Medical Fertility Treatments Such as IUI ( Artificial Insemination) in and near Los Angeles
A few of the medical treatment options covered here are ovulation induction and artificial insemination (intrauterine insemination, or IUI), all available at our Los Angeles-area facilities. According to the American Society for Reproductive Medicine, most cases of infertility in the United States (85 percent to 90 percent) are treated with conventional therapies such as medical or surgical treatment as opposed to in vitro fertilization (IVF) or assisted reproductive technology (ART).
The fertility physicians of the Southern California Reproductive Center in the Los Angeles region have decades of combined experience in determining the best treatment alternatives for each couple. The choice of medical treatment versus surgical infertility treatment should be made based on your unique individual circumstances, and with the input of your Southern California Reproductive Center physician. Our overview of fertility provides a helpful background to the following exploration of medical vs. surgical options for infertility.
Medical Treatment Options
Medical Treatment Options
Medical treatment could be thought of as "nonsurgical" treatment, or as the use of medications or procedures that do not involve surgery. A medical treatment is often the most appropriate first choice for couples who have not been able to conceive. The comprehensive evaluation of both partners' medical history and condition at the Southern California Reproductive Center will help to determine which treatment is most likely to bring about a healthy pregnancy for you.
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Treatment of Ovulatory Disorders
The most common infertility factor for women is an ovulatory disorder. Ovulatory disorders can be classified by their underlying cause.
Class I Ovulatory Disorders
Class I ovulatory disorders involve women with low levels of pituitary hormones and estrogen. These women can probably respond well to medications that are injectable forms of pituitary hormones in the setting of in vitro fertilization (IVF) or ovulation induction with intrauterine insemination (IUI).
Class II Ovulatory Disorders
Class II disorders are experienced by women who have normal levels of pituitary hormones and estrogen, but fail to ovulate a dominant follicle. This category includes women with polycystic ovary syndrome (PCOS). These patients are candidates for ovarian stimulation with clomiphene citrate (Clomid®). If patients fail to conceive after three or four ovulatory cycles on Clomid®, however, they will be counseled regarding whether to proceed to a more aggressive treatment.
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Class III Ovulatory Disorders
Class III disorders include women with high levels of pituitary hormones due to waning ovarian function. This category includes older women in the perimenopause and women with premature ovarian failure. These patients have the poorest prognosis for conceiving using their own oocytes, and are counseled on the use of egg donation as an alternative with high pregnancy rates.
Class IV Ovulatory Disorders
Class IV disorders involve women with high levels of prolactin (the milk secretion hormone), resulting in low estrogen and pituitary hormone levels. These patients tend to respond very favorably to medications that lower prolactin secretion.
Inducing Ovulation
The most commonly used ovulation induction agents are Clomid® (clomiphene citrate) and gonadotropins.
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Clomid®
Clomid® is an orally active agent taken in pill form. It stimulates the brain to increase levels of pituitary hormones, which in turn mildly stimulate the ovaries to recruit and ovulate follicles. Clomid® treatment usually begins at the start of the menstrual cycle, with the patient taking five days of pills. With Clomid® use by appropriate patients, approximately 70 percent ovulate and up to 40 percent may conceive within the first four cycles. The patient should ideally undergo no more than four failed Clomid® cycles before proceeding with an alternative agent.
Gonadotropins
Gonadotropins are medications that mimic the hormones normally secreted by the pituitary gland. Gonadotropins are administered by injection. Because gonadotropins have the potential for greater stimulation in the patient, the ovarian response is monitored closely to determine the degree of stimulation, the size of the developing follicles, and the best time to stimulate ovulation. Gonadotropins can be used in conjunction with intrauterine insemination (IUI), or as part of the in vitro fertilization (IVF) procedure at our Los Angeles region facilities.
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Cycle Monitoring and Stimulation
At the core of all assisted reproductive procedures is the monitoring and stimulation of the ovulation cycle. This is accompanied by close monitoring with blood tests and ultrasound. Blood hormone levels and the size of the ovarian follicles are used to track response to medications and to help your Southern California Reproductive Center physician predict when ovulation is most likely to occur. Stimulation of ovulation is typically accomplished with an oral medication such as Clomid®, or with injectable gonadotropins. In order to support the second half of a cycle, progesterone is typically administered to ensure normal levels of this naturally occurring hormone and to ensure that the uterus will be properly prepared for a fertilized egg.
Ultrasound Tracking of Ovulation
Ultrasound testing is a highly reliable and safe method of tracking ovulation. A vaginal ultrasound is performed at specific stages of an ovulation cycle and will give an accurate count and measurement of follicles and eggs as they are developing in the ovaries. This allows for very accurate timing for natural intercourse or artificial insemination, such as the IVF procedure, to ensure the highest rate of success. The ultrasound procedure is very safe and creates virtually no discomfort. It involves the insertion of a small transducer into the vagina that is similar in shape and size to a tampon.
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Intrauterine Insemination ( IUI)
Intrauterine insemination (IUI) is a type of artificial insemination we offer at our Los Angeles-area facilities. It is the most common type of artificial insemination in that when most people think of "artificial insemination," what they're thinking of is actually the IUI procedure. IUI is most often prescribed in cases where couples have been unsuccessfully attempting to have a baby for at least one year, and, after a thorough consultation, examination, and diagnosis, other causes for their infertility have been ruled out. In IUI, semen is washed of its seminal plasma and injected directly into the uterus.
