IUI Procedure from Maureen Moomjy on Vimeo.
What is an IUI?
IUI is the abbreviation for Intrauterine Insemination. In reality it is two procedures. One for you as the patient and one for your partner. Fair enough right?
On the day of a scheduled IUI, the partner provides a specimen of sperm that undergoes the process of sperm separation with a density gradient. Once this is complete, the patient receives the concentrated specimen of sperm in her uterus, with the assistance of Dr. Moomjy utilizing a thin, plastic, sterile, tube (catheter) to place the specimen in the upper portion of the uterus. A Single Woman would arrange for donor sperm for her IUI.
What is Sperm Preparation for IUI?
Did you know that sperm needs to be prepped and cleaned prior to inserting into the uterus!? The normal ejaculate contains motile sperm, non-motile sperm, fluid with prostaglandin chemicals, some immature sperm cells, and sometimes bacteria and inflammatory cells. By preparing the specimen with an isolate gradient and then sperm wash, the ideal final product contains only concentrated good quality motile sperm. The separation gradient is set up in a test tube to provide 2 different density solutions layered one on top of the other. One layer traps the good motile sperm. The other layer traps the seminal fluid; the prostaglandins that cause cramping; and the non-motile sperm that cannot provide fertilization. Sperm Preparation is a multi-step lab procedure that involves incubation, use of the separation gradient, centrifugation, and decanting or separating. This procedure should only be performed by trained technicians, nurses, or doctors. The office of Dr. Maureen Moomjy, Fertility, Gynecology, and Reproductive Medicine is licensed and routinely inspected by NYS as an Insemination Site.
Is an IUI Painful?
This is a pretty common question for those preparing for an IUI. An IUI is similar to a Pap test. It is not painful, however, an IUI does take more time than a Pap test. For some patients, it is a challenge to keep a speculum in place for a few mins. or longer if needed. There can also be mild cramping with the IUI procedure, but that’s about it. It is rarely necessary to pre-treat with pain medication as the cramping is brief. There are occasional patients who have scarring of the cervix or a cervix that is difficult to negotiate with the IUI catheter. But have no fear, Dr. Maureen Moomjy will evaluate your uterus and cervix prior to the procedure date and be sure that the IUI will be comfortable for you and make any necessary preparations!
Can I Go Back to Work After in IUI?
Yes, after an IUI, the patient will rest for 15 mins in the office, and then return to her normal activities for that day.
How Do I Get Ready to do an IUI?
It is best to have a basic fertility work up to confirm that you are a good candidate for this type of treatment. You should have normal tubal function, as confirmed by the HSG Xray. You should have normal ovarian reserve. If ovarian reserve is reduced or age is 38 or more, you should have a discussion about the relative merits of IVF versus IUI with Dr. Moomjy. You and your partner should have cultures that prove that there is no evidence of pelvic or genital tract infection. Your partner should have a semen analysis with concentration and motility that is appropriate for IUI.
Should I take fertility medications for my IUI?
IUIs are closely timed to ovulation. Dr. Moomjy recommends to either monitor your natural cycle, or to take low dose ovulation induction agents to release 1-2 eggs. Either approach should facilitate ovulation with a small injection of Ovidrel®, a recombinant hormone that helps eggs complete the last stage of maturation, and release, generally within 36 hours of the injection. Pelvic ultrasound(s) and blood estradiol levels are necessary to time the injection and the IUI(s). You should have consultation with Dr. Moomjy to assess your history, ovarian function, and current markers of ovarian reserve, to permit decision making about fertility medication selection and dosing.
What is My Chances of Success with an IUI?
An IUI treatment cycle is a mild treatment. Although there is time and effort involved, hormonal profiles are close to natural cycle levels, with the goal to bring more good quality motile sperm close to the egg or eggs on the day of ovulation. To prevent higher order multiple gestation, only 2 eggs should be released for younger patients. The number of eggs release is correlated with the chances of success. For patients under the age of 37, chances of success are approximately 15% per month of treatment. With 3 months of treatment, there will be opportunities for pregnancy. For those who do not conceive with 3 months of treatment, serious consideration should be given to IVF and an IVF consultation with Dr. Moomjy is advised.
Are There Any Risks with an IUI?
There is a risk of infection with any procedure. This risk is exceedingly low in an IUI cycle, as Dr. Moomjy would be sure to culture and treat all possible genital infections for each member of the couple. Risks and side effects of the low dose hormones used for an IUI cycle are infrequent but are best discussed between Dr. Moomjy and each patient once the exact medication protocol is chosen. Should a patient choose to use any cycle with 2 or more follicles, then there is a risk of a multiple gestation. As the risk of multiple gestation is directly related to the age of the patient, the patient should decide with Dr. Moomjy whether to use any cycle with more than 2 follicles.
Motile Sperm (20x magnification with green filter) from Maureen Moomjy on Vimeo.