IUI AND IVF CENTER FOR INFERTILITY (TEST TUBE BABY)

IUI

IUI - Intrauterine Insemination. Sperm that has been put through a centrifuge is injected into the woman's uterus using a catheter. IUI is relatively painless for most women and is done as an outpatient procedure. IUI is the same procedure used for Donor Insemination. IUI is also referred to as AI (artificial insemination) or AIH (artificial insemination - husband) and AID (artificial insemination - donor)
An IUI -- intrauterine insemination -- is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn't take very long — it usually only requires the insertion of a speculum and then the catheter, a process that maybe takes a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove the catheter — going slowly helps reduce discomfort). Sometimes when the cervix is hard to reach a tenaculum is used to hold the cervix, which makes the process a bit more uncomfortable. A typical "Tomcat" catheter is shown below.

Best Timing For IUI

Ideally an IUI should be performed within 6 hours either side of ovulation — for male factor infertility some doctors believe after ovulation is better, otherwise chances of success are higher with insemination before ovulation with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG, though some do it at 24 hours, and some clinics are reporting better results when doing the IUI at 40-42 hours post-hCG. If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG. Some reports show no increase in success rates with two IUIs, but others suggest it may increase success as much as 6 percent.
Some doctors will base timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm, but doing them at 24 hours is also pretty common since ovulation may be a bit earlier. When two inseminations are planned, they are usually timed between 12 and 48 hours after the surge is detected. The egg is only viable for a maximum of 24 hours after it is released

IVF

IVF - In Vitro Fertilization. Aspirated ova are mixed with sperm in a petri dish. IVF can be combined with ICSI (see below), with egg donation and with sperm donation. Embryos created with IVF can also be used in embryo adoption.

Boosting the woman's egg supply

You will be prescribed drugs that will help to control when your eggs are produced.  You will also take drugs to increase the number of eggs you produce.  This means that more eggs can be fertilised and the clinic will have a greater choice of fertilised eggs to use in treatment.

Checking on progress

The clinic will carry out vaginal ultrasound scans to monitor your developing eggs.  They will also do blood tests to chart the rising levels of oestrogen produced by your eggs.  This helps to track how your eggs are maturing. 34-38 hours before your eggs are due to be collected, you will have a hormone injection to help your eggs mature.

Collecting the woman's eggs

Eggs are usually collected by ultrasound guidance, which takes around 30 minutes.  Your doctor will insert a thin needle through your vagina into each ovary. The eggs will be sucked into the needle.  Very occasionally, eggs will be collected by laparoscopy (a small telescope with a light attached). This procedure involves making a small cut in your stomach and extracting the eggs with a fine needle, as before. 

Collecting the man's sperm

Around the same time that the eggs are collected, the male partner will produce a sperm sample. This will be stored for a short time, and the sperm washed and spun so that the healthiest sperm can be used to fertilise the eggs.  If you are using donor sperm, this will be taken from the freezer and prepared in the same way.

Fertilising the eggs

The eggs and sperm are mixed and left in a laboratory dish for 16-20 hours. They are then checked to see if any have fertilised.  Those that have (now called embryos) are left for another 24-48 hours before being checked again. 

Preparing for pregnancy

Two days after egg collection, the woman will be given progesterone to help prepare the lining of the womb for pregnancy. This is given with pessaries, injection or gel.

Transferring the embryos

Two to five days after the eggs fertilised, the healthiest ones are selected to be put back into the woman's womb.  For women under the age of 40, one or two embryos can be replaced.  If you are 40 or over, a maximum of three can be used.  Remaining embryos can be frozen in case you have further IVF treatment.