Timed Sexual Intercourse (TSI)

The process of timed sexual intercourse involves three steps and can take up to four weeks from the start of the menstrual period to the pregnancy test. This technique is relatively simple and requires two main conditions: the fallopian tubes must be open and a normal sperm sample is needed (known as normozoospermia). TSI is recommended for couples who have been trying to conceive for a relatively short period (less than two years) and for patients who are experiencing anovulation as their primary issue.

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The steps are described below:

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1. Assessment to determine suitability for treatment.

• Typically, when undergoing this fertility treatment, various blood tests such as AMH, FBC, and TSH are conducted alongside a transvaginal scan known as HyCoSy or saline infusion sonogram (SIS tubal). These tests are done to assess the uterus, ovaries, and tubal patency. On the male side, a semen analysis (SA) is also important to ensure that the sperm is suitable for the treatment. If the Fallopian tubes are blocked and/or the SA is unsuitable for treatment, we would recommend another technique like IVF/ICSI.

 

2. Stimulation of ovaries using gonadotropins or tablets (clomiphene or letrozole)

• During this stage, which lasts for about 10-12 days, the ovaries are stimulated with medications to induce follicle growth. Transvaginal ultrasounds are performed during this time to monitor the ovaries and count the number of follicles and their size. When follicle(s) reach a size of 17-22 mm, a trigger shot is administered, and the patient is instructed to have intercourse typically 34-36 hours after the last injection. Gonadotropins are administered subcutaneously whereas the tablets are normally taken for 5 days. 

 

3. Pregnancy test 

• The pregnancy test should be conducted normally after 14 days following the intercourse. It is recommended to have a determination of B-HCG level in the blood rather than a urine test, as it is more precise. If the result is positive, instructions will be given to return after 4-6 weeks to perform a transvaginal scan to check the viability of the embryo. If the result is negative, the medication intake will stop and a conversation with your doctor will occur in most cases.