New York Cryo, our New York State Licensed sperm bank is also licensed for processing of semen specimen for IUI (intrauterine insemination) on request of a licensed practitioner. We can process the specimen by various methods as specified by your doctor and as required by your specimen quality.
General Information on Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a form of therapeutic insemination (TI) using either the husband’s (AIH) or donor (AID) sperm. Therapeutic insemination has been used as treatment for infertile couples for many years. More recently, IUI has become an option for many couples prior to considering more complicated and expensive assisted reproductive treatment such as in vitro fertilization (IVF).
IUI involves bypassing the cervical mucus barrier and depositing a concentrated population of motile spermatozoa, washed free of seminal plasma, directly into the uterus. This is performed by your doctor (usually your gynecologist) as close to the time of ovulation as possible. Many different sperm washing techniques can be used, e.g., Density gradient centrifugation, buffered wash, swim-up. The choice of technique will depend on the quality of semen on analysis of the specimen.
INDICATIONS FOR IUI:
IUI is now being used in infertile couples demonstrating abnormal male or female factors, or both.
Male Factor: Indications
- Decreased sperm counts
- Decreased sperm motility when sperm processing appears to correct the defect.
- Decreased sperm quality, e.g., clumping or hyperviscosity.
- Disorders of sperm function, e.g., defective egg penetrating ability as determined by laboratory testing (sperm penetration test), where increasing sperm concentration or special processing of the sperm (Percoll separation) appears beneficial.
- Defects of the penis, e.g., hypospadias or severe penile curvature.
- Retrograde ejaculation or other forms of ejaculatory dysfunction, e.g., spinal cord injury patients who need electroejaculation.
Female Factor: Indications
- Scant or unreceptive mucus
- Persistent cervicitis
- Cervical stenosis
- Unexplained Infertility
Since government guidelines recommend the use of only frozen sperm for donor insemination, we must act accordingly. In addition, we have found that using IUI results in an increased pregnancy rate and requires fewer sperm per insemination.
Data from several programs has indicated success rates for IUI with husband’s sperm ranging between 5%-40%. Most agree that there should be a period of at least six months with documented ovulation and accurately timed IUI before treatment is considered a failure and an alternate therapy is considered. IUI with donor sperm has a range of success between 40%-70%.
- The goal of sperm processing is to select a fraction of highly motile, morphologically normal sperm, as free of inflammatory cells (white blood cells), debris, and seminal fluid as possible.
- Several methods exist for processing spermatozoa from the ejaculate, e.g., swim-up, buffered washing and Density gradient separation.
- Seminal plasma contains prostaglandins which may cause uterine cramping when placed directly into the uterus; processing markedly decreases these contaminants.
- The method for processing the sperm will be decided by your doctor prior to the time of insemination
A semen analysis is required prior to or at the time of the first processing to evaluate the quality of the specimen and to help in determining the best method to use for processing. Certain blood testing might be requested. These tests will be determined by your doctor For donor insemination, there might be other tests performed as requested by your doctor
SCHEDULING SEMEN PROCESSING AND IUI
Accurate timing of ovulation is crucial to achieving a pregnancy with IUI. Several methods can be used to determine the time of ovulation: basal body temperature monitoring (BBT), ovulation predictor kits (e.g., Ovuquick™), and follicular ultrasounds. The use of follicular ultrasounds and at home kits is often used to determine the time of ovulation. Your gynecologist most commonly will decide how ovarian monitoring will take place. To schedule IUI call your doctor’s office (and our office) at the beginning of the menstrual cycle. Ultrasounds and a tentative date for the IUI will be scheduled. Depending on the ultrasound reports, the IUI may need to be rescheduled within a day or so of the tentative date. Working closely with our office will help alleviate any misunderstanding and allow for accurate timing of the insemination.
Semen processing takes at least one hour (usually 1-2 hours). Due to the fact that several couples may need IUIs on the same day, and that we process only one specimen at a time, it is essential to be as prompt as possible and to keep your scheduled time for processing and IUI.
The IUI is performed in your doctor’s office, by your doctor or the nurse. It is usually painless, simple, and quick.
After the specimen has been processed, it will be placed directly into the uterus using a small catheter which passes the cervical canal. A special sponge might be placed in the vagina and will be removed by you after five hours. You will usually remain in the procedure room on your back for about 15 minutes; you will then leave and can resume normal activity. It is recommended that you not perform high-impact aerobic activities or heavy lifting until pregnancy has been determined.
On rare occasions, slight bleeding may be noted and some abdominal cramping. Very rarely, infections or allergic reactions may result from an IUI. Allergic reactions in response to insemination, although exceedingly infrequent, may range from vaginal itching to generalized anaphylaxis.
Should any problems arise after the procedure, contact your doctor immediately.
Patient Instructions for Sperm Processing
- Call your doctor and our office (516-487-2700), at the beginning of your cycle, so that a tentative appointment range can be determined.
- Purchase an ovulation predictor kit, if you are on a natural cycle or a Clomid/Serophene cycle. The one we recommend is Ovu-Quick. Most pharmacies do not stock this kit, but they can order it for you. You can also order it yourself by calling 1-800-874-1517. If you need a kit immediately, your doctor will usually have them available in their office. [NOTE: If you are taking Clomid/Serophene, wait 2 days after your last pill before beginning testing.]
- If follicular ultrasounds are ordered, your doctor or our office will tell you what day to begin, based on the length of your cycle. Review your results daily with your doctors nurse.
- When you show a positive color change on your ovulation predictor kit, plan on coming in that day or the next for the first of your two inseminations. This timing will depend on your individual situation, and your doctor or your doctor’s nurse will indicate which day.
- If you are going to receive a human chorionic gonadotropin (hCG) injection, they usually time your insemination at 24-48 hours after the injection.
- The IUI is usually performed in your doctor’s office, between the hours of 8:00 a.m. and 4:00 p.m., Monday through Friday. On weekends and holidays, scheduling is limited to the morning hours, between 8:00 and 11:00 a.m.
- The IUI procedure is usually painless and of short duration. After the specimen has been processed (e.g., washed), it is placed directly into the uterus using a small catheter. You will usually be asked to stay on your back in the procedure room for about 10-15 minutes. Afterward, you may resume normal activity. We do recommend that you keep activity at a low impact level and maintain a healthy lifestyle.
- On some occasions, slight bleeding and abdominal cramping may be noted. This is normal and should cause no alarm.
- Should any problems arise after the procedure, please contact your doctor immediately.
Bruce R.Gilbert, M.D., Ph.D. at 516-487-2700 or firstname.lastname@example.org.