IUI

IUI helps where the problem is one of the sperm reaching the egg in enough numbers at the right time: a count or movement that is a little below normal, a cervix that is hostile to sperm, difficulty with intercourse, or unexplained infertility where every test is normal and timed cycles have not worked. It is combined with tablets or low-dose injections to make sure an egg is released, and the cycle is scanned.

It does not help where the tubes are both blocked, because the sperm still cannot reach the egg; where the count is very low, because there are too few to prepare; or where the reason lies in the eggs themselves. For those, IUI is a step skipped with a reason, and the IVF consultation is where the conversation goes.

From day two or three, tablets or injections to grow a follicle, as in step 2. Scans from about day ten to watch it grow. When it is the right size, an injection to trigger ovulation, and the IUI is timed for about thirty-six hours later. At the registered ART centre, on the day, he gives a sample, which is prepared in the laboratory over an hour or so: washed, concentrated, and the most active sperm selected. The prepared sample is placed inside the uterus through a fine soft tube passed through the cervix. That takes a few minutes, feels like a cervical smear, and you go home afterwards and carry on as normal. Two weeks later, a pregnancy test.

The tablets, the scans and the trigger are planned and done here. The preparation of the sample and the insemination itself happen at a registered ART centre, which you are told about before the cycle starts, and the follow-up comes back here.

The fortnight between the procedure and the test is the hardest part of any fertility treatment, and nothing on this page will make it shorter. What helps a little: a normal life, no bed rest, no special diet, and a test on the day you are given rather than every morning from day seven. Progesterone support is sometimes given through the two weeks; you are told if it is and why.

Every cycle teaches something. If the follicle grew, the timing was right and the sample was adequate, and there is no pregnancy, that is one fair try used, and the next is planned. If the follicle did not grow or the sample was poorer than expected, the dose or the plan is adjusted before the next one. After the agreed number of cycles without a pregnancy, the conversation moves to the next step, and it is a conversation you have already had in outline before the first cycle.