About IUI and Artificial Insemination
Because sexual intercourse only allows for a small percentage of the sperm to travel successfully through a woman's genital and reproductive tract, artificial insemination / IUI was developed to dramatically increase the number of sperm reaching in the fallopian tubes, where natural fertilization is given a significant boost in chances for success. The IUI process bypasses the cervix, allowing the sperm to target the ovaries without being slowed or stopped by the reproductive tract.
Historically, pregnancy rates are much improved with IUI over regular intercourse, especially when factoring in male infertility or when infertility is a result of cervical factors. Used in conjunction with ultrasound to track follicular development, the procedure can be timed to maximize the chances for pregnancy.
Fertility drugs are often employed during an artificial insemination / IUI treatment. Known as controlled ovarian hyperstimulation (COH), this application of fertility medications and IUI has been shown in studies to have a very positive effect on the success rates of IUI. To find out whether you are a good candidate for an artificial insemination procedure such as IUI, contact one of our Los Angeles-area offices today.
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Male Partner Requirements for IUI
Other than sperm preparation and uterine injection, artificial insemination / IUI ultimately relies on the natural characteristics of healthy sperm to fertilize an egg within the woman's reproductive tract. Where the sperm count or shape is deficient, studies have shown that successful fertilization will not occur. The following sperm parameters are important to male fertility:
- Sperm count (the number of sperm per cc)
- Motility (the percentage of sperm moving)
- Sperm morphology (the shape of the sperm)
- In the State of California, blood tests must rule out the presence of certain infectious diseases.
Female Partner Requirements for IUI
Testing for the female partner must rule out any obvious conditions of infertility. In addition, the woman's test results must show normal ovulation, open fallopian tubes, and an otherwise normal uterine cavity.
Even if the woman has an ovulatory disorder, if she responds positively to fertility drugs, the IUI treatment can be timed to take place in concert with controlled ovarian hyperstimulation, which, as mentioned above, is typically done even if there is no ovulatory dysfunction.
Women with endometriosis respond successfully to an IUI treatment as long as there is no distortion of the pelvic structures. Women who experience mild endometriosis typically are treated in the same fashion as women with unexplained infertility.
If a woman has severely damaged or blocked fallopian tubes, IUI will not be helpful and will be ruled out as a fertility treatment option.
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The Benefits of IUI
Success rates of intrauterine insemination (IUI) assisted by superovulation (from hormone treatments) range from 5 percent to 15 percent per cycle and are dependent on the age of the woman, and assume that the requirements for the male's sperm are met, and that the woman has normal, healthy fallopian tubes.
Typically, three cycles of IUI are attempted and, if successful results are not achieved, your Southern California Reproductive Center fertility doctors will recommend more aggressive fertility treatments such as in vitro fertilization (IVF). Artificial insemination / IUI does not involve the collection of eggs from the woman's uterus, nor does it require the administration of a general anesthetic. For a private consultation regarding artificial insemination / IUI at our Los Angeles-area clinics, contact the Southern California Reproductive Center today.
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The IUI Procedure
The IUI procedure consists of five steps.
Step 1. Fertility drugs are administered to stimulate the growth of two to three eggs to maturity. Typically, Clomid® pills or gonadotropin injections are employed to nurture the growth of follicles, which cause ovulation to take place.
Step 2. Monitoring of the drug treatments is conducted to measure the growth of follicles, and to control the drug doses to the specific needs of the patient, so as to stimulate positive follicular growth without causing serious side effects. Because fertility drugs can produce multiple eggs, monitoring is also needed to reduce the risk of multiple pregnancy. Blood tests are used to measure estrogen concentrations, and ultrasound is used to track follicular development. Generally, the goal of an IUI treatment is to produce three to five mature follicles.
Step 3. When monitoring shows the maturity of at least two or three follicles, the patient receives an injection of the hormone hCG (human chorionic gonadotropin), which will induce ovulation.
Step 4. On the morning of ovulation, a sperm sample is provided by the male partner, prepared for the IUI, and injected later the same day. With a very fine catheter, the washed and concentrated sperm sample is inserted through the cervix and high into the uterus of the woman. Comparable to a Pap test, the procedure is fairly painless and uncomplicated.
Step 5. After the IUI, pregnancy testing and early ultrasound monitoring are conducted at appropriate intervals.
To learn more about IUI or other artificial insemination treatments, contact our Los Angeles-area fertility offices.
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Sperm Preparation/Gender Enhancement for IUI
Careful analysis of the semen is critical to successful IUI. A sperm sample is taken from the donor and analyzed for count, motility, and morphology. Additional steps can be performed at this time to enhance the sperm for gender selection. Based on this analysis, appropriate steps are taken to prepare the sperm to ensure the highest probability of successful insemination and, through a special washing procedure, the sperm can be prepared to increase the odds that a child of the desired gender will be conceived through IUI or IVF.
Donor Insemination
A pregnancy from a donor’s sperm is another option. The Southern California Reproductive Center works with discreet, highly reputable sperm donor banks, or you may use your own donor. Combined with IUI or IVF treatment, donor insemination provides a safe, reliable method for producing a pregnancy. We have several sources of screened donor sperm that you can discuss with our staff.
Schedule an Artificial Insemination/IUI Consultation at Our Los Angeles-Area Offices
Whether the appropriate medical treatment for you is ovulation induction or IUI (artificial insemination), the skilled fertility physicians at the Los Angeles-based Southern California Reproductive Center's can advise you about the best options for you. Contact the Southern California Reproductive Center for a private consultation to discuss your alternatives.
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