Intra-Uterine Insemination

INTRA-UTERINE-INSEMINATION

IUI is one of several infertility treatments where a small catheter is utilized to deposit carefully prepared sperm directly into the uterus in a process similar to a pap smear. The goal of IUI is to increase the number of good sperm that reach the fallopian tubes to increase the odds of fertilization. If there are no contraindications (age, blocked oviducts, adhesions), IUI in conjunction with “fertility drugs” is usually selected as a first line of fertility treatment.

An IUI cycle with injectable medications is sometimes used as part of a progressive treatment for a specific patient group. The treatment may progress from timed intercourse, to IUI with oral medications (clomiphene / clomid), to IUI with injectable medications. However, the highest probability of pregnancy is when IUI in association with FSH is utilized.

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Nurse assisting with egg

It is important to remember that IUI in general is only effective if the diagnosis indicates ovulatory or sometimes cervical issues. It will be ineffective for cases of blocked tubes, as it still requires that the eggs make the journey through the tubes prior to fertilization. Because in most cases, injectable medications won’t provide much (if any) benefit over oral medications for IUI, they are in many cases an unneeded expense that can be skipped in favor of moving on to IVF. Occasionally, a patient who doesn’t respond well to oral medications can be put on a regimen of FSH for IUI and have a successful cycle.

IUI SUCCESS RATES

Age is one of the main determinants of success. So any discussion about success must include the age as a factor. Birth rates per cycle of IUI performed for the correct indications are reported to be around

• Patients < 30 years old around 15%-20%

• Patients between the age of 35 – 39 around 5% – 8%

• Patients 30 – 35 years old around 8% – 12%

• Patients >39 have the lowest chance of success which is <3%

THERE ARE MANY FACTORS THAT AFFECT THE OUTCOMES, AMONG THEM ARE:

• The best results with IUI are obtained when gonadotropins (e.g., Gonal-F or Follistim) are used to induce ovulation. The pregnancy rate can be up to 20% per cycle of treatment for young patients.

• When clomiphene citrate is used for ovarian stimulation, the success rate is lower than the one achieved through the use of gonadotropins.

• Women over 35 years old should opt to be treated with injectable gonadotropins (Gonal-F or Follistim) instead of oral medications (Clomid or Letrozole) to maximize the probability of success.
• The poorest results with IUI are seen in cases of moderate or severe male infertility (success rates are less than 7% per cycle) and where IUI is performed in natural (unstimulated) cycles.

• Endometriosis and hydrosalpinx create an unfavorable pelvic environment that lowers the probability of fertilization. In general, endometriosis reduces pregnancy rates to about 6% or less per cycle following COH.
• Unless there is no option women 38-39 years of age or older should go immediately to IVF as pregnancy rates with IUI are usually very low. Please consult your nearest FERTILITE office for more information on IUI costs.

IUI COMPLICATIONS AND SIDE EFFECTS

The IUI procedure itself causes very few side effects. Some mild cramping may occur after the insemination. In general, the side effects experienced are related to the fertility medications taken to stimulate ovulation. Common side effects related to hormonal treatment may include hot flashes, mood swings, breast tenderness and/or bloating, nausea, headaches, bruising or rash at the injection site (if injectable medications are used). There is a higher than normal risk of multiple gestation, which can lead to premature birth and the associated risks.

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