IUI- When And How Will It Help Me?

Author : Dr. Monica Sachdeva
Date : 21 Nov 2019

Fertility treatment is broadly divided into two categories. One is IUI, and the other is IVF. While age and fertility diagnosis may be the primary considerations for selecting a treatment, there are other factors to consider, including demands of treatment and cost.  

What is Intrauterine Insemination?              

Intrauterine Insemination (IUI) is a fertility procedure in which sperms are washed in a laboratory to concentrate the most active sperm which are placed directly into the uterus using a catheter passed through the cervix. While historically also called "artificial insemination," the term "artificial" is no longer used because it is inaccurate and dubious.

The insemination is performed at or just before a woman is ovulating. It may be either during a natural cycle or one in which oral or injectable ovarian stimulation fertility medications are used.

Doctors often suggest IUI as one of the first fertility treatments, because it is relatively simple, cheaper and increases pregnancy rates when performed with ovarian stimulation. 

Who is the right candidate for IUI?

Different factors affect both women and men to make IUI an excellent first option. Read in detail

For women:

IUI is often the first treatment considered for

  1. Polycystic ovarian syndrome (PCOS) or other ovulation problems because fertility medications make cycles more regular. IUI can also increase pregnancies.
  2. In women with mild endometriosis or unexplained infertility.
  3. IUI is also a good option for women with cervical abnormalities, including scarring from prior surgery or abnormal development of the cervix or vagina. These abnormalities can impair the passage of sperm from the vagina to the uterus. 
  4. At least one unblocked and reasonably regular fallopian tube.
  5. Regular ovulation with or without the help of fertility medication 

IUI is not recommended for women with:

  • Moderate to severe endometriosis
  • Severe disease of the fallopian tubes
  • A history of pelvic infections
  • Longstanding (>4 years) infertility 

For Men:

IUI is a good option  

  1. If a partner has healthy sperm or mild male infertility factor including a below-average sperm count, motility problems or mildly abnormal sperm morphology
  2. Helpful if there are ejaculation problems. IUI is not usually successful with severe male infertility.
  3. IUI is also a good option after male fertility preservation for men who have frozen their sperm before cancer treatment or surgery that might affect their fertility. It only applies, however, if their female partner is the right candidate for IUI. And, if there's a sufficient quantity of frozen sperm available to use for IUI with enough left for IVF if IUI is unsuccessful.
  4. IUI is often used by couples where the male has a genetic defect that is managed by using donor sperm. 

For Women and Men:

IUI is usually tried first – along with medications to stimulate the development of 2 or 3 mature eggs – for those with unexplained infertility. This diagnosis affects one out of every five couples with fertility issues.

IUI is also helpful for couples where there have been sexual problems like vaginismus or premature ejaculation. 

What is the success rate for IUI?

Success rates with IUI depends on age, the reason for infertility, whether fertility drugs are used, and how many cycles are performed.

IUI pregnancy rate in women less than age 35 is about 8% to 10% per cycle. The cumulative pregnancy rate (total pregnant) after two cycles is about 18% and with 3 cycles about 25%.

Pregnancy rates decrease after three unsuccessful cycles. After six cycles of ovarian stimulation and IUI, the cumulative or the total number of women pregnant is about 35%. By age 38 or older, pregnancy rates per cycle are usually 5% or less.

For couples with unexplained infertility, IUI is double the success rate of no treatment.

What are the advantages, disadvantages, and risks of IUI?

The IUI procedure is relatively safe, easy and non-invasive. It is also much faster and less costly than IVF.

The major disadvantage of IUI is the significantly lower live birth rate than IVF. Also, while taking fertility drugs is safe, there can be side effects – clomiphene can cause:

  • Headaches,
  • Hot flashes,
  • Fluid swings and
  • Mood swings in some women.

However, most women tolerate clomiphene quite well.

The primary risk of IUI, when done with ovarian stimulation is multiple pregnancies. Multiples carry risks for the mother and babies, including premature birth, disability, infant mortality and health issues for the mother.

Twins can occur in up to 30% of pregnancies with gonadotropins. However, this risk can be substantially reduced if only 2 or at the most, 3 mature follicles are created during ovarian stimulation.

When limited to 2 or 3 eggs ovulated, the twin rate is about 8% to 10%. It is important to note that the multiple pregnancy risk comes primarily from the ovarian stimulation of multiple follicles, not the IUI itself.

Where to get an IUI done?

Infertility clinics, as their semen preparation can be done in a better manner and travelling of semen sample is avoided. Also, sonography will be available for the follicular assessment. Competent doctors will be around for smooth procedure.

To summarise, IUI is a good option for a young couple with milder causes of infertility.But the number of IUI attempts should be judiciously decided upon. Any failure be it an IUI cycle increases the mental and financial burden on the couple so just for the sake of protocols we shouldn't be sticking on futile IUI cycles.