Polycystic Ovary Syndrome (PCOS) is a common reproductive endocrine disorder, affecting about 5% of women. In women with polycystic ovaries, the ovaries are enlarged with multiple small cysts, which are nothing but the immature eggs which are not growing. These ovaries also have thick stroma which produces excessive androgens. They may also have an altered ratio of pituitary hormones- FSH and LH which interferes with ovulation. Excessive androgens are also responsible for acne and hirsutism.
- What is IUI?
Intrauterine insemination (IUI) is a type of artificial insemination in which there is a transfer of many motile (actively swimming) sperm, through the cervix and directly into the uterus.
- Why is IUI performed?
IUI can be performed depending on the age and reproductive health of the woman.
- Lack of conception after a woman has been on ovulation enhancing agents. This can be particularly important when taking Clomiphene since it can cause decreased cervical mucus
- Cervical factor
- Mild to moderately abnormal semen parameters can be an indication for IUI
- Unexplained infertility
- Minimal – mild endometriosis
- Advancing maternal age
- Male ejaculatory dysfunction
- Use of frozen sperm
- When donor sperm needs to be used
- How is an IUI performed?
An IUI is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. It usually requires the insertion of a speculum and then the catheter. The whole process takes only a few minutes.
- When is the best time to do an IUI?
Ideally, an IUI should be performed around the time of ovulation. When timing is based on an hCG (human chorionic gonadotropin) injection, the IUI’s are usually done between 24 and 48 hours later. If two IUI’s are scheduled, they are usually spaced at least 24 hours apart.
- Where is the sperm collected? How long before the IUI?
Usually, the sample is collected through ejaculation into a sterile collection cup. Most clinics want the semen to be delivered within a half-hour of ejaculation, around the time of liquefaction, so if one lives close enough the sample can be collected at home.
There will delay between when the semen sample is given for washing and when it will be inseminated. The amount of time depends on the washing technique used, which takes 30 minutes to two hours. Most will perform the IUI as soon after washing is completed as possible.
- How long does washed sperm live?
Current research indicates that washed sperm can live 24-72 hours; however, it does lose potency (ability to fertilize the egg) after 24 hours. Another issue with Intrauterine insemination (IUI) is that the sperm can keep on swimming beyond the fallopian tube, so the ideal window is really within 6-12 hours of the egg being released, with a larger margin before ovulation than after since the egg’s viability is shorter. Sperm can live up to 5 days in fertile mucus, 2-3 days being pretty common, so combining IUI with intercourse may provide better coverage.
- How long do I have to lie down after an IUI?
It is advisable to lie down for 30 minutes after the procedure.
- Do I need to rest after an IUI?
Most people don’t need to, but if you had cramping or don’t feel well afterward it makes sense to take rest for a while. Some people reduce their aerobic activity and lifting heavy weights during the luteal phase, in the hope that it will increase the chance of implantation.
- How long before an IUI should the male abstain from intercourse/ejaculating and store up sperm?
This depends on your individual situation, but it usually should not be more than 72 hours since his last ejaculation in order to ensure the best motility and morphology. Where low sperm count is the reason for IUI, it is generally best to wait 48 hours between ejaculation and collecting sperm for the IUI. With no sperm count issues, it makes sense to wait at least 24 hours.
- How soon after an IUI can I have intercourse?
Usually, you can have intercourse anytime after an IUI. In fact, most doctors suggest having intercourse, when that is an option, soon after the last IUI to help make sure ovulation is covered. The best fertility doctors may suggest waiting 48 hours to resume relations if you had any bleeding during the IUI.
- What are the risks involved in IUI?
The main risks are some discomfort such as cramping, a minor injury to the cervix that leads to bleeding or spotting, or the introduction of infection. There are also risks of hyperstimulation associated with the use of ovulation induction medications such as clomiphene citrate (low risk) and gonadotropin therapy (higher risk). Proper technique and adequate monitoring reduce risks.
- When will I have to test for pregnancy after an IUI?
The pregnancy test should be done 2 weeks after an IUI.