IUI Protocol with Donor Sperm

Introduction to IUI Protocol

• Women undergoing IUI with donor sperm should receive intrauterine insemination rather than intracervical insemination, combined with ovarian stimulation using low-dose gonadotropins (≤75 IU/day), clomiphene citrate, or tamoxifen, with single insemination performed 24-40 hours after hCG trigger or 1 day after spontaneous LH surge 1, 2

Ovarian Stimulation Protocol

• Ovarian stimulation should be combined with IUI to improve live birth rates, particularly in women with good prognosis 1, 2
• Use low-dose gonadotropins (≤75 IU/day starting dose), clomiphene citrate (100 mg/day from cycle days 5-10), or tamoxifen as acceptable first-line options 1, 3
• Do not add GnRH agonists to gonadotropins as they increase multiple pregnancy rates and costs without improving pregnancy rates 1, 3

Cycle Monitoring and Timing

• Cancel the cycle if >2 follicles >15 mm OR >5 follicles >10 mm are present at time of hCG injection or LH surge to prevent high-order multiple pregnancies 1, 2, 3
• Perform single IUI 24-40 hours after hCG trigger in stimulated cycles, or 1 day after spontaneous LH surge in natural cycles 1, 2, 3
• Double insemination per cycle does not improve pregnancy rates over single insemination and should not be performed 1, 4

Sperm Preparation

• Use any standard preparation technique (swim-up, gradient centrifugation, or wash and centrifugation) as there is no evidence that one method is superior to another 1, 2, 5

Post-Insemination Care

• Apply 10-15 minutes of bed rest immediately after insemination 1, 2, 4

Number of Cycles

• Perform at least 3 consecutive IUI cycles before considering transition to IVF/ICSI, as pregnancy rates continue to increase through multiple cycles 1, 2, 6

Infection Screening

• Screen both partners for infectious agents (including HIV, hepatitis) based on local, regional, and national standards before initiating treatment 1, 2, 8

Risk Counseling

• Inform patients about increased risk of preterm birth and low birthweight in IUI-conceived pregnancies compared to spontaneous conception, even in singleton pregnancies 4, 8
• Multiple pregnancy risk is 10-20% with gonadotropin stimulation but can be minimized through strict cycle cancellation criteria 1, 3