Intrauterine insemination (IUI) is a form of therapeutic insemination (TI) using the husbandís (AIH) or donor (AID) sperm. Therapeutic insemination has been used as treatment for infertile couples for many years. More recently, IUI has become an option for many couples prior to considering more complicated and expensive assisted reproductive treatment such as in vitro fertilization (IVF).

IUI involves bypassing the cervical mucus barrier and depositing a concentrated population of motile spermatozoa, washed free of seminal plasma, directly into the uterus. This is performed as close to the time of ovulation as possible. Many different sperm washing techniques can be used, e.g., Percoll separation, chymotrypsin treatment, buffered wash, ěsoftî wash, etc. The choice of technique will depend on the quality of semen to be processed.

INDICATIONS FOR IUI:

IUI is now being used in infertile couples demonstrating abnormal male or female factors, or both.

 

Male Factor: Indications

1. Decreased sperm counts

2. Decreased sperm motility when sperm processing appears to correct the defect.

3. Decreased sperm quality, e.g., clumping or hyperviscosity.

4. Disorders of sperm function, e.g., defective egg penetrating ability as determined by laboratory testing (sperm penetration test), where increasing sperm concentration or special processing of the sperm (Percoll separation) appears beneficial.

5. Defects of the penis, e.g., hypospadias or severe penile curvature.

6. Retrograde ejaculation or other forms of ejaculatory dysfunction, e.g., spinal cord injury patients who need electroejaculation.

Female Factor: Indications

1. Scant or unreceptive mucus

2. Persistent cervicitis

3. Cervical stenosis

Unexplained Infertility

Donor Insemination

Since government guidelines recommend the use of only frozen sperm for insemination, we must act accordingly. In addition, we have found that using IUI results in an increased pregnancy rate and requires fewer sperm per insemination.

SUCCESS RATE:

Data from several programs has indicated success rates for IUI with husbandís sperm ranging between 5%-40%. Most agree that there should be a period of at least six months with documented ovulation and accurately timed IUI before treatment is considered a failure and an alternate therapy is considered. IUI with donor sperm has a range of success between 40%-70%.

SPERM PROCESSING:

 

1. The goal of sperm processing is to select a fraction of highly motile, morphologically normal sperm, as free of inflammatory cells (white blood cells), debris, and seminal fluid as possible.

2. Several methods exist for processing spermatozoa from the ejaculate, e.g., swim-up, buffered washing and Percoll gradient separation.

3. Seminal plasma contains prostaglandins which may cause uterine cramping when placed directly into the uterus; processing markedly decreases these contaminants.

4. The method for processing the sperm will be decided by your doctor prior to the time of insemination.

TESTING:

Certain testing is required for patients undergoing both husband insemination and donor insemination. All couples will be required to have an HIV drawn before insemination can begin. This can be done in our office. For donor insemination, there will be other tests performed, and those are detailed on a separate attachment.

SCHEDULING SEMEN PROCESSING AND IUI:

Accurate timing of ovulation is crucial to achieving a pregnancy with IUI. Several methods can be used to determine the time of ovulation: basal body temperature monitoring (BBT), ovulation predictor kits (e.g., Ovuquick™), and follicular ultrasounds. It is highly recommended to use follicular ultrasounds and an additional ěat homeî method to help determine the time of ovulation. Your gynecologist most commonly will decide how ovarian monitoring will take place.

To schedule IUI through our office, please call (713) 798-4001 (#5 on menu) or 798-4554, at the beginning of the menstrual cycle. Ultrasounds and a tentative date for the IUI will be scheduled. Depending on the ultrasound reports, the IUI may need to be rescheduled within a day or so of the tentative date. Working closely with our office will help alleviate any misunderstanding and allow for accurate timing of the insemination.

Semen processing takes at least one hour. Due to the fact that several couples may need IUIs on the same day, it is essential to be as prompt as possible and to keep your scheduled time for processing and IUI unless otherwise pre-arranged.

The semen specimen is collected in a sterile container at home or in the office. If you need to transport the specimen, it should be kept warm (e.g., in your pocket) and transported as quickly as possible (within an hour). Sterile containers are available from our office if needed.

