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Understanding How IUI Works

Understanding How IUI Works

By Team BHF

What’s the difference between IUI and IVF? If you are having difficulty getting pregnant, it might be time to start thinking about pursuing fertility treatment. After all, there’s a lot of research and planning to be done before even committing to the idea.

Two fertility treatments you’ll hear about a lot are IUI (Intrauterine Insemination) and IVF (In Vitro Fertilization). But what exactly are they? What’s the difference between the two? (Spoiler alert: There are A LOT of differences!) And, most importantly, how are you supposed to know which one is the best match for you?

Whether or not you choose IUI or IVF depends upon a number of variables: you and your partner’s medical history, how long you have been trying to conceive, your age and many, many more. Here, we break down the basics of IUI and IVF to help you determine your best next steps.

What is IUI?

In a nutshell, IUI (Intrauterine Insemination) is a medical procedure where sperm is placed directly inside of the uterus. It is also referred to as Artificial Insemination (AI). With the goal of helping to facilitate pregnancy, it is often performed around the time of ovulation. By shortening the distance that sperm must travel, and foregoing any obstacles it may need to overcome, it becomes considerably easier to fertilize the egg.

Here’s a brief overview of just exactly how IUI works:

Step 1: Ovarian Stimulation

Timing: About 2 weeks

After initial consultations with your fertility doctor, the first step of IUI is Ovarian Stimulation to control how and when your eggs mature.  Depending on your personal health history and your particular treatment plan, you may be prescribed certain drugs to help stimulate (or supress) your ovaries.

What drugs are prescribed during ovarian stimulation?
  • Clomiphene Citrate (Clomid)

When it comes to infertility medication, Clomid is a common first step. Taken orally, not injected, Clomid is a fertility medication that causes the pituitary gland to release hormones that stimulate the ovaries to produce and release eggs.

Also an oral medication, Letrozole is another fertility medication that can be used to stimulate the ovaries and has been eclipsing Clomid in popularity due to its more mild side effects for many. While headaches, fatigue and nausea may still be common, Letrozole has been shown to cause fewer mood swings and have less of an impact on the endometrial lining of the uterus.

  • Gonadotropins

A category of drugs that stimulate the Gonads (sexual organs), Gonadotropins are injectable fertility medications that are used to stimulate follicular development in the ovaries. There are two types:

  • Luteinizing Hormones (LH), produced naturally by the anterior pituitary gland, is a reproductive hormone that stimulates the body to produce estrogen, triggers ovulation and stimulates the corpus luteum. Common LH names include Lupron and Antagon.
  • Follicles Stimulating Hormones (FSH). Taken in conjunction with LH, FSH kickstarts premature eggs in your follicles to start growing. As they grow, they release estrogen. FSH is typically started on day 2 or 3 of your cycle. Popular FSH brands include Gonal-F, Follistim and Repronex.
  • hCG A mouthful to speak, Human Chorionic Gonadotropin often goes by the abbreviation hCG. Similar to LH, an hCG injection of “trigger shot” will cause ovulation - the release of eggs - approximately 36 hours after you take it. The goal?  Being able to best time insemination (or retrieval if you are doing IVF). Common labels for hCG include names Ovidrel, Novarel, or Pregnyl.
Can I do IUI without medication?

Surprisingly to many, the answer is yes! Intrauterine Insemination can be performed with or without medication. Also referred to as a “Natural Cycle”, IUI without medication involves carefully tracking your cycle until it’s time for ovulation. Oftentimes, this can be done through ovulation prediction kits (OPKs). Then, a thin catheter is used to insert the sperm directly into the uterus.

Studies, however, show that unmedicated cycles yield slightly less desirable results with success rates ranging in the 4% area as opposed to a 8-20% chance of successful pregnancy when doing a medicated cycle. Despite the odds, there are a number of reasons why you might choose to do IUI without medication. Those include a much higher likelihood of conceiving multiples with a medicated cycle. Also, at the top of the list? Reasons such as preexisting allergies and finances. IUI medication costs can range from $2-5,000 per cycle depending on insurance coverage.

