pregnancy is progressing normally

If you have not already done so, and you are trying to become pregnant, you should be on a prenatal vitamin

Before becoming pregnant the following screening tests need to be up to date:

• Pap smear
• Mammogram

Expanded carrier screening (ECS) is a genetic test that attempts to identify
gene mutations that are associated with certain inheritable diseases. ECS tests specifically for what are known as silent gene mutations. This means that many individuals carry these common gene mutations in their DNA but only when they conceive with a person who shares that same gene mutation is there a chance that the resulting offspring gets an actual disease. This is also known as an autosomal recessive gene pattern of inheritance and means that offspring have a 1 in 4 or 25% chance of getting a disease when both parents are carriers. Without screening before pregnancy, most people would not know they are carriers until they have a child born with the disease.

In order to proceed with IUI treatment, it is necessary to have the following labs completed within the past 12 months.

For female recipient of insemination only: Blood type and Rh status, Rubella titer, Varicella titer, TSH and CBC

For both partners : RPR, HIV I&II, HBV Ag, HCV Ab, Gonorrhea and Chlamydia.

For women using donor sperm, CMV IgG/IgM is also required

The following imaging studies should be considewred before embarking on an IUI cycle and can be discussed with your provider.

• Saline sonogram
• Hysterosalpingogram