It may surprise you to know that despite the massive strides in Fertility management technology, a vast percentage of infertility patients fall under this category – ‘Unexplained Infertility’. Barely 10 to 15% of these need a major treatment like IVF. Most can be managed through medical treatment or minor, low cost procedures like IUI. Infertility is a significant social and medical issue affecting 15% of reproductive couples worldwide. Some cases can be detected and treated well in time. Unexplained infertility is about 10% of all cases. Unfortunately, unexplained infertility is not a diagnosis and deeper understanding and diagnosis are needed of the hour. With only about 15% of ejaculated sperms able to enter the fallopian tubes during sexual intercourse, it is not surprising that many couples have difficulty conceiving. When the diagnosis is made about tired sperm which are unable to travel up to the fallopian tube. There are many ways by which infertility clinics can improve the chances of conception. One of the most effective ways is IUI or Intrauterine insemination. The procedure of IUI involves placing the sperm, either fresh or frozen directly into the uterus. IUI can be the procedure of choice for infertility of some causes including: Regular cycles, but unexplained infertility Mild male factor infertility: inability to achieve erection, Infertility caused by mild endometriosis IUI is not the treatment of choice when, Blockage of both fallopian tubes Infertility due to severe male factor Comorbid issues like PCOD or endometriosis, insufficient cervical mucus, irregular menstrual periods Severe pelvic scarring For such conditions IVF is the treatment of choice In most cases, IUI is done as part of a treatment cycle along with ovulation induction medications or injectable hormones. Women who have PCOS as an ovulatory disorder may benefit from multiple IUI procedures within one month until conception happens. Women having gynecological surgeries might not be able to use IUI. How IUI works It is a very simple procedure and is routinely carried out. IUI demands commitments of the couples for time and trust. What happens in an IUI Process? The process varies from couple to couple. Tentatively its three steps before the artificial insemination process: Preliminary Investigations: The couple is advised blood tests to check hormone levels & sperm testing for checking quality and quantity. Ultrasounds during mid-cycle: In the first week of the menstrual cycle, certain injections are given to produce 2-3 mature eggs for the IUI procedure. Periodic visits are necessary to track the number of eggs and their development. Trigger Shots: they are given to release the mature eggs and the IUI procedure is attempted 32-36 hours after the trigger injections. During IUI, sperm are washed, debris is removed, and The best sperm is now placed in the uterus via a catheter. The timing of the procedure is during ovulation which can happen naturally or with ovulation induction. In this relatively simple procedure IUI, we are still hoping that sperm and egg meet, fertilization occurs, the good quality embryo develops, and implantation in the uterus lining takes place which will eventually lead to pregnancy. Success rates of IUI The chances of success of pregnancy in the case of IUI depend on the woman’s age and the medical record of the couple. What are the Treatment Options for IUI? 1. Natural cycle insemination: This does not require any medication and relies on the woman’s natural menstruation cycle. This is useful for women where natural intercourse is a problem. 2. Clomiphene citrate ovulation induction: this is done with the help of clomiphene citrate along with IUI, and offered higher success rates as compared to natural IUI. 3. Follicle-stimulating hormone induction: ovarian induction is stronger, and careful monitoring is required to avoid overstimulation. This offer superior conception rates as compared to natural & clomiphene citrate IUI induction. IUIs along with the best medications determine success. After the age of 30, the advancing female age has decreased fertility, irrespective of the method used to get pregnant. Why would we have 6 failed IUIs and then IVF success? After several failed IUIs, many couples believe, their fertility problem is so severe that they will never get pregnant. However, their problem can be solved with IVF Some couples are very inefficient with sex and with IUIs, but very efficient reproducers with IVF IVF preferably bypasses many problems that IUI cannot What is the success rate of IUI? The pregnancy rate with each cycle of IUI is between10% to 20%. It varies with every couple depending on a combination of several factors that include: Age Cause of infertility History of Previous childbirth Male and female infertility Number of IUI cycles taken IUIs vs. IVF – when to move on? The short and evidence-based, time-tested answer is to move on to IVF after 3 failed IUIs If the fertility problem is due to a lack of ovulation, maybe try IUI for a few more If the female is under 30 with a good ovarian reserve may be worth trying again. Costs of fertility treatments are deciding factor to move beyond IUI If the female is 40 or older, and another ovarian reserve is low, consider moving to IVF sooner than later. In vitro fertilization is the next step after IUIs – with a much higher success rate undoutedly. What are the other options if IUI fails and needs to move on? With every IUI cycle, the success rate probably tends to improve. Due to various reasons, it may or may not work for you. Your doctor will guide you about other fertility treatment options based on your medical records. Some of the other options are: In Vitro Fertilization (IVF) Intracytoplasmic Sperm Injection (ICSI) Surrogacy Adoption In a nutshell, women shouldn’t consider a failed IUI as a sign that they won’t be able to