Step 2: Cycle Monitoring

During IUI, the cycle monitoring phase during IUI is pretty much what it sounds like: frequent check-ins to track the progress of your ovaries in action. During this time period, you can plan on quite a few visits to your fertility clinic so best to keep travel plans to a minimum. Why do they need to keep such a close eye?

Usually starting on day 2 or 3 of your cycle and continuing every 2-4 days afterwards, monitoring appointments include blood tests to check your hormone levels. A transvaginal ultrasound will also be performed to confirm that the eggs within your follicles are developing as desired.

Step 3: Semen Collection

When it’s time for semen collection, your spouse or partner will provide a sample either at home or on location at the fertility clinic on the day of insemination. Vaginal liquid, lubricants and other materials have the potential to damage or kill some sperm so these tools should be avoided. Once collected, it will be washed to separate sperm from seminal fluid. If you are using donor sperm, ICI-ready (unwashed sperm that will then be washed) or IUI-ready sperm (washed prior to cryopreservation but will still need some preparation) may be used.

Step 4: Insemination

Thanks to careful planning, monitoring and medications, your doctor will be able to plan your IUI procedure to take place close to the time you ovulate. It is usually scheduled for about 1-1.5 days after your “trigger shot” which will cause a surge in LH.

During the insemination, a catheter is used to insert the sperm (now washed, prepared and concentrated)  directly into your uterus. By optimizing the time of insemination, maximizing the concentration of sperm and jumping over any “roadblocks” that might be in the way, the chances of conception are significantly greater.

Is IUI painful?

During IUI, most patients report minimal pain - this, without the use of any pain medication or anesthesia. And, because the IUI procedure itself is relatively quick, any discomfort dissipates quickly. To address any mild cramping that might occur, your doctor may prescribe an ibuprofen or over the counter pain reliever.

Step 5: Two-Week Wait

Think it’s ok to take that pregnancy test on day 10 or 11 after an IUI? Think again! The “two week wait” got it’s name for a reason. As agonizing as it is, this is the necessary amount of time it takes to get a true reading on any at-home test.

There are actually a number of ways early testing can screw with your mind. For example, the trigger shot you gave yourself just a day or two prior to the IUI procedure actually contains hCG. This is the very hormone that your body pumps out in the early stages of pregnancy and the very same hormone that pregnancy tests are designed to detect. So, if you test too early, you may very well end up with a false positive.

It can take up to 12 days for a fertilized egg to implant in your uterus. Then, once you are technically pregnant, it can take a few additional days for your body to build up the hCG. So, you really do need to wait, wait, wait and wait some more. Former IVF patients advise taking on a project to keep your mind & hands busy and your emotions in tact. 

Am I a good candidate for IUI?

While every individual and couple is different, IUI tends to benefit those who suffer from blocked tubes or male factor infertility the most. Keep in mind, blocked tubes can be caused by a number of things including some more mild cases of endometriosis, pelvic inflammatory disease, fibroids, previous ectopic pregnancies and more. Similarly, male factor infertility can include sperm quantity, quality and mobility in addition to conditions like erectile dysfunction.  IUI can also be a wonderful option for same sex couples looking to get pregnant themselves or with a gestational carrier.

Do I have to take medication for IUI?

While the majority of IUI procedures do use some form of medication, it is not necessary. During “Natural IUI or “Unmedicated IUI”, a woman’s eggs are harvested during her regular cycle without the use of fertility medications. By carefully tracking your cycle through the use of over the counter ovulation predictor kits (OPKs), you can determine when you are ovulating. When a test reports an elevated LH level, or a “surge” as doctors call it, this indicates that your body is releasing an egg and it’s showtime.

Who would opt for an unmedicated IUI cycle?

Basically, anyone who needs help getting pregnant but does not necessarily suffer from ovulatory issues. It can be a good, low-cost option for women who are using donor sperm but do not suffer from infertility.

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