Step One - Do you have ovulation?
Undoubtedly, to be performed an IUI procedure, it is necessary the woman to have ovulation, i.e. a mature egg from the follicle to be separated.
Your physician should have determined whether your ovulation occurs normally or there is a lack of ovulation.
The Intrauterine insemination can be performed as stimulated or on the basis of a natural cycle.
The insemination can be conducted without stimulation (natural cycle) in cases when there is neither male nor female infertility factor, and when it is determined that a woman has ovulation. This means, that before the procedure, only the levels of lutein hormone (LH) are estimated and a woman undergoes ultrasound examinations to be determined when the insemination will be performed without the use of medications.
When such a procedure does not lead to success, the process proceeds with insemination by stimulation.
Step Three - Stimulation on the move:
Most often a woman is stimulated with medications, and the aim is two or three eggs to reach their maturity stage. Some ccommonly used medications are pills, such as "Clomiphene" ("Clomid") or gonadotropin injections, used the ovaries to be stimulated to produce follicles and the ovulation to occur.
Clomiphene (Clostylbegit, Serofen, Sarpafar and other medications – are names of the same medication) is the oldest technique of stimulating the ovulation. These are pills that are taken orally. Clomiphene is not a hormone, but it influences your hormones by increasing their levels and thus the effect of the stimulation is achieved. Clomiphene has unfavorable effect on the endometrium by slightly suppressing its growth. Another side effect is that it interferes negatively the synchrony between the egg maturation and the preparation of the endometrium for implantation.
Another type of stimulation is stimulation with gonadotropin hormones (the ones that we use for stimulation in IVF procedures). These are subcutaneous, or less frequently, intramuscular injections. They do not have the side effects of clomiphene. The risk in this case is that many follicles are starting to grow, and thus appears a risk of multiple pregnancy and the so-called hyper-stimulation. This is a real fact, although the quantities of the medications used in stimulation, are much smaller than those used in an In vitro procedure.
Stimulation with letrozole (Femara): This is a medication in the form of pills, mainly used for suppression of hormones in patients with cancer. When applied for five days, there is a sharp rise in the accumulation of your hormones and thus the effect of stimulation is achieved.
Important: When stimulation is carried out there is always an individual approach applied to each particular case in the selection of the medications, as well as in their doses.
How is it carried out?
When a patient uses medications for the stimulation, it is important her condition to be tracked with ultrasound so that her physician can measure the growth of the follicles. The medications, used for the stimulation, can produce many eggs and your physician should observe you during your menstrual cycle in order to take into consideration any possible side effects, and the risk of multiple pregnancies to be reduced.
The level of the hormone estradiol in the blood is examined with ultrasound which makes possible the growth of the egg to be monitored.
Usually the aim of the intrauterine insemination is three to five mature follicles to be produced. When two or three follicles reach their optimal size, an injection of hCG can be applied in order an ovulation to be induced.
Around the time of the expected ovulation a fresh sperm portion is processed in the laboratory. The procedure is called sperm "washing". This process enables the separation of the sperm from the other components in the seminal fluid.
The procedure for washing the sperm takes 60-120 minutes depending on the techniques applied.
The separated and washed sperm, composed mainly of fast-moving sperm, is injected into the cervix or high in the uterine cavity via a very thin and soft plastic catheter. The procedure is painless and the feeling is similar to the one when the woman is having a Pap test.
When the procedure is completed the woman remains in the gynecological chair for the next 15 minutes. The semen does not flow out when the woman gets out of the chair since the semen has been deposited high in the uterine cavity.