Ovulation Induction IUI Cycle Stimulation
Ovulation induction and Intrauterine Insemination is the generally the first line of treatment for most fertility patients who have been through a workup and diagnosed with:
Male Factor with reasonable sperm count, motility and normal morphology
Women using Donor Sperm
Women who have had surgery to correct Tubal or Uterine Factor issues
The goal of OI/IUI is to recruit 2 or 3 eggs, rather than the single egg that is produced in a “natural cycle” and schedule an intrauterine insemination of a prepared semen sample on the day of ovulation. This means that more eggs are in the right place at the right time and are exposed to more sperm in the fallopian tube to enhance the likelihood that fertilization will occur.
OI/IUI cycles take place over the course of a menstrual cycle. Fertility medications are generally started on Cycle Day 2, 3, 4 or 5 when it is possible to recruit more than one follicle/egg. Some physicians may start all IUI patients on Clomid/Serophene for several months; others may start with injectable gonadotropins. Clomid/Serophene drives the pituitary gland to release more endogenous FSH than it would in a “natural cycle” while injectable gonadotropins (Bravelle, Follistim, Gonal-F, Menopur, Repronex) are the actual hormones that the pituitary produces to stimulate the ovaries to produce follicles/eggs. Ovarian response is generally monitored by TVUS (transvaginal ultrasound) and blood estradiol after 5 days of medication. The dose of injectable gonadotropins might be adjusted up or down based on response and may be continued for a total of 7 to 10 days. Once there are enough mature follicles containing eggs, the gonadotropins are discontinued and a one- time dose of an injectable HCG product (HCG, Novarel, Ovidrel, Pregnyl) is given in the evening. This cause ovulation (release of the matured eggs) 36 to 40 hours later which allows the IUI to be scheduled 2 days following HCG administration.
A semen sample is obtained and prepared in the Andrology Lab so that the sperm are separated from the seminal fluid which would never enter the uterine cavity after intercourse and thus cannot be injected into the uterus. The “washed” sample is then drawn up in a small syringe with an insemination catheter attached. A speculum exam allows visualization of the cervix, the opening to the uterine cavity. The catheter is inserted through the cervix into the uterus and the sperm are “injected” into the uterine cavity. This allows greater numbers of motile sperm to reach the fallopian tubes by placing them much closer than they would be in the vagina after intercourse. Women generally rest for 10 to 15 minutes after the insemination and then can go about their normal activities. A pregnancy test is generally scheduled 14 days after the IUI.
If there is no pregnancy after a reasonable course of OI/IUI (generally 2 to 4 cycles) more aggressive therapy such as IVF should be discussed.
Gina Paoletti-Falcone, RN, BSN is the Clinical Services Manager at Freedom Fertility Pharmacy, the leading fertility specialty pharmacy in the US (www.freedomfertility.com). Prior to joining Freedom, Gina worked as a fertility nurse and as a Clinical Services Manager at one of the largest fertility practices in the Boston area for 16 years. Gina developed the Freedom MedTEACH website, an on-line patient educational resource with video instruction for all the injectable fertility medications, because she believes that patients’ anxiety over injectable medication administration can be addressed by giving them control over when and how often they have the opportunity to review the information, including when they are ready to administer their medication.