Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors

The Logistics of IUI

Course / The Logistics of IUI

Determining The Course: Selecting the Right IUI Protocol

The first and most critical decision in the IUI process is selecting the appropriate stimulation protocol. This choice balances the goals of achieving an optimal response (developing 1-3 mature follicles) while minimizing risks (like high-order multiples or Ovarian Hyperstimulation Syndrome – OHSS). The decision is based on the surrogate’s age, ovarian reserve (AMH, AFC), and previous cycle history.

We typically categorize IUI cycles into three distinct protocols:

  • Natural Cycle IUI
  • Stimulated Cycle IUI (using Clomiphene Citrate or Letrozole)
  • Gonadotropin-Stimulated IUI

The following modules will break down the logistics, advantages, and considerations for each.

Natural Cycle IUI: The Minimalist Approach

To time the insemination precisely with the surrogate’s natural ovulation, without the use of ovarian stimulation drugs.

Clinical Logistics:

  • Monitoring: Transvaginal ultrasounds begin around cycle day 10-12 to track the growth of the dominant follicle. Urinary or serum LH levels are closely monitored to detect the impending LH surge, which triggers ovulation.
  • Trigger Shot (Optional): In some cases, a trigger shot of hCG (e.g., Ovidrel) may be used to precisely time ovulation 36-40 hours later, ensuring the IUI is perfectly scheduled.
  • Sperm Preparation: The sperm sample from the intended father or donor is washed and prepared on the day of the procedure to isolate motile, healthy sperm.

Best For:

  • Young surrogates with proven ovulation and regular cycles.
  • Situations where using fertility medications is not desired.
  • Cases of mild male factor or unexplained infertility where minimal intervention is the preferred first step.

Key Considerations:

  • Advantage: Lowest cost, virtually no risk of multiples, and no side effects from stimulation medications.
  • Disadvantage: The cycle is entirely dependent on the body’s natural rhythm, with a lower per-cycle success rate compared to stimulated cycles. There is a higher chance of cycle cancellation if ovulation occurs unexpectedly early or late.

IUI With Clomid or Letrozole (Oral Ovulation Induction)

To stimulate the ovaries to produce multiple (typically 1-3) mature follicles, thereby increasing the number of available eggs for fertilization.

Clinical Logistics:

  • Medication: The surrogate takes either Clomiphene Citrate (Clomid) or Letrozole (Femara) orally for 5 days, typically starting on cycle day 3-5.
  • Monitoring: Transvaginal ultrasounds begin around cycle day 10-12 to monitor follicle growth and endometrial lining thickness. The goal is 2-3 follicles measuring 18-22mm.
  • Trigger Shot: A trigger shot of hCG is almost always administered once the lead follicles reach maturity. This precisely schedules ovulation and the IUI procedure for 36 hours later.
  • Luteal Support: Progesterone supplementation (vaginal suppositories or injections) may be prescribed post-IUI to support the endometrial lining and facilitate implantation.

Best For:

  • The most common protocol for IUI cycles.
  • Surrogates who may have irregular ovulation or anovulation.
  • Maximizing success rates by increasing the number of follicles.

Key Considerations:

  • Advantage: Significantly higher success rates than natural cycle IUI. Cost-effective and minimally invasive.
  • Disadvantage:
    • Multiple Gestation Risk: The risk of twins is approximately 5-12%. Triplets or more are a rare but serious risk, which may lead to a recommendation for cycle cancellation or selective reduction.
    • Side Effects: Clomid can sometimes thin the endometrial lining and cause side effects like hot flashes or mood swings. Letrozole is often preferred for its more favorable lining effects.

IUI With Gonadotropins (Injectable Hormones)

Objective: To achieve controlled ovarian hyperstimulation with a higher number of follicles than possible with oral medications, used in cases where a stronger response is needed.

