What Is the Beginning of the IUI Procedure Step By Step?
Intrauterine insemination or IUI is a technique used to help certain couples conceive a child. In summary, the treatment involves inserting “prepared” sperm into a woman’s uterus. Ideally, these sperm will fertilize the egg and pregnancy will result. While the procedure is less invasive and less time-consuming than other assisted reproductive techniques, such as in vitro fertilization, IUI still requires several steps to maximize the likelihood the procedure will be successful.
Reasons a Couple May Choose IUI
According to the American Pregnancy Association, most couples choose IUI as a fertility method because a partner may have a low sperm count or sperm motility. Sperm count is important because the more sperm available to fertilize an egg, the more likely it is the egg will be fertilized. Motility, the rhythmic movement that propels sperm forward toward the uterus, is necessary because the sperm cannot otherwise reach the uterus to fertilize the egg. Because IUI implants the sperm directly into the uterus, affected motility is less likely to create a problem.
However, there are other reasons that a couple may choose to utilize IUI as a fertility treatment. Examples of these reasons include:
- Conditions that may affect the progression of sperm past the cervix, such as cervical mucus complications. If the cervical mucus is too thick, the sperm cannot progress to the uterus.
- History of scar tissue in the cervix due to previous surgical history or medical conditions that cause scarring
- Problems with ejaculation
- Infertility of unknown causes. According to the Mayo Clinic, IUI is often performed as a first-line treatment for unknown fertility because it is less costly and invasive than in vitro.
Just as there are reasons IUI may be successful for a couple having difficulty conceiving, there are also reasons why IUI may not be effective in treating fertility. These conditions include women who have severely diseased Fallopian tubes or a history of moderate to severe endometriosis, where uterine tissue grows outside the uterus. These conditions affect an egg’s ability to reach the uterus. As a result, IUI would not be effective because only the semen would be present in the uterus, not the egg.
Doctors will not usually recommend fertility treatments until a couple has been trying to get pregnant for a year if the woman is under the age of 35. However, women over the age of 35 may wish to seek fertility treatments after trying to get pregnant for six months due to concerns over aging and quality and quantity of eggs.
Pre-Testing for IUI
A doctor will usually conduct several rounds of pre-testing before recommending IUI to a couple. As previously mentioned, IUI will not be effective for couples with certain medical conditions that affect fertility. Examples of tests that a doctor may use include:
- Semen Analysis: If a man does not have enough high-quality sperm present in his semen, the likelihood for conception via IUI is almost none. Therefore, a doctor will recommend performing a semen analysis in advance.
- Pelvic Ultrasound: A doctor will usually perform a pelvic ultrasound on a woman to ensure that her Fallopian tubes are not blocked in some manner. If the fallopian tubes are blocked, the egg cannot travel to the uterus and a woman cannot get pregnant.
- Blood Hormone Testing: Sometimes a woman may not ovulate for various reasons. Testing several different hormones in the blood can help a doctor identify if a woman has sufficient hormones in her body to ovulate.
Step 1: Using Ovulation Medications
While not all women who use IUI to try to get pregnant take medications to encourage ovulation, many opt to do so because it increases their chances of success when using IUI. There are a number of medications that can help to support ovulation in a woman. One is the medication Clomid. This medication encourages the release of hormones from the pituitary gland that stimulate the body to release luteinizing hormone and follicle-stimulating hormone. Each of these hormones are responsible for helping encourage the release of an egg and also to encourage the egg to mature.
Another ovulation medication is human chorionic gonadotropin (hCG). This medication is a replication of a hormone within the body that can trigger a woman’s ovarian follicle to release an egg. Sometimes a woman will take both Clomid and hCG as a means to encourage ovulation.
Step 2: Preparing the Sperm
A man will donate his sperm at the doctor’s office. The sample is then taken and prepared or “washed” in a manner that will concentrate the more active and higher-quality sperm. A technician will also separate the non-sperm portions of the semen. This helps to reduce the likelihood that a woman’s body will have an allergic reaction to the sperm. Using this smaller, more concentrated amount of healthy sperm is associated with a greater chance for getting pregnant.
Sometimes a woman may also choose to utilize sperm from a donor instead of a partner’s sperm. If a partner’s sperm is of a significantly low count and quality such that she could not become pregnant, a donor’s sperm may need to be used instead. If a woman does choose to use donor sperm, the sperm bank that sends the sperm will ensure they are prepared before the IUI procedure.
