Intrauterine Insemination: Patient Guide

Intrauterine examination or artificial insemination as it is commonly known, involves the preparation of a semen sample in the laboratory followed by its direct placement into the uterine cavity for fertilization. IUI has been a method of infertility treatment utilized by physicians for the past several decades. Initially used only as a treatment for male factor infertility, the indications of IUI have broadened, as it is currently implemented for:

1. treatment of immunologic infertility (the presence of anti-sperm antibodies),
2. unexplained infertility,
3. cervical factor infertility,
4. As an adjunct to Clomid or FSH therapy.
5. Donor insemination.

A. Collection and processing of the semen specimen

For identification purposes, it is of vital importance that all semen samples collected are labeled with the subjects name, Social Security number, date, and time of collection. Under no circumstances will the laboratory accept unlabeled specimen!

The optimal method for a semen sample collection is masturbation. Samples should be collected following two to three days of sexual abstinence. Samples can be collected on site or at home if delivered to the office within 45 minutes of collection and kept at body temperature. All off-site collections require the use of a sterile container be tested for toxicity to sperm, which may be acquired from NEFI Staff.

It is extremely important that water, saliva, mineral oil, K-Y jelly, or any other form of lubricant do not contaminate the sample, as these materials are toxic to sperm in specific instances where masturbation is not a viable option, the sample may he collected via sexual intercourse using a sterile, none spermicidal condom obtained from the lab.

Laboratory appointments for both clinic and home collection must be made in advance so as to provide the lab with adequate time to prepare the semen for insemination.

After the semen sample has been collected, it is taken to the laboratory and analyze for parameters such as sperm count, motility, in volume. The sample is then washed with a non-toxic media utilized in gradient layering technique in order to separate the sperm from the collection of sugars enzymes and proteins which compromise the ejaculate and seminal plasma.

Many of the formerly mentioned components of the seminal plasma, most specifically prostaglandins, can induce a very adversely affect in women is placed directly into the uterus without washing. Following the washing of the semen sample, further processing is performed in order to increase the concentration of motile sperm in the final insemination sample.

B. Intrauterine insemination procedure

After the semen sample has been processed, it is loaded into a syringe and taken to the exam room where the patient is located. Intrauterine inseminations are performed by nurse practitioners, physician assistants, nurses, and physicians.
A speculum was placed into the vagina and the cervix is visualized. The catheter, a small plastic tube containing the insemination sample, is maneuvered through the cervix into the uterine cavity. No anesthesia is required for the procedure as the placement of the catheter may cause only mild cramping, which generally abates within one to two minutes. The specimen is gently placed into the uterine cavity once any cramping has subsided. After the procedure, the patient is asked to rest of 5-10 minutes in the exam room and then is allowed to resume her normal daily activities.

Inability to collect the specimen

Occasionally the patients are unable to collect a semen sample when scheduled. If collection problems are anticipated or your partner may be out of town and the day of insemination, there is an option to collect and freeze a sample in advance of your procedure for possible backup. However, whenever possible, a fresh specimen is always the specimen of choice. If you wish to have a specimen frozen, additional testing is required in the testing must be performed well in advance. The expenses of sperm freezing may not be covered by insurance.

Please be advised: in the event that a fresh sample was obtained and the frozen sample is no longer needed, the fertility Institute does not automatically discard the frozen sample. New England fertility Institute must obtain a written consent in order to discard the sample or have it transferred to a long term storage facility.

Possible complications of intrauterine insemination

Side effects, adverse reactions, and other possible complications from intrauterine inseminations are infrequent and rarely severe. The following is a list of possible complication the patient may encounter either during or following an intrauterine insemination procedure.

1. Uterine cramping: uterine cramping occurs in approximately 5% of all patients undergoing intrauterine insemination. The cramping is usually mild and subsides within several minutes following the procedure. The cramping does not compromise the outcome of the procedure and can be treated with acetaminophen or aspirin.
2. Mild spotting: Mild bleeding occurs in approximately 1% of all patients following intrauterine insemination. Spotting as a result of minor irritation to the cervical gland was by the threading of the insemination catheter through the cervix and into the uterine cavity. Within several hours of the procedure any bleeding we usually subsides without treatment.
3. Gastrointestinal upset: mild nausea and diarrhea occurs in approximately 0.05% of all patients with undergoing intrauterine insemination the presence of prostaglandins is responsible for any gastrointestinal upset. Any discomfort usually subsides within a few hours of the completion of the procedure.
4. Pelvic infection: potentially, the most serious complication of intrauterine insemination is pelvic infection. Pelvic infection occurs in less than .01% of all patients who undergo the procedure. Patients who are at risk are those whether history of a prior pelvic infection. For those patients antibiotic prophylaxis is administered prior to the insemination procedure. Early symptoms of infection include fever cervical and uterine tenderness, lower abdominal pain, and follow a bloody vaginal discharge. Symptoms generally begin within a few days to a week following the intrauterine insemination procedure. Should a patient begin to experience any of the abdomen should symptoms, they must notify the physician immediately.