Intrauterine Insemination – IUI
This in-office procedure, also known as “artificial insemination” involves placing “washed” sperm into the uterus, with a small catheter through the cervix. Sperm can be from the husband, significant other, or from a sperm bank, depending upon your situation and needs. The sperm is washed several times to remove substances that can cause cramping.
IUI is often performed if you have failed attempts at timed intercourse, or if there is a determination of abnormal cervical mucus/sperm interaction or slightly abnormal semen analysis.
In the latter case, the sperm is injected past the cervical barrier, to enable them to then move into the fallopian tube, and reach the egg. Variations in the procedure include taking medications to produce multiple follicles, and the release of more than one egg (superovulation or ovulation induction) in order to achieve fertilization.
Insemination may bring your fertility potential to a 15% to 20% pregnancy rate/cycle. Usually a patient will undergo from three to six IUI cycles before moving to a more aggressive procedure.
The cost of intrauterine inseminations varies depending on the type of ovarian stimulation protocol, how much your insurance covers, and the number of cycles.
Ovulation Induction – Clomid
Occasionally women need to have their ovulation induced when they are having problems conceiving. Clomid is a fertility medication, which induces ovulation. We usually start this medication at 50 mg. (one tablet) daily on days 5-9 of your menstrual cycle (please see instructions below). If the lower dosing fails to induce ovulation we may increase the dosage.
After Clomid, one of three things may occur:
Ovulation will be induced, but you will not get pregnant. In this case, you will have a period on days 27-30 of your cycle. Ovulation will be induced, and you will get pregnant. You will not have a period, and should visit our office for a pregnancy test. The dosage of Clomid may fail to induce ovulation. In this case, you will not have a period, and will have a negative pregnancy test. We will most likely increase the dosage of the medication at this point. If your period does start, then repeat the cycle with Clomid again. Mark the days on your calendar with the instructions below to ensure that you are following them correctly. If you have a period on days 27-30 after taking Clomid, then the medicine is working correctly. You should continue taking the medication and have intercourse at the time of ovulation. If you fail to have a period, but your pregnancy test is negative, you are not pregnant. We will induce a period with medication. During your next cycle, we will increase the Clomid to 100 mg. to be taken days 5-9 of your cycle. We will continue to increase the dose if you do not ovulate when taking the lower dosage.
Instructions for your calendar:
When your period begins, mark this as “day 1″ on your calendar. Count and mark the number of days until “day 5″ and mark this on your calendar.
This is the day you will begin taking Clomid. Take the medication on days 5, 6, 7, 8 and 9. You may then label the calendar on the days you may ovulate (most likely days 12-15). You should have intercourse at least on days 12, 14, and 16 of your cycle. Then count and label your calendar on “days 27-31.” This may be when your period begins again. If your cycle has not begun by “day 31″ please call our office.
Clomid is a fertility medication. One important side effect is the possibility of multiple births. The probability of having twins while taking this medication is 7% (meaning 7 out of 100 women taking Clomid will get pregnant with twins). The chance of having more than twins is rare.
LH and FSH – These compounds are human hormones produced by the pituitary gland (Brand names, Bravelle, Follistim, Menopur) and are used to stimulate ovarian follicular development. These drugs can’t be ingested orally, and are therefore administered by subcutaneous injection.
Injections usually begin on day 3 of the menstrual cycle and continue for several days until the developing follicles are approximately 16 millimeters in diameter. Daily dosage, and the length of time needed for adequate stimulation, varies from patient to patient, and from cycle to cycle. Most patients will receive injections for 7 to 10 days.
During the stimulation with these gonadotropins patients are monitored closely with ultrasounds and estradiol levels.
These compounds are used in women who do not ovulate, or who don’t ovulate or conceive on Clomid, or to produce multiple follicles needed for an ART procedure.
An injection of hCG is given to cause ovulation when ultrasound and estrogen measurements indicate appropriate follicular development. All of these compounds are excreted from the body and will leave no long lasting effects on the menstrual cycle. Remember, these hormones are naturally produced by the pituitary gland, they are chemically the same and they are not synthetic like Clomid. Dosages are adjusted based upon a myriad of factors, including but not limited to the patient’s response to treatment.
Other side effects can include: ovarian cysts, nausea, vomiting, diarrhea, abdominal cramps, bloating, irritation at the injection site, and multiple births.
Multiple births occur about 20 to 25% of the time.
Failure to adequately monitor and adjust dosage can lead to a very serious condition, ovarian hyperstimulation syndrome (OHSS). This syndrome is characterized by ovarian enlargement, followed by abdominal pain, abdominal distention, weight gain, circulatory problems, sometimes requiring hospitalization. OHSS can be very serious; therefore, once a patient starts a regimen of gonadotropins it is very important that they follow the physician and nurse coordinator’s instructions.