The amount of monitoring with IUI or artificial insemination varies based on the type of cycle:
Natural Cycles with IUI
Natural cycles with IUI have the least amount of monitoring, In these cases, either over-the-counter LH predictor kits are used to determine when ovulation occurs and the IUI is timed accordingly. Alternatively, an ultrasound can be performed between cycle days 11-14 to determine if a mature follicle has developed, and subsequently, HCG is administered which will cause ovulation to occur within 36-44 hours. Then the insemination(s) are scheduled. Progesterone vaginal supplementation is then started one day after the IUI and continued for 12-14 days until the pregnancy test. If the pregnancy test is negative, the progesterone must be stopped in order to allow for the period to occur.
Clomiphene citrate (Clomid) cycles have slightly more monitoring. An ultrasound is performed on cycle days 2, 3, or 4 in order to confirm that no ovarian cysts are present prior to starting the Clomid. Taking Clomid in the presence of cysts can lead to an abnormal response and the enlargement of already present cysts. The woman then takes Clomid either 50 to 150 mg daily for five days. A mid-cycle (days 11-14) ultrasound is performed to determine if and how many mature follicles (measuring 20-24mm) are present and also evaluate the endometrial lining. In 10% of women, the anti-estrogen effect of Clomid can cause unexpected thinning of the endometrial lining which is detrimental to the implantation of an embryo. If this persists over two or more attempts, Clomid may not be an appropriate treatment option. Once mature follicles are present, HCG is administered and the IUI(s) will follow within 24-48 hours, once again followed by the use of vaginal progesterone. The risk of a multiples pregnancies with Clomid is approximately 8% with the majority being twins.
Gonadotropin Cycles (Fertility Shots)
Gonadotropin cycles (fertility shots) increase both medication costs and the necessity of ultrasounds and bloodwork. In these cycles, a baseline is once again performed between cycle days 2 through 4 to confirm no cysts being present. At this point, the injectable medication is started. Multiple days of ultrasounds and blood hormone levels will follow in order to closely follow the growth of the follicles and assure that the ovaries do not over-stimulate (ovarian hyperstimulation syndrome) and that too many follicles are not present. One of the risks for this type of stimulation is that of higher-order multiples. If multiple follicles are developing, the risk of higher-order multiples (triplets and above) increases. The overall risk of multiples with gonadotropins is approximately 20% and the presence of too many follicles (greater than 4-5) may prompt the cancellation of the cycle. Many people are unaware that the majority of higher-order births (triplets and above) are a result of gonadotropin/IUI treatments that are not managed and canceled appropriately. It is a misconception that these higher-order births are a result of IVF; IVF provides a much more controlled treatment limited to the number of embryos being transferred. Once a reasonable number of mature follicles are noted (between 1 to 4), the HCG trigger shot is given followed by the insemination(s). Once again this is followed by progesterone vaginal support.