Stimulated intrauterine insemination (IUI)

The end of the process of intrauterine insemination is the same whether or not a stimulated or an unstimulated cycle is used. The differences between these two infertility treatments lie in the preparation that takes place before the sperm are introduced into the uterus. A cycle of stimulated intrauterine insemination combines artificial insemination with hormone treatments or fertility drugs that make sure ovulation occurs, and that make it more likely that the uterus is ready for pregnancy.

Whether you are offered stimulated intrauterine insemination as your first infertility treatment, or as a follow up to unstimulated IUI, will depend on personal history and the regularity of the woman’s menstrual cycle. If she is not ovulating regularly, or is not always producing an egg, stimulation to regulate ovulation before intrauterine insemination can help.

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The role of Clomid in stimulated intrauterine insemination

If a woman has a pattern of irregular ovulation, the fertility drug Clomid (clomifene citrate) is often used to control the release of the egg and to make it more likely that an egg will be produced. Without ovulation, pregnancy cannot occur.

If you are prescribed Clomid as part of a cycle of stimulated intrauterine insemination, you will be asked to start taking it on the second day after your period starts. This is day 2 of your menstrual cycle. You will need to take the tablets each day up to day 6. During this time it will act on your ovaries to stimulate them to produce eggs. You may produce more than one egg; this not only increases your chance of pregnancy after intrauterine insemination, it also increases your risk of a multiple pregnancy.

Many women find they are troubled with annoying symptoms that resemble pre-menstrual tension when they are taking Clomid, and their periods can be heavier, they can be more prone to spots and they have a tendency to gain weight.

The role of metformin in stimulated intrauterine insemination

Metformin is a drug that is also used to treat type 2 diabetes but it can also stimulate ovulation. It is recommended in women with polycystic ovary syndrome, who often ovulate irregularly, and often those who are either overweight or obese because of their condition. Women taking metformin tend to have side effects that affect their digestive system – they experience sickness, pain in the abdomen, diarrhoea and a metal-like taste in their mouth.

Stimulated intrauterine insemination in women with pituitary problems

In women whose pituitary gland does not produce enough gonadotrophin-releasing hormone (GnRH), ovulation does not occur because this hormone does not trigger the release of follicle stimulating hormone (FSH). FSH is released in the first half of the menstrual cycle to stimulate the production of an egg follicle in the ovary. If levels of GnRH and therefore FSH are low, no egg is produced.

Giving GnRH in a pulse-pump that releases it to mimic the way the pituitary gland does normally can correct this problem. It is not used often, but it can be successful in women with low levels of GnRH when used in combination with intrauterine insemination.

Deciding whether to proceed with intrauterine insemination

Having stimulated intrauterine insemination requires more monitoring of how well the egg follicles are developing in your ovaries. If the process of stimulation has been too successful, and you are either in danger of developing ovarian hyperstimulation syndrome, or you are producing more than three egg follicles, the cycle of intrauterine insemination may have to be abandoned. It can be repeated a couple of months later, but your stimulation drugs may need to be changed.

If all looks OK, you will be given an injection of human chorionic gonadotrophin hormone to release the eggs that have matured. Intrauterine insemination with fresh sperm from your partner, or with frozen and thawed sperm from a sperm donor, can then take place.

The process of insemination

This is done in exactly the same way as in an unstimulated IUI cycle; sperm are introduced directly into the uterus, above the cervix, through a thin tube that is passed through the cervix. This should not be painful and takes less than 20 minutes. Some fertility clinics will introduce the sperm with a larger volume of nutrient fluid. The theory behind this is to give the sperm a better chance of reaching the fallopian tubes, where the egg will be, but there is no hard evidence that it does so.

Two weeks after intrauterine insemination a pregnancy test will hopefully confirm that you are pregnant, but it is important to bear in mind that the success rates for this form of infertility treatment range from 11 % to 15 %, which is less than half that of in vitro fertilisation.

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