Why offer fertility treatments?
Infertility is a disease of the reproductive system, which affects approximately one out of four couples. Infertility is defined as the inability to conceive or carry a pregnancy to term after one year of unprotected intercourse. Intrauterine insemination becomes easier to perform in the OBGYN office, resulting in successful treatment of infertile couples rather than referrals to the IVF specialists. From key products to consulting and billing, Androcare offers you the “how-tos” in setting up a successful practice.
Why perform Intrauterine Insemination (IUI) in your facility?
Most OBGYNs currently have the ability and equipment needed to evaluate the basic reasons why a patient is having problems conceiving. There is no need for expensive lab equipment or specially trained personnel.
When is IUI performed?
IUI is often the initial treatment for infertility and is also used in cases where unexplained infertility occurs. IUI may be used in male infertility (i.e., low sperm counts or if a sperm donor is being used) as well as when a woman's cervical mucus is less than ideal. IUI may also be used if a couple would like to try to avoid the higher cost of IVF treatment.
How is insemination performed?
A semen specimen is either produced at home or in the office after 1 to 3 days of abstinence from ejaculation. The semen is then "washed" in the physician's office or in a laboratory. The separated and washed specimen consisting of highly motile sperm is placed high in the uterine cavity using a very thin, soft catheter.
What experience and technology does Androcare offer in making it possible for OBGYNs to treat infertility?
With many years of experience in assisted reproductive procedures, Androcare provides the knowledge, expertise and technology needed to support fertility options for couples in a simple, less expensive method with proven results.
What will the financial impact be as a result of providing fertility treatment in your office?
Unless the office decides to purchase new equipment and staff to manage this portion of the practice, there would be very little overhead expense. It is important to note that the billing for additional visits and other necessary services as part of offering fertility treatment will make up for any minimum overhead expense.
What percentage of your caseload could involve infertility work?
It is estimated that the average OBGYN facility fertility workload is approximately 10% depending on the size and location of the office. How do you identify the appropriate patients for fertility workup? IUI is designed for patients with a cervical factor such as severely thickened cervical wall, cervicitis, cervical stenosis, vaginal anomalies, antisperm antibodies, male-factor infertility, sexual dysfunction, immunologically mediated infertility and other unexplained infertility. In these cases, IUI is often the first step before other assisted reproductive technologies are administered. It is important to note that IUI is not appropriate for patients with ovarian failure or tubal occlusion. These types of patients will require other forms of therapy and should be referred to a reproductive endocrinologist for further testing. Full evaluation of both partners is necessary and in the case of IUI, it is important to determine if the patient is an appropriate candidate for IUI in order to warrant a successful insemination.
On average, how many visits are needed for a patient workup?
The average workup can be done in three to four visits, with most of the evaluations combined during individual visits. For example, hysterosalpingogram and semen analysis are often performed during separate laboratory visits, while cervical culture, endometrial biopsy (if indicated) and lab blood tests can all be done during the same office visit.
How do you identify the appropriate candidates for IUI?
In most cases, the ideal candidates are couples having difficulty supplying healthy sperm to the right place at the right time. For example, while a man may ejaculate 50 million motile sperm, 90% of sperm and semen dissipates and is lost in the vaginal fluid, with only 5 million (10%) finding the cervical canal. Other candidates include couples who have sexual dysfunction, patients with a sperm donor, and in 10% of the cases the problem will end up resulting from poor cervical mucus. The highest success rates will occur within this segment as IUI bypasses the cervix and deposits sperm directly into the uterus.
When should the IUI procedure be performed?
The procedure should be performed on or close to the time of ovulation.Monitoring ovulation and the size of the follicles via transvaginal ultrasonography can be conducted if available; others use ovulation predictor kits or basal body temperature charts to time IUI.
Overview of the procedure
A semen specimen is either produced at home or in the office after 1 to 3 days of abstinence from ejaculation. Note: Abstaining for more than 7 days can result in decreased motility. The semen is then "washed" in the physician's office or in a laboratory in a “swim-up technique.”The separated and washed specimen consisting of highly motile sperm is placed high in the uterine cavity using a very thin, soft catheter. Depending on the timing of ovulation and because sperm lose some their function within 24 hours after ejaculation, a second insemination can be performed between 12 and 24 hours after the first insemination. If there is a concern with entering the uterus a second time, the Pro-ception Fertility Pak or Oligospermia Cup can be used.
What is the “swim-up” technique in regard to washing sperm and what are the benefits of this procedure?
The semen specimen is allowed to stand for between 15 and 30 minutes to liquefy before processing. The liquefied sample is then placed in a solution with culture media layered on top. The tube is allowed to stand for 45 minutes. During the incubation time, the healthy, motile sperm swim up from the fluid into the cultured media and are then drawn off and used for insemination. This process eliminates the dead, weak or dysfunctional spermand allows only the healthy sperm to be inseminated.
What are the benefits of the swim-up technique?
The benefits include less handling of the specimen, reducing the chances of damaging the sperm, and collection of the healthiest specimen, resulting in a higher chance of pregnancy. The procedure is easy to perform and requires no expensive equipment or specialized staff. The procedure is inexpensive and reduces the workload placed on the technician. The swim-up technique has been used in many assisted reproductive centers around the world for many years.
How many IUI procedures should be performed on a patient?
It may take up to three cycles for an IUI to be effective. Pregnancy rate on average is approximately 25% without superovulation and 35% when superovulation is used. If after six cycles no pregnancy is achieved, it is recommended that you refer the patient to a reproductive endocrinologist for a more aggressive infertility workup.
What is the cost for an IUI procedure?
The average cost for performing an IUI in the OBGYN offices is 15,000 naira to 18,000 naira. Billing patients for an IUI procedure can range anywhere from 80,000 naira to 160,000 naira per cycle, compared to IVF fees which can range between 1,000,000 and above.
Success with IUI
With properly selected patients, IUI can offer pregnancy rates that are comparable to those achieved by in vitro fertilization (IVF) and other assisted reproductive technologies (ARTs). When a man using Sperm Select ejaculates 50 million motile sperm, 25 million motile sperm will be recovered, resulting in at least a 5 times higher efficiency rate in bringing motile sperm to the oocyte. The procedure is safe, easy, affordable and relatively comfortable for the patient.