More Information on Ovulation Induction (OI) with Intrauterine Insemination (IUI)
Ovulation Induction: First Steps
Once the patient and physician decide to proceed with an ovulation induction (OI) treatment, the patient meets with a nurse or physician assistant who schedules her for an orientation class and remains a point of contact, along with her physician, throughout the cycle. Ovulation induction is often coupled with intrauterine insemination (IUI).
CRM offers an OI/IUI orientation class. Taught by a nurse, the class includes:
- Staff introduction
- Treatment timeline
- Medication protocols
- How to mix and administer medications
- Injection technique
- Post-treatment follow-up
- Support services
- Billing and insurance questions
Types of Ovulation Induction Treatments
There are two types of OI treatments:
- Oral medicated cycle
- Injectable medicated cycle
Oral Medicated Cycle
After a baseline monitoring ultrasound and blood test at the beginning of her menstrual cycle, a patient undergoing an oral medicated cycle takes clomiphne or letrozole for five days. Beginning at day 10 of her cycle, the patient undergoes further ultrasound scans and blood testing at CRM (3-4 appointments in total) to track her response.
Oral medicated cycles are relatively simple and inexpensive, and are a frequent first-line fertility treatment.
Injectable Medicated Cycle
An injectable medication cycle utilizes injected hormones (gonadotropins), taken for 7 to 12 days. The duration of injections depends on monitoring results. Patients undergoing an injectable medicated cycle are monitored every day or every other day while taking injections. Further, a patient’s medication dosage may be adjusted depending on her response to the medications.
Patients undergoing an injectable medicated cycle will also generally take supplementary progesterone after ovulation, to support the lining of the uterus and facilitate implantation (attachment) of the embryo.
The OI patient is instructed to administer an hCG injection when ultrasound monitoring and blood test results indicate that she is at the right point in her cycle. hCG, a hormone, completes the egg’s maturation and "triggers" the release of the egg from the ovary.
In natural cycles and many oral medicated cycles, the patient may ovulate on her own and does not require an hCG trigger.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a relatively simple procedure in which a catheter is inserted through the cervix to deposit the sperm in the patient's uterus. IUI is an office-based, painless procedure, does not require anesthesia and takes approximately five minutes to perform. The most frequent side effect is mild uterine cramping on the day of the procedure.
Intrauterine insemination is performed 24-36 hours after the administration of the ovulatory (either hCG or natural) trigger.
In some cases, the physician may judge that neither oral nor injected medication are necessary to induce ovulation. As in medicated cycles, the progress of patients undergoing a natural cycle is monitored via blood testing and ultrasound scans. Natural cycle patients usually begin monitoring day 10 of their menstrual period and undergo an intrauterine insemination.
Semen Specimen Preparation
The male partner can produce a fresh specimen at CRM’s Andrology Laboratory on the day of the IUI procedure. The male partner should generally abstain for three-to-five days before the procedure, wash with an antibacterial soap and rinse well the morning he is to produce the specimen. The specimen is processed by the Andrology staff before the IUI procedure.
If a frozen (partner or donor) specimen will be used in the IUI, Andrology Laboratory staff can receive a frozen specimen from New York State-accredited sperm banks and thaw it in preparation for the IUI procedure.
After the Treatment
Confirming Pregnancy Test
Fourteen days after the OI/IUI cycle, a pregnancy blood test is performed. The pregnant patient transitions to the care of an obstetrician after the fetal heartbeat is confirmed at an office visit with her CRM physician, approximately seven weeks into the pregnancy.