Step 3: Ovulation Monitoring
When it comes to getting pregnant, timing is everything. When a woman is ovulating, she has a window of time that is anywhere from 12 to 24 hours for the sperm to fertilize an egg. To ensure the timing is just right for the IUI procedure, a doctor will monitor a woman for signs of ovulation. Some women may choose to use an at-home kit to test for ovulation. This involves testing a woman’s urine for the presence or increase of the luteinizing hormone that is associated with ovulation. Another option is to go to a doctor’s office and undergo imaging testing to determine how close a woman is to releasing an egg. Sometimes a doctor may recommend administering a shot of the hormone human chorionic gonadotropin (hCG) hormones that will result in ovulation and often cause a woman to release more than one egg at a time. As a general rule, a doctor will have a woman come to the office for the IUI procedure anywhere from one to two days after identifying that a woman is ovulating and will ultimately release an egg or eggs soon.
Step 4: Performing the Procedure
When a doctor identifies that it is the appropriate time for the IUI procedure, a woman will come to the doctor’s office. The procedure itself takes a very short amount of time. A woman will lie on an exam table with her feet in stirrups (known as the lithotomy position). The doctor will insert an instrument known as a speculum into her vagina. This speculum allows the doctor to more easily access the cervix. The doctor will insert a long flexible tube called a catheter through the vagina, past the cervix, and into the uterus. The doctor will take the sperm sample and insert the sperm into the uterus. The doctor will then remove the catheter and speculum.
The procedure usually takes less than 5 minutes and is not associated with significant pain. A woman will usually remain lying on her back for a period of time to ensure the sperm remain in the uterus. After this time, a woman can usually return to her daily activities unless otherwise instructed by her doctor.
Step 5: Taking a Pregnancy Test
A woman can usually start taking a pregnancy test about two weeks after the IUI procedure. However, even if she gets a negative result at this time, it is still possible that she is pregnant. Sometimes her hormone levels may not have yet exceeded the threshold for the pregnancy test to detect the pregnancy. If a woman is taking the hormone hCG for ovulation, it’s possible that she could also have a false-negative result because an at-home pregnancy test measures the levels of hCG in the body.
Sometimes a doctor may recommend coming to their office for a blood test to determine if a woman is pregnant. This test is often more sensitive to the likelihood a woman is pregnant that an at-home test.
Step 6: Repeating the Test
If a woman does not become pregnant at this time, the doctor may recommend trying the IUI procedure several more times before concluding it will not be effective. According to the Mayo Clinic, doctors usually will perform the procedure three to six times before recommending other treatments.
Conclusions on the IUI Procedure Step by Step
The IUI procedure is one that is usually painless and associated with minimal risks. Potential effects after the procedure can include vaginal bleeding/spotting. A woman is also at risk for an infection because the procedure is somewhat invasive. If a woman takes medications to stimulate ovulation, she may be at greater likelihood to become pregnant with more than one child because the medications may stimulate the release of more than one egg.
American Pregnancy Association: Intrauterine Insemination (IUI)
Attain Fertility: Understanding the IUI Procedure
Human Fertilization & Embryology Authority: What Is Intrauterine Insemination (IUI) and How Does It Work?
Mayo Clinic: Intrauterine Insemination (IUI)
The National Infertility Association: IUI
At its most basic form, prenatal testing is any kind of test you get while you’re pregnant (thankfully, not the multiple choice kind). This could include ultrasounds, taking your blood pressure, or testing your urine. However, there are other prenatal testing types available throughout your pregnancy that can confirm your baby’s gender or test for abnormalities in your baby’s growth and development.
An ultrasound test can be one of the most exciting tests you’ll do while pregnant. Another name for it is a sonogram. That’s because an ultrasound allows you to see your baby, and allows your obstetrician to track your baby’s growth and development. The technology uses sound waves to re-create an image of your baby on a computer screen. Some doctors perform this test twice: in your first trimester and around 20 weeks of pregnancy. Others provide the test more frequently to monitor your baby’s growth and levels of amniotic fluid.
In your second trimester, somewhere between 24 and 28 weeks’ gestation, your obstetrician will have you complete a glucose screening test. Most commonly, you’ll drink a glucose-containing drink (like a Sprite, but with more sugar), and test your blood to see how well your body processes the sugar. The test is to determine if you could have gestational diabetes, a condition that affects your blood sugar in pregnancy.
