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Intrauterine insemination (IUI) is often a
"first line" treatment for many causes of infertility.
Patients attempting IUI undergo ovulation induction, usually
with follicle stimulating
hormone (FSH). FSH causes the development of multiple
follicles each of which contains an egg. Once the eggs are
judged to be mature, an injection of hCG is given and retrieval
is scheduled for 36-40 hours later.
While undergoing stimulation, patients regularly
come to our office for ultrasound
and hormone monitoring. This is done to minimize potential
medication side effects and monitor follicular development.
Stimulated IUI cycles should only be conducted by a trained
specialist to help avoid complications such as high order
multiple births or ovarian hyperstimulation syndrome.
The male provides a sperm sample on the day
of the insemination. His sperm is specially prepared (washed)
for insertion into the uterus. "Unwashed" sperm
must never be placed into the uterus as serious, even fatal,
allergic reactions can occur. The washed sperm are placed
into the uterus using a small catheter with little or no
associated pain.
IUI is commonly used in cases of cervical
disorders, such as poor mucus or antisperm antibodies,
since it bypasses the vaginal canal. IUI was once the only
treatment available for male infertility, often using a
male donor. With the advent of IVF
with ICSI,
men with little or no sperm in their ejaculate can still
father children.
The per cycle success rates with IUI
are much lower than IVF, however, more IUI cycles may be
possible because of lower cost. IUI is also much more likely
to result in high order multiple births (>3) since the
exact number of eggs ovulated cannot be controlled. In IVF,
the physician and embryologist tightly control the number
of embryos placed into the uterus.
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