If the IUI is to be performed by another physician, contact the Special Procedures Laboratory, at (713) 798-4026, to schedule the semen processing.

If the IUI is to be performed in our office and the reason for IUI includes a female factor, we will work closely with your gynecologist. He may recommend medical treatment, e.g., Clomid and/or human chorionic gonadotropin (hCG). Any other problem which may be identified at the time of the procedure will be promptly related to him for his evaluation or treatment.

THE PROCEDURE:

The IUI is performed in the office by Dr. Lipshultz, or his nurse. On the weekends it will be performed by the nurses or one of the physicians working with Dr. Lipshultz and Kim. It is usually painless, simple, and quick.

After the specimen has been processed, it will be placed directly into the uterus using a small catheter which passes the cervical canal. A special sponge will be placed in the vagina and will be removed by you after five hours. You will remain in the procedure room on your back for about 15 minutes; you will then leave and can resume normal activity. It is recommended that you not perform high-impact aerobic activities or heavy lifting until pregnancy has been determined.

On rare occasions, slight bleeding may be noted and some abdominal cramping. Very rarely, infections or allergic reactions may result from an IUI. Allergic reactions in response to insemination, although exceedingly infrequent, may range from vaginal itching to generalized anaphylaxis.

Should any problems arise after the procedure, please do not hesitate to contact Dr. Lipshultz, at (713) 798-4001.

COST:

Follicular Ultrasound Series* $250.00-$300.00

IUI Procedure** $100.00

Semen Processing** $100.00

Weekend inseminations will be performed when necessary at an additional cost of $120.00, i.e., $60.00 for the procedure (physician/nurse fee) and $60.00 for processing (technician fee).

INSTRUCTIONS FOR INTRAUTERINE INSEMINATION (IUI)

1. Call Brenda Stewart, R.N., at 713-798-4554, at the beginning of your cycle, so that a tentative appointment range can be determined.

2. Purchase an ovulation predictor kit, if you are on a natural cycle or a Clomid/Serophene cycle. The one we recommend is Ovu-Quick. Most pharmacies do not stock this kit, but they can order it for you. You can also order it yourself by calling 1-800-874-1517. They will ask you for Dr. Larry Lipshultzís PPA number, which is 6500. If you need a kit immediately, we have them available in our office. [NOTE: If you are taking Clomid/Serophene, wait 2 days after your last pill before beginning testing.]

3. If follicular ultrasounds are ordered, your doctor or our office will tell you what day to begin, based on the length of your cycle. Review your results daily with the nurse.

SCHEDULING IUI:

1. When you show a positive color change on your ovulation predictor kit, plan on coming in that day or the next for the first of your two inseminations. This timing will depend on your individual situation, and the nurse will indicate which day.
   
2. If you are going to receive a human chorionic gonadotropin (hCG) injection, we usually time your inseminations at 24-48 hours after the injection.

IUI PROCEDURE:

1. The IUI is performed in the office by Brenda Stewart, R.N., or one of the physicians working with Dr. Lipshultz, between the hours of 10:00 a.m. and 5:00 p.m., Monday through Friday. On weekends and holidays, scheduling is limited to the morning hours, between 9:00 and 11:00 a.m.
   
2. The IUI procedure is usually painless and of short duration. After the specimen has been processed (e.g., washed), it is placed directly into the uterus using a small catheter. You will be asked to stay on your back in the procedure room for about 10-15 minutes. Afterward, you may resume normal activity. We do recommend that you keep activity at a low impact level and maintain a healthy lifestyle.
   
3. On some occasions, slight bleeding and abdominal cramping may be noted. This is normal and should cause no alarm.
   
4. Should any problems arise after the procedure, please do not hesitate to contact the office at 713-798-4001 or 798-4554. If it is after hours or on the weekend, you can page Brenda at 713-404-7382.
   