Your doctor will draw a sample of your blood for testing for certain conditions that could affect you and your baby. Examples include HIV, anemia, hepatitis B, and your blood type. Your blood type is especially relevant if you have a “negative” blood type, like B-negative and your partner has a positive blood type. This is known as Rh incompatibility and may require the administration of a special medication known as RhoGAM that can reduce the risks for adverse effects to your baby.
Not all expectant moms need (or want) genetic testing, but it is available. Some are known as screening tests that will test for potential risks for a baby to experience a condition, such as cystic fibrosis or Down’s syndrome. Other tests are diagnostic and can more definitively say if your baby has a certain medical condition. There are some instances where a doctor may recommend these tests. This includes if you are older than age 35, have had a premature baby in the past, or are a known carrier for certain genetic conditions.
An amniocentesis is a test that involves taking a sample of the amniotic fluid in your uterus to test for abnormalities. This involves inserting a thin needle into your belly, so it is associated with some risks. The test is usually performed between 14 and 20 weeks into your pregnancy. Doctors don’t usually recommend amniocentesis unless you have had an abnormal blood test or ultrasound that may indicate the potential presence of an abnormal condition in your baby. An example could be if your baby has fetal anemia and may require a blood transfusion.
Uterine contractions are the body’s way of moving your baby down the birth canal and into the world. However, there are different types of contractions a woman can have during pregnancy, including Braxton Hicks contractions and actual labor contractions. Women also experience contractions differently, which can make them difficult to recognize in the early stages. Read on to learn more about contractions, and how to recognize when your contractions signal that labor is imminent.
Braxton Hicks contractions are also known as false labor contractions or sometimes as “practice” contractions. They typically occur from the second trimester on. Some women never experience them, and some women have them for months. Doctors don’t know exactly why women have Braxton Hicks contractions. Some theories are the contractions prepare the uterus for labor and/or that they may encourage blood flow to the placenta. These contractions aren’t harmful to baby, but they can cause alarm on the part of the expectant mom.
Some symptoms associated with Braxton Hicks contractions include:
- Tightening of the uterus for 30 to 60 seconds
- Irregular in their occurrence
- Remain at the same intensity and frequency over time
- Taper off with time and will often stop altogether
Real labor contractions are designed to help the cervix start to thin out and widen as well as ultimately helping baby move through the birth canal. Having labor contractions doesn’t mean that labor is going to happen within a few hours or even day. However, they do mean you are getting closer to meeting your little one(s). Labor contractions have some distinct differences from Braxton Hicks contractions. They include:
- Pain or discomfort that gets worse with movement instead of better (Braxton Hicks contractions will often go away with movement).
- Become more frequent in intensity over time. They may also start to occur more closely together.
- Lower abdominal pressure that may feel like heavy menstrual cramping.
- Are accompanied by other signs of labor, including a rupture of membranes or bloody show, which is when the mucus plug passes.
What Contractions Feel Like
The experience of having contractions can differ from mother to mother. Some moms may describe pain and pressure in the lower back while others may have front abdominal or pelvic pain. Contractions are basically muscle cramping, but cramping that can be prolonged and occur at regular intervals. Some descriptions of contractions laboring moms have described include:
- Deep abdominal pain
- Gas pains
- Strong backache
- Strong menstrual cramping
The position of the baby as it moves down the birth canal as well as the mom’s own individual pain experience can all determine what contractions may feel like for an expectant mom.
When to Call Your Doctor
A woman may have contractions for weeks before her baby actually arrives (they are usually quite a bit of time apart and lesser in intensity). However, there are some contraction instances you should always call your doctor about:
- If your contractions are growing stronger and your baby isn’t 38 weeks old yet
- If your water breaks, and the fluid is green or brown.
- if the contractions cause the umbilical cord to slip out of the vaginal canal.
- The contractions are causing you intense and/or unbearable pain.
- You are experiencing vaginal bleeding.
Otherwise, you should call your doctor if your contractions start to be somewhere between five to seven minutes apart. This frequency of contractions can indicate that labor may be imminent.
Edema is another word for fluid retention. You most often see edema expressed as swelling in the legs and ankles, although you might also notice puffiness in your face, neck, or hands as well. Some degree of swelling and edema is common in pregnancy. Your body produces more fluid when you’re pregnant and fluid tends to shift from the blood vessels into the tissues of your body. You often see swelling in the ankles and calves during the late second and third trimester of pregnancy as the weight of the expanding uterus puts pressure on the veins that carry blood and fluid back to the heart.
