Download superovulation (so) and intra-uterine insemination (iui)

CRGW Ltd: 07029220
CENTRE FOR REPRODUCTION AND GYNAECOLOGY WALES
Ely Meadows, Rhodfa Marics
Llantrisant CF72 8XL
Tel. (01443) 443999 : Fax (01443) 445869
www.crgw.co.uk
SUPEROVULATION (SO) AND INTRA-UTERINE INSEMINATION (IUI)
WHO CAN BENEFIT FROM IUI?
Couples undergoing infertility treatment may benefit from having superovulation (SO) and
intra-uterine insemination (IUI). The treatment involves stimulating the ovaries to develop
more eggs than during a natural cycle and timing the release of the eggs with the
placement of a prepared sperm sample in the uterus. The sperm are then closer to the
egg and can have a better chance of fertilizing an egg, hopefully resulting in a pregnancy.
Couples having SO and IUI will be those who have an adequate sperm count (normal or
close to normal) and have open fallopian tubes, so that the egg and sperm can meet.
Such conditions are unexplained infertility, mild male factor and mild endometriosis could
benefit from this treatment.
WHAT IS INVOLVED?
The treatment involves closing down your own hormonal pathway using a drug that you
inject every day. You will then require another drug which you will inject in order to
stimulate the ovaries to produce more eggs than would occur in the natural cycle. The
injections will be given by yourself. We have to monitor your response to the treatment in
order to time ovulation accurately. This involves vaginal ultrasound scans of the ovaries.
The exact timing of these may vary according to the response of the ovaries.
When the scans are satisfactory the final injection will be given by yourself to trigger
ovulation (release of the egg/s). One or two days later a sperm sample from your partner
or from a sperm donor, whichever your treatment requires, will be prepared. If sperm from
your partner is to be used, he will have to report to CRGW on the day the sperm sample is
to be prepared to provide the laboratory with a sperm sample. The sperm sample is
prepared in the laboratory to provide the best sperm for insemination. The insemination
procedure is painless and involves an examination similar to having a smear test.
A pregnancy can first be detected 16 days after the insemination, by means of a urine
test. If the urine test is positive then a scan will be arranged to confirm the pregnancy.
A few women may over respond to the stimulation hormones, which will be recognised.
POSSIBLE SIDE-EFFECTS AND PROBLEMS
 During the careful monitoring. This response can lead to a condition called ovarian
hyperstimulation syndrome (OHSS). If left unattended the consequences of OHSS
can be very severe. In severe cases the ovaries become enlarged and there is fluid
retention in the abdomen (stomach area) which can cause pain or discomfort.
There may also be diarrhoea, nausea, vomiting, reduced urine output, thirst,
breathlessness and a feeling of faintness or weakness. This is a rare complication. If
you have difficulties, please get in touch with us at CRGW, rather than any other
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CRGW Ltd: 07029220
hospital doctor or your GP. If you are experiencing these symptoms, please telephone
us on 01443 443999. A consultant is on call 24 hours a day.
If the woman has responded too strongly to the hormones, and more than 3 large
follicles have developed, the cycle may be abandoned. If treatment were to proceed at
this stage, there is a very high risk of a multiple pregnancy, which would be dangerous
to the woman and any potential baby. If your cycle is cancelled, you will be told to
avoid sexual intercourse, and it is very important that you follow these instructions.
There is a possibility that the ovaries may not stimulate well, and the hormone doses
can be adjusted to try and improve the response. Sometimes this may not work and
we may advise you to cancel the treatment cycle.
Pregnancies established after IUI are still exposed to the same ante-natal risks as
natural pregnancies such as miscarriage or abnormalities.
As the ovaries are stimulated to produce more than one egg there is a chance that if
you become pregnant there may be more than one baby, a multiple pregnancy. About
1 in 3 pregnancies arising for superovulation and IUI results in twins, and about 1 in
100 results in triplets. Multiple pregnancy places a greater physical strain on the
mother as well as increasing the risk of complications such as miscarriage and
premature delivery (before the due date). Also, the mother is more likely to have to be
admitted to hospital. The average pregnancy is 34 weeks for triplets (three babies)
which is 4-6 weeks earlier than the due date. These babies often have to stay in the
intensive care unit for up to a month and if they progress well they have many hurdles
in front of them. Depending on the maturity and weight some babies do not survive.
Looking after triplets is very demanding especially for the first three years and the
parents face chronic tiredness, anxieties, tensions and a strain on their relationship.
The costs of looking after three babies should also be considered.
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