Clinical Logistics:

  • Medication: The surrogate administers daily subcutaneous injections of Follicle-Stimulating Hormone (FSH) preparations (e.g., Gonal-F, Follistim). This requires careful training and compliance.
  • Intensive Monitoring: This protocol requires very close monitoring with frequent ultrasounds and blood work (every 1-3 days) to track follicle growth and estrogen levels. This vigilance is critical to prevent over-response.
  • Trigger Shot & IUI Timing: A trigger shot is used once an optimal cohort of follicles (typically 2-4) has matured. The IUI is scheduled 36 hours post-trigger.
  • Luteal Support: Progesterone support is standard.

Best For:

  • Cases where oral medications have failed to produce an adequate response.
  • Unexplained infertility where a more aggressive approach is warranted before moving to IVF.
  • Certain endocrine conditions.

Key Considerations:

  • Advantage: Can yield the highest per-cycle success rates of all IUI protocols due to the number of follicles.
  • Disadvantage:
    • Significantly Higher Cost due to medication and monitoring expenses.
    • Highest Risk of Multiples and OHSS. Cycle cancellation rates are higher if too many follicles develop to ensure patient safety.

Insemination Day: The IUI Procedure

The IUI procedure itself is a brief, relatively painless clinical event.

Clinical Logistics (Step-by-Step):

  1. Sperm Sample Collection & Preparation: The sperm sample is provided and undergoes a “sperm wash” process in the andrology lab. This separates the highly motile sperm from the seminal fluid, dead sperm, and debris, creating a concentrated sample in a small volume of culture medium.
  2. Specimen Placement: The surrogate is positioned as for a Pap smear. A speculum is inserted into the vagina to visualize the cervix.
  3. Catheter Insertion & Insemination: A very thin, flexible catheter is threaded through the cervix into the uterine cavity. The prepared sperm sample is gently injected directly into the uterus.
  4. Post-Procedure: The catheter and speculum are removed. The surrogate rests for 10-15 minutes before being discharged. Normal activities can typically be resumed the same day.

Pro Tips: Maximizing Success from a Clinical Perspective

  1. Sperm Quality is Paramount: The IUI process optimizes sperm delivery, but it cannot improve intrinsic sperm quality. A thorough semen analysis before the cycle is non-negotiable. For intended fathers with known male factor issues, IVF with ICSI may be a more efficient path.
  2. The “Two-Follicle Sweet Spot”: In stimulated cycles, the ideal target is 2-3 mature follicles. This maximizes the chance of pregnancy while keeping the risk of high-order multiples (triplets+) acceptably low. Be prepared for a frank discussion with your doctor about the risks if 4 or more mature follicles develop.
  3. Don’t Underestimate the Lining: A thick, trilaminar (three-line) endometrial lining is crucial for implantation. If oral medications like Clomid consistently thin the lining, discuss switching to Letrozole or adding estrogen support.
  4. The Timing is Non-Negotiable: The IUI must occur within a strict window after the trigger shot (typically 36 hours). Ensure all logistics—sperm availability, clinic schedule, surrogate’s availability—are locked in beforehand.
  5. Know Your “Stop” Rule: Have a clear plan with your physician for when to cancel a cycle. Common reasons include: inadequate follicle growth, premature ovulation, a thin endometrial lining (<7mm), or an excessive number of follicles (>3-4) which poses a significant safety risk.
Previous Lesson
Next Lesson

Surrogacy Near Me

USA

Canada

USA

Canada

Begin Your Journey to Having a Baby with Us and Our Affiliated Physicians at Surrogacy4All

Our job is to listen, to connect the dots between your needs, and to determine how we can best help you have your baby. If you’re asking how much does it cost for a surrogate, we’ll walk you through every step of the process to ensure there are no surprises.

To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.

Become A Parent
Become A Surrogate
Become An Egg Donor

Surrogacy Near Me

USA

Canada

Surrogacy Near Me

USA

Canada

All Rights Reserved to Surrogacy4all