In most cases, swelling and edema during are nothing to worry about. Almost all women will experience it to some degree during pregnancy. However, in some cases, edema can be a sign of health problems. For example, if you have edema along with a headache and blurred vision, you could be suffering from a condition called preeclampsia. With preeclampsia, you also have an elevation in blood pressure. It typically shows up after 20 weeks of pregnancy and can be fatal. In general, you should worry about swelling if you have other symptoms like shortness of breath, headache, blurred vision, pain in a swollen area, or distended or painful blood vessels in the area. You should also be concerned about swelling that comes on suddenly.
Another red flag is swelling in only ONE leg. If you have swelling in one leg only, it could be a blood clot. Blood clots are dangerous because part of it can dislodge and move to the lungs where it can interfere with air exchange and lead to death. Due to hormonal changes, blood clots are more common during pregnancy, especially during the first trimester, and need immediate evaluation. Always let your doctor know if you have swelling greater on one side more than the other. You’re at higher risk of developing a blood clot if you smoke, are overweight, have a family history of blood clots, sit for prolonged periods of time, or are over the age of 35. Always tell your health care provider if you have a family history of blood clots.
What can you do to ease the swelling, assuming it’s not due to something more serious? Here are some tips:
- Avoid standing or sitting outside in the heat or for prolonged periods of time.
- Cut back on sodium and eat more potassium-rich fruits and vegetables.
- Take a brisk 30-minute walk daily to reduce your risk of blood clots.
- Stay well hydrated. Being dehydrated places you at higher risk of a blood clot.
- Wear comfortable shoes, ones that can expand to accommodate the swelling.
- When you’re sitting, prop your feet up so they’re higher than your heart.
The Bottom Line
Edema in pregnancy isn’t typically a cause for concern as long as you have no other symptoms and the swelling isn’t on one side only. Still, it’s a good idea to let your doctor know if you’re experiencing it. Also, take the six steps mentioned to reduce the amount of edema you experience.
American Pregnancy Association. “Swelling During Pregnancy”
Mayo Clinic. “Preeclampsia”
Edema in pregnancy – how common is it? More importantly, what can you do about it? This article discusses why you develop edema when you’re pregnant and tips for dealing with it.
What You Should Avoid When You’re Expecting
Pregnancy changes your lifestyle, at least temporarily, and for good reason! What you’re exposed to while you’re pregnant can impact the development of the tiny being growing inside you. Let’s look at some of the things you should avoid when you’re pregnant.
What to Eat and What Not to Eat
As you might expect, diet matters. When you’re “eating for two,” nutrient-dense foods, like lean protein, fruits, vegetables, and whole grains provide nutrition without excess calories. In contrast, packaged and processed foods are high in salt, sugar, and contain questionable additives and preservatives. So, keep packaged foods to a minimum and read labels carefully for ones that you do buy. Avoid ones with a long list of ingredients, especially ones that you can’t pronounce.
Other foods to avoid include undercooked or processed meat and dairy (including eggs). Deli meats can be contaminated with Listeria and raw or undercooked meat may harbor bacteria that cause food poisoning. More sources of Listeria include: smoked meat and fish, soft cheeses, and unpasteurized meat. According to the Centers for Disease Control and Prevention, even uncooked vegetables can harbor listeria. Make sure that what you eat while you’re pregnant is cooked well. Avoid raw sprouts as well. They can be a source of harmful bacteria. If you consume dairy, make sure it’s pasteurized to kill harmful bacteria.
Deep water fish are a good source of omega-3s, healthy fats that support fetal brain development. Unfortunately, fish can be a source of heavy metals, like mercury, that are unsafe for a developing baby. According to Mayo Clinic, it’s safe to eat 2 to 3 servings of low-mercury fish each week. Make sure it’s well cooked and avoid large fish high on the food chain. These fish are more likely to have accumulated heavy metal and other toxins. Wild-caught salmon, sardines, herring, anchovies, and Atlantic or Pacific mackerel are good choices.
Smoking and Alcohol
It might seem obvious but smoking and alcohol aren’t healthy for a developing baby or for you. Consuming alcohol during pregnancy, is linked with growth retardation and damage to organs, particularly the brain of a developing baby. As the Mayo Clinic points out, there is no safe level of alcohol during pregnancy.
