IUI INFO

Found this posted by a DOC on another fertility website
Good info I did not know about before





Sperm preparation technique There are several methods for "washing" sperm, and many variations upon them. Differences in outcome can even be caused by using lower quality products – so always insist on knwoing whether the lab uses FDA-cleared products such as media. According to the world experts in sperm preparation technology, the best method is a simple 2-step density gradient centrifugation, followed by a single centrifugal wash step. This allows separation of the sperm from the seminal plasma (which must never enter the uterine cavity) quickly and efficiently.
But before the sperm can be washed the semen specimen must be produced and delivered to the lab. If the sperm spend more than 30 minutes in the seminal plasma (i.e. there is a delay of more than 30 minutes between the man collecting his semen specimen and the lab starting the washing procedure) then their functional potential can be irreversibly compromised. And of course the sperm must be protected against hot and cold (i.e. temperatures above body temperature and below room temperature) during that time.

Insemination technique How the insemination is performed can also have great impact on the chance of conceiving. It must be as simple and atraumatic as possible. And the catheter used must be FDA-cleared for that purpose. There are cheap catheters out there that have been used for IUIs for many years, but they are known to be toxic to sperm (with great between and within batch or lot variability), and if a clinic uses one of these then the results could be compromised.

Timing of the IUI Obviously the insemination must be performed at the right time of the cycle. How this is determined varies between clinics and doctors, but the plan is to have the sperm inseminated a few hours before, or very soon after the time that the egg will reach the site of fertilization in the oviduct (fallopian tube). If the sperm are there too early then they might become exhausted or even die while waiting for the egg, and if they're inseminated too late then the egg may have become unfertilizable. Judging this is a skill that has to include not only knowledge of the ovulation process, but also the performance dynamics of the particular method being used to predict ovulation. Some studies suggest that two inseminations are better than one (see study below).


What's a good success rate? This will depend to some extent on whether any ovarian stimulation is used in the IUI cycle. But great care must be taken not to use too much, or too powerful drugs, as that runs a very high risk of multiple pregnancy: not just twins, but triplets, quadruplets or more! Always ask about success rates specific for the EXACT treatment that you'll be receiving, and also ask about the risk of multiple pregnancy, and whether the clinic uses "selective reduction" in cases where multiple embryos implant after IUI in "stimulated" cycles. Working hard to get pregnant and then having to choose to kill one or more of the embryos that has implanted in your womb is surely not the best way to hamdle TTC!

With no stimulation, or perhaps just some clomid, a fecundity rate (pregnancy rate per cycle of trying) of 8 to 12% should be achievable. Although I believe Clomid is over used in IUI and other stimulation meds offer a better per cycle pregnancy rate (see article below). With some mild stimulation the fecundity rate should be in the range of 16 to 24% per cycle or so. Of course, if a clinic treats a lot of patients by IUI who have a poor prognosis then these results will be lowered. Clinics where patients are screened carefully as to their suitability for IUI treatment report fecundity rates of 25% per cycle in those patients for whom IUI is deemed appropriate. Patients with lower chances are better channeled towards IVF, although the higher cost of IVF might cause them to remain in an IUI treatment population (and hence lower the apparent overall success rate).

The bottom line: If a clinic can't or won't explain just what they'll be doing, or give you the answers to your questions, you should exercise your right as a patient to seek a second opinion or go to another doctor or clinic.

Fertil Steril. 2005 May;83(5):1510-6. Related Articles, Links


Women with ovulatory dysfunction undergoing ovarian stimulation with clomiphene citrate for intrauterine insemination may benefit from administration of human chorionic gonadotropin.

Vlahos NF, Coker L, Lawler C, Zhao Y, Bankowski B, Wallach EE.

Re: IUI INFO

Thanks Donna -- this is all good info. I am hoping my IUI worked...but if I need to ask these questions in the future, I know what to ask.,....

Re: IUI INFO

Great info , thanks for posting Donna...

Timing of the IUI Obviously the insemination must be performed at the right time of the cycle. How this is determined varies between clinics and doctors, but the plan is to have the sperm inseminated a few hours before, or very soon after the time that the egg will reach the site of fertilization in the oviduct (fallopian tube). If the sperm are there too early then they might become exhausted or even die while waiting for the egg, and if they're inseminated too late then the egg may have become unfertilizable. Judging this is a skill that has to include not only knowledge of the ovulation process, but also the performance dynamics of the particular method being used to predict ovulation. Some studies suggest that two inseminations are better than one (see study below).

That's why I am so against OPKs as a form of monitoring a patient for IUIs....I just think the timing of an IUI is so critical.