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THERAPEUTIC INSEMINATION FEE SCHEDULE FOR
NEW PATIENTS ENTERING DONOR PROGRAM
(EFFECTIVE JANUARY 1, 1996)

PROCESSING OF SPERM (HUSBAND) FOR OUTSIDE PHYSICIAN:

$100.00 For regular wash

$150.00 For Percoll, Sperm Prep II, or chymotrypsin wash

 TIH/IUI (THERAPEUTIC INTRAUTERINE INSEMINATION/HUSBAND):

Each visit is charged separately as follows:

$100.00 Artificial insemination

$100.00 Semen processing      

$200.00 Total

ADDITIONAL WEEKEND CHARGES

Because all of our employees are salaried for a 5-day week, weekend working hours are purely voluntary. The patient is responsible for paying the nurse, physician, or technician for the weekend procedures as follows:

Nurse or Physician (for procedure): $60.00

Medical Technologist/Technician (for seminal processing): $60.00

TID/IUI (THERAPEUTIC INTRAUTERINE INSEMINATION [IUI]/DONOR):

$550 Registration Fee (To Include): Extensive donor screening, recruiting, cryopreservation, consultation with the Program Coordinator and administrative costs. This fee CANNOT be submitted to insurance.

$1,950† for 6 inseminations:

Itemization for 6 initial visits = $325.00 Per insemination

$200.00 Artificial insemination

$ 50.00 Semen analysis

$ 75.00 Semen processing (for IUI)

$325.00 Total

†The $1,950 is a flat fee for 6 inseminations, regardless of when pregnancy occurs.

If pregnancy occurs within the 6 inseminations, we are unable to issue itemized receipts for the balance.

After the 6 initial inseminations, subsequent inseminations will be $325.00 per insemination and the charges subdivided as above; no additional flat fee will be required.

DONOR WASH (PROCESSING OF DONOR SPERM) FOR OUTSIDE PHYSICIAN:

$275.00 For 1 vial

$495.00 For 2 vials

$675.00 For 3 vials, etc.

RESERVING DONOR SPECIMENS FOR FUTURE PROCEDURES:

$100.00 Per specimen Long-term

$ 25.00 Per specimen Short-term (1-3 months)

HOW TO ACCESS DONOR SPERM

TO ORDER DONOR SPERM:

The donor can be chosen by the doctor ordering the sperm, the patient, or the sperm bank. If the doctor wishes to choose the donor, the donor is chosen from the donor list provided by the bank. The sperm is then ordered by the selection of the donor code number.

PLEASE NOTE: If donor sperm is needed on a Monday or a weekend, please order by or before noon on Thursday of the previous week.

TO STORE OR BANK SPERM:

Organisms transmitted by donor semen pose risks to the recipient woman and child similar to that posed by an infected partner. In order to reduce these risks to a minimum, we feel it is essential that the donor and donor semen be screened and tested regularly for various diseases and organisms.

THE MOST IMPORTANT VIRUSES AND BACTERIA EVALUATED INCLUDE:

1. HIV (AIDS Antibody Blood Test) Serum test.

2. Hepatitis B Virus Serum test.

3. Hepatitis C Virus Serum test.

4. SGOT Serum ěsurrogate markerî for non-A, non-B hepatitis and HIV.

5. Syphilis Serum test (RPR).

6. Cytomegalovirus (IgG + IgM) Serum test. If positive, test semen or exclude.

7. Neisseria gonorrhoeae Semen culture and/or gram stain; urethral swab.

8. Chlamydia trachomatis urethral swab.

ALSO INCLUDED IN THE INITIAL SCREENING ARE:

1. Karyotype Serum test; complete chromosome analysis.

2. ABO/Rh Typing Serum test; blood type.

POSITIVE RESULTS OF ONE OR MORE OF THE ABOVE INDICATES BASIS FOR EXCLUSION FROM THE PROGRAM.

ADDITIONAL BASES FOR EXCLUSION:

1. Homosexual preference.

2. Blood transfusion (within 1 year).

3. Abundant number of sexual partners.

4. History of congenital hereditary diseases.

5. History of sexually transmitted disease, including herpes simplex

REPETITION OF TESTS:

1. HIV every 3 months.

2. Other tests at 6-month intervals.