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.

References:

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