Treatment Options

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Intrauterine Insemination (IUI)

Ovulation Induction and IUI

Ovulation Induction is often one of the first line therapies used to assist women who are having difficulty getting pregnant. Medications such as Femara (Letrozole) or Tamoxifen help women to ovulate more regularly, thereby improving the chance of getting pregnant. OI is a low cost and low-tech option that has minimal side effects.

When is it used?

OI is prescribed for women who do not ovulate or have irregular menstrual periods. It can also be used in women who ovulate regularly as a method of increasing the number of eggs produced. Most women who have regular periods have approximately a 15% to 20% chance of conceiving in any one month. OI does not work for some women, especially if there are other factors contributing to their infertility.

What to Expect:
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Typically, medication is taken orally for 5 days. Ovulation is then monitored. Using an in-home urine ovulation predictor kit is sometimes used to confirm ovulation. This kit detects the rise in luteinizing hormone (LH) which occurs approximately 36 hours before ovulation. Unprotected intercourse is recommended between days 10 and 16 of the cycle. Studies have shown that the greater the frequency of intercourse the greater is the likelihood of achieving pregnancy.

Complications:

Hot flashes and other menopausal symptoms can occur the first few days of taking the medication, as well as mood swings and breast tenderness. Ovarian Hyperstimulation Syndrome (OHSS) is a rare but dangerous complication of treatment. There is also a risk of Multiple Pregnancy when having OI.

Success Rates:

80% of women who undergo OI treatment will ovulate, but less that half of these women will conceive. The following study published by Fertility and Sterility in 1998, compared the expected pregnancy rates achieved each month dependent upon the treatment used.

Type of Treatment Approximate Chance for Pregnancy Per Month
try on own – no treatment 1.3-4.1%
Insemination, no ovarian stimulation 3.8%
Clomid + intercourse 5.6%
Clomid + insemination 8.3%
From: Guzick D, et al: Efficacy of treatment for unexplained infertility. Fertility and Sterility 1998;70:207-213.)

 

Combined Cycle and IUI

Intrauterine insemination is a fertility treatment where the sperm is placed in the woman’s birth canal, using a narrow catheter. The sperm is washed to separate the sperm from the seminal fluid so that the most vigorous motile sperm are deposited in the birth canal.

IUI can be done in a natural cycle where a woman does not desire or is unable to take fertility medications. This procedure is timed 12 to 48 hours after ovulation, when the ovary releases the egg into the fallopian tube.

IUI is often combined with Ovulation Induction to increase the chances of pregnancy. Follicle development is monitored using ultrasound scans, and a trigger injection is usually given when the follicles (containing eggs) are mature. IUI is timed 24 to 36 hours later.

When is IUI used?

There are many factors which can affect conception. IUI is often used as a first line treatment in mild or moderate male factor infertility as well as erectile and ejaculatory dysfunction (retrograde ejaculation).

IUI is necessary when using therapeutic donor insemination (TDI) to achieve a pregnancy. TDI is commonly used by single women, same sex female couples, or when the male partner has poor quality sperm. In this instance, sperm is purchased from a certified distributor who meets all of Health Canada Guidelines.

Unexplained Infertility:

IUI is typically one of the first treatment options used in unexplained infertility. Studies have shown that using IUI in combination with a drug to stimulate ovarian production, increases the chances of a pregnancy occurring.

What to Expect:

1. Monitoring Ovulation:
Intrauterine insemination must be done around the time of ovulation, therefore watching for signs that ovulation is about to occur is critical. At Oasis Fertility Centre we believe that accurate timing of ovulation is important to increase the success rate of IUI treatment. This means your follicle development will be monitored by ultrasound scans, a trigger injection of human chorionic gonadotropin (HCG) will be administered when the egg is ready, and IUI is then timed accordingly.

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2. Sperm Preparation:
Your partner will produce a sperm sample (frozen sperm is thawed) and the sample is washed to separate the motile normal sperm from poorer quality sperm. Washing removes chemicals and bacteria that can cause adverse reactions when placed directly into the uterus. Using a small sample of concentrated sperm can increase the chances of achieving a pregnancy.

Complications:

Intrauterine Insemination is a safe, low risk procedure. But with any medical intervention there is always a risk of complication. These include:

 Multiple Pregnancy – IUI alone will not increase the chances of multiple pregnancy by itself. However, when it is combined with ovulation induction (where medication is prescribed to stimulate the ovaries to create more eggs) there is a significantly higher chance of having a multiple pregnancy (twins, triplets, etc.)

 Infection – There is a slight risk of developing an infection as the result of placing the catheter into the uterus.

 Bleeding – Placing the catheter into the uterus can cause vaginal bleeding. Bleeding should not impact the chance of a pregnancy.

Success rates:

Success rates for IUI vary depending on the woman’s age, and the factors causing the infertility. Success rates can be as low as 5%, or as high as 25% if you are under the age of 35, but it is highly dependent upon the factors causing fertility issues.

 

Superovulation Induction and IUI

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