It’s Not a “Turkey Baster” Treatment!
Intrauterine insemination (IUI) is a commonly used treatment for infertility when there is unexplained infertility, mild male factor infertility or when the female partner has cervical mucus problems. Some reproductive endocrinologists will also prescribe ovulation stimulating drugs for the woman before performing IUI.
If you are going to have an injectable IUI cycle, you should be carefully monitored. Here’s what you can expect.
Clomid First, Then Gonadotropins, Then hcG
Fertility drugs may help you conceive with IUI because they stimulate your ovaries to produce more eggs than in a normal cycle, which increases the sperms’ chance of getting to an egg. Some fertility doctors will use Clomid, or clomiphene citrate, first. The timing of the IUI with a Clomid cycle may be done with urinary ovulation prediction kits or using ultrasound monitoring. If Clomid doesn’t help you get pregnant, your doctor may recommend injectable gonadotropin, which is a follicle stimulating hormone or FSH.
On day 3 of your menstrual cycle you will have a baseline ultrasound and blood work, prior to starting any injectable drugs. Injectable medications are started that day, after the testing is completed, and are used for six to ten days. Usually you inject them yourself, under the skin on your belly.
During that time you will have blood work and ultrasounds three or four times, so your fertility team can monitor how your eggs are growing and developing. Once the lead egg, also called a follicle, reaches a certain size, you will be instructed to take an injection of human chorionic gonadotropin (hcG) which causes ovulation. IUI will be performed one or two days after the hcG injection.
How Will You Feel?
Clomid may have side effects including hot flashes, mood swings, and bloating. Most women don’t experience any side effects from the injectables. Some women will feel breast tenderness, bloating and other mild side effects.
IUI itself is no more painful than a normal pelvic exam. Your doctor or a specially trained nurse will insert a speculum in your uterus and expand it. Then the sperm is introduced by a soft catheter that passes directly into the uterus. IUI is a relatively quick procedure and is performed without anesthesia. Most women won’t feel any pain, although some women report mild discomfort.
Pros and Cons of IUI with Injectables
There is some controversy about whether injectable IUI cycles are more effective than IUI cycles with Clomid. An injectable IUI cycle is considerably more expensive than one using Clomid due to the high cost of the fertility drugs and the need for monitoring with ultrasounds and blood work. It also has a significantly higher risk for twins and multiple pregnancies.
A major factor in the chance of success with ovulation stimulating drugs and IUI, whether clomiphene citrate or gonadotropins are used, is the age of the female partner. The success rate of any fertility treatment declines over age 35, and declines sharply at age 40. Some fertility specialists recommend going straight to IVF treatment if Clomid and IUI do not work, in order to save time and money for what is usually a more effective treatment.