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SUPEROVULATION (SO) AND INTRA-UTERINE INSEMINATION (IUI)
Who Can Benefit From IUI?
Couples undergoing infertility treatment may benefit from having superovulation (SO) and intrauterine 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?
Before you are able to commence a cycle of IUI, you must have had the following investigations:
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HSG (hysterosalpingogram) to assess tubal patency
Semen analysis
Virology bloods (Hepatitis B core antibody & surface antigen, Hepatitis C and HIV) for both
partners
If the virology blood results are not available before your first scan appointment, you will
not be able to start off that cycle.
You will need to call the clinic on Day 1 of your period and we will arrange to scan you between
within the first 3 days. You will then start treatment if this scan is normal.
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 and need to be given at the same time each day. 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
Document Name: PI 12 SO & IUI and Medication
Approved By: Umesh Acharya
Author: Amanda O’Leary
Version 2 (June 2013)
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CRGW Ltd: 07029220
is a rare complication. If you have difficulties, please get in touch with us at CRGW, rather than
any other 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.
SUPER OVULATION / INTRAUTERINE INSEMINATION DRUGS
This is a simple description of the drugs used in our SO/IUI programme. You will be using these
drugs, but your protocol is tailored for your individual use.
BUSERELIN / SUPRECUR (Store in fridge)
Daily injection: dose = 0.3mls, given subcutaneously, once a day, at a 45 angle into an
area of pinched skin.
We usually advise our patients to inject either into their thigh area or the area just below your
navel (belly button).
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Patients will start to take Buserelin / Suprecur Day 2 of their period.
The drug controls your own cycle and gradually “switches off” your own hormones prior to egg
collection.
This injection continues daily at the same time, until final HCG injection.
Possible side effects: hot flushes, night sweats, breast enlargement, headache, palpations,
vaginal dryness, and mood changes. Localised pain, redness. Please also see the manufacturers
leaflet enclosed with your drug. N.B. Symptoms usually resolve when commence injections of
FSH.
Document Name: PI 12 SO & IUI and Medication
Approved By: Umesh Acharya
Author: Amanda O’Leary
Version 2 (June 2013)
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CRGW Ltd: 07029220
FOLLICLE STIMULATING HORMONE (FSH)- Menopur and Gonal F
These drugs need to be stored at the correct temperature. The dose and method of administration
are variable. Some drugs need to be reconstituted whilst others come premixed in an injectable
pen. Inject the drug at a 90º angle into an area of pinched skin.
This drug encourages the ovaries to produce several egg-containing follicles instead of the usual
one or two.
Possible side effects of FSH:1. Ovarian hyperstimulation syndrome (OHSS) – over reaction producing symptoms of abdominal
bloating and discomfort. Other symptoms may include nausea, vomiting, thirst or shortness of
breath.
2. Localised pain and swelling at injection site.
HUMAN CHORIONIC GONADOTROPHIN [HCG] – Pregnyl or Ovitrelle
Pregnyl (store in fridge) - This drug is supplied in powder form with water (dilutent) for mixing.
Please pinch up your skin as demonstrated at your appointment and inject at a 45º angle. The
dose is 10,000 IU (2 powders to 1 liquid). To be administered at a given time, according to your
individual regime, two days before ovulation is required. This has the effect of completing
development of the eggs and preparing them for release (ovulation).
Ovitrelle (store in fridge) – This drug comes as a pre-mixed solution in a pen form for
administration. It is a single dose pen containing 250IU of drug.
Possible side effects: bloating, headache, injection site reaction, breast tenderness and may
exacerbate hyperstimulation (OHSS).
CYCLOGEST PESSARIES – (Store in cool cupboard)
This contains the hormone progesterone, which is absorbed through the internal tissues and may
help with implantation of the embryo.
Dose:
 One pessary is to be used on the evening of your IUI and is to be inserted into the vagina, or
rectum.
 From then on continue with a daily pessary in the evening until performing your pregnancy test.
 If it is positive you will need to continue with the Cyclogest Pessaries until you are 12-weeks
pregnant unless directed otherwise. If the test is negative we will ask you to stop using the
pessaries.
 The progesterone helps to maintain the lining of the womb (endometrium), which the embryos
need to embed in.
Possible side effects: pre-menstrual-like symptoms e.g. bloating, fluid retention, nausea, breast
tenderness, headaches, skin reactions.
References:
1. www.bnf.org
2. Manual of Clinical Nursing Procedures Ed 6, CH 9, p194.
Document Name: PI 12 SO & IUI and Medication
Approved By: Umesh Acharya
Author: Amanda O’Leary
Version 2 (June 2013)
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