Smoking is a “no-no” too. Smoking during pregnancy is linked with preterm labor, placental problems, like placental abruption and placenta previa, as well as ectopic pregnancy, a condition where a fertilized egg implants somewhere other than the uterus. An ectopic pregnancy can be life-threatening, so use that as motivation to kick the smoking habit.
Don’t Miss Doctor Appointments
Prenatal care is essential for the well-being of your future baby and for your health as well. Always the prenatal vitamin your doctor prescribes during pregnancy. You need the folic acid to lower the risk of spina bifida. Consult your doctor before taking any medication, prescription, non-prescription, or supplement, while you’re pregnant. Avoid getting x-rays as well. Each scheduled visit with your obstetrician is important for checking your blood pressure, blood sugar, urine etc. to make sure you’re not developing pregnancy complications such as preeclampsia and gestational diabetes.
Other Things to Avoid without Consulting Your Doctor First:
Herbs and herbal teas
Hot saunas and Bikram yoga
Exposure to x-rays
Exposure to pesticides – Consider buying organic
Cleaning cat litter boxes
The Bottom Line
Your doctor may have other recommendations on what to avoid, based on your medical history. Be sure to ask!
Centers for Disease Control and Prevention. “Listeria”
Mayo Clinic. “Pregnancy and Fish: What’s Safe to Eat?”
March of Dimes. “Smoking During Pregnancy”
Mayo Clinic. “Pregnancy: Week by Week”
If it’s your first pregnancy, it’s hard to know what to expect. Your experience may be quite different from another woman at your stage of pregnancy. One condition that some women face is ptyalism. Although the name is a bit intimidating, ptyalism simply refers to the increased production of saliva.
You’re probably familiar with the salivation you get when you see or smell something delicious, but the ptyalism of pregnancy often happens out of the blue, is excessive and usually unpleasant. Some women describe the excess saliva they produce as bitter in taste. You’re more likely to have this problem if you have morning sickness. Along with nausea, you may notice that your mouth feels with saliva, sometimes to the point that you have to spit it out.
What Causes Ptyalism during Pregnancy?
Even the experts sure why salivary glands sometimes become hyperactive during pregnancy. As with most symptoms, you deal with when you’re pregnant, fluctuating hormones likely play a role. Often nausea, related to morning sickness, aggravates the problem. You’re most likely to experience ptyalism during the first trimester of pregnancy.
Women who aren’t pregnant can also develop ptyalism and it’s more common in people who suffer from heartburn. Since heartburn is also common during pregnancy, it may be a factor in some cases of ptyalism, although you can experience it in the absence of heartburn.
Ptyalism and Heartburn
Heartburn, also known as acid reflux, is where the flap that separates your esophagus and stomach opens and allows acid from your stomach to move into your esophagus. Acid reflux causes symptoms like nausea, a sensation of acid in the back of the throat, and burning in the chest. When the acid enters your esophagus, it triggers the salivary glands to produce more saliva to help neutralize the acid.
Even if you don’t have acid reflux, you can still have ptyalism. Although it’s likely related to pregnancy, it’s a good idea to check with your doctor since other conditions can cause your salivary glands to overproduce saliva, including certain medications.
You might wonder whether ptyalism is linked with other problems during pregnancy? One study found that women who developed ptyalism were more likely to have hyperemesis gravidarum (excessive vomiting during pregnancy) and more likely to give birth to a male baby. It also found ptyalism was linked with a slightly higher incidence of delivering a small birth-weight baby.
What Can You Do about Ptyalism?
Unfortunately, there isn’t a way to tone down your salivary glands and make them behave. You wouldn’t want to tone them down too much since you need saliva to discourage the growth of bacteria that cause cavities and gum disease as well as for starting the process of digestion. Plus, a dry mouth would feel very uncomfortable. Some things you can do to reign in the symptoms:
- Avoid eating spicy or heavily seasoned foods. Heat and spice increase saliva flow and also worsen heartburn.
- Chew on ice cubes. This helps some women get relief from the excess saliva flow.
- Consider hypnosis. A study found hypnosis was effective for relieving the symptoms.
- Keep a cup by your side, in case you need to empty your mouth.
- Drink plenty of water to make your saliva more dilute and less bitter tasting.
N Am J Med Sci. 2009 Nov; 1(6): 303–304.
Arch Gynecol Obstet. 2013 Apr;287(4):629-31. doi: 10.1007/s00404-012-2614-x. Epub 2012 Nov 3.
Am J Clin Hypn. 2015 Oct;58(2):215-23. doi: 10.1080/00029157.2015.1013186.