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Intrauterine insemination (IUI) is a fertility treatment that involves preparing and selecting the best quality sperm from your partner, and then depositing the collected sperm inside the uterus using a syringe or catheter-like medical device around the time that the egg is being released.

There are two types of IUI:

1. Natural cycle IUI  

Natural cycle IUI is one of the more simple assisted reproduction methods. You do not require any form of hormonal stimulation. It is usually performed around the time of ovulation. This is more suitable for women who have regular menstruation cycles, and can predict ovulation. You will be required to monitor your own ovulation cycle, which may involve using LH strips on urine samples to monitor a LH surge, blood estradiols, regular scans, etc.

2.  Stimulated IUI

A stimulated IUI is a process in which you are given fertility drugs to stimulate ovulation. The fertility drugs given can either be orally administered tablets or injections. Medication will usually be started on Day 2 of the cycle for 4 to 5 days. This is better suited for women who do not have a regular cycle as it helps to generate more than one follicle.

Stages of IUI

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Stage 0

Preparing for IUI

Prior to the IUI, both you and your husband should have already done the necessary blood tests and fertility tests to ensure that IUI is appropriate.

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Stage 1

Monitoring the Follicle

On Day 10 of your cycle, you will be scheduled for a transvaginal ultrasound scan to monitor follicle development.

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Stage 2

Day of the IUI

On the day of the IUI, the husband would have already been given a scheduled timing to submit his sperm sample.

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Stage 3

After the IUI

Your doctor may or may not start you on medication such as progesterone to help improve the chances of implantation ...

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Stage 4

Pregnancy Test

Around 2 weeks after the IUI procedure, you will be asked to return to the clinic to get a blood test

 

Stage 0 : Preparing for IUI

Prior to the IUI, both you and your husband should have already done the necessary blood tests and fertility tests to ensure that IUI is appropriate. To maximise the success rate of an IUI, both of you try to be in an optimal state of health. Eat healthy, and exercise regularly. Stop smoking, and reduce your intake of alcohol and caffeine at least one month prior to your IUI.

Women should also:

1. Start taking folic acid,  which helps to prevent birth defects such as spina bifida.

2. Start taking Coq10, usually (600mg) which may support fertility and a healthy pregnancy.

And men should:

1.  Take antioxidant supplements with vitamins A, C and E to improve their sperm quality.

2.  Avoid hot baths, saunas and Jacuzzis as sperm quality can be badly affected by high temperatures.

3.  Avoid medications that can adversely affect their sperm function. 

 

Stage 1 : Monitoring the Follicle

On Day 10 of your cycle, you will be scheduled for a transvaginal ultrasound scan to monitor follicle development. This is to determine if a mature follicle has developed, ascertain the size of the follicle and to check the thickness of the endometrial lining. 

Both sides of the ovaries will be scanned to check the number of follicles. If there is more than one follicle, both will be checked for size and the bigger follicle will be used as the basis for the “trigger shot”, which is an injection of HCG into your stomach to help mature the egg within the follicle. The final IUI procedure is then usually performed 24-40 hours after the trigger shot. 

You will be told by the clinic when to come in for the IUI.

Practical pointers

  • You will be taught by the nurse how to administer the trigger shot. You will need to squeeze your belly and just poke the needle in and press down. For many ladies, the injection does not hurt too much. 

  • If you or your husband (or other family member / friend) are not comfortable administering this injection, you can ask the nurse for a referral letter, which will let you go to any clinic for the injection to be administered for you.

 

Stage 2 : Day of the IUI

Collection of the sperm

 

On the day of the IUI, the husband would have already been given a scheduled timing to submit his sperm sample. To produce the best possible sample, the husband would have been instructed to abstain from ejaculation or sexual intercourse for 3 to 5 days before the day of collection.

Semen can be collected into the given sterile specimen container at home and brought to the lab, but it should be kept warm at all times and it should reach the clinic within the stipulated time frame (usually 1 hour) to ensure optimal quality of the sperm. Some private clinics and public hospitals may have a collection room on site - you should check this in advance, to avoid having to use public toilets instead.

The sperm sample will then be submitted to the lab, where the husband will have to sign the necessary documents and produce his NRIC for verification. The lab will then proceed with the basic sperm wash where the sperm will be placed into a test tube and cleaned. This is a necessary step as extra seminal fluid, dead or weak sperm, bacteria, debris, and prostaglandins are removed, leaving the most motile sperms in the final sample. This procedure usually takes about 20 minutes to an hour. 

Insemination

 

After the submission of the sperm sample, you will be given a timing to return to the clinic for the actual procedure. The prepared sperm sample will then be brought to the room in a syringe.

You will then be asked to remove your underwear and lie down. Your husband is allowed to be with you throughout the procedure. 

The doctor will then do a transvaginal ultrasound to ensure that the follicle is of the appropriate size and determine whether ovulation has already started. The doctor will then proceed to use a duck beak clamp to open your cervix, and then push a thin flexible tube through your cervix into your uterus and syringe the prepared sperm directly into your uterus. This marks the end of the procedure. The procedure itself is quick and painless; however, you may feel some cramping after the procedure due to irritation from the catheter or clamp. 

Practical pointers

  1. Prior to the IUI procedure, it is recommended to drink lots of water so that you have a full bladder. This may help the doctor guide and angle the catheter into the uterus. 

Real women say…

“I really didn’t know what to expect at the IUI procedure. It ended up being much like a pap smear. And it was really fast”

"I kind of remember being asked to keep my legs in the air in stirrups for a while after IUI. My personal tip would be to try to ignore the full bladder and  think of pleasant things, or ask for a urine catheter."

 

Stage 3 : After the IUI

Your doctor may or may not start you on medication such as progesterone to help improve the chances of implantation, depending on whether he/she feels that you require it. 

You may also be requested to come in for a blood test seven days after the insemination to monitor your progesterone levels. If your progesterone levels are low, you may be given more progesterone (via injections or tablets).

 Practical pointers

  • Try not to be too stressed after your procedure. Keeping yourself busy to take your mind off things will be beneficial, as stress can affect hormones, leading to reduced blood flow to the uterus and endometrial lining, thus making it less receptive for the embryo to implant.

  • Avoid strenuous exercise after your IUI, as it can cause premature cramping, which can prevent implantation. Low impact exercises such as walking, yoga, and light aerobics are generally acceptable. 

  • You and your husband should continue taking your prenatal vitamins to ensure that both of you remain in optimal health, and that you are receiving the necessary nutrients to support a healthy pregnancy.

 Real women say…

“During and after my first IUI, I stressed about every detail, I read everything I could regarding symptoms and could not take my mind off anything but the IUI. My IUI ended up failing after I got my period 1 week earlier then it was supposed to. I’m pretty sure it was because of the stress. Next time round, I’m going to try to relax more”

 

Stage 4 : Pregnancy Test

Around 2 weeks after the IUI procedure, you will be asked to return to the clinic to get a blood test to check for whether the IUI has been successful. Results are usually out a few hours after the test. If you are successful, you will be given a follow-up appointment with your doctor to monitor the progress of your pregnancy. If you are not successful, you will be given the choice to stop your fertility treatment here, continue with another IUI, or proceed to IVF. 

 Practical pointers

  1. As the trigger shot that you take prior to the IUI procedure contains HCG, which is the same hormone that is in your body during pregnancy, some women may experience positive results on their home pregnancy tests even though they are not really pregnant. It is preferable to wait until at least 14 days after the IUI procedure for an accurate pregnancy test so that the HCG from the trigger shot will no longer be in your body. 

Real women say…

“After my st IUI, I was extremely hopeful thinking that my IUI would definitely be successful, I tested with home pregnancy kits every day at home, and every time it showed a negative, I was upset. My period finally came a day before the scheduled pregnancy blood test, I was devastated. However, we still decided to try IUI again”

“At the start of our fertility appointments, our doctor told us that if our IUI was to fail 2 times, to then proceed to IVF. We have now failed 2 IUIs, and will be starting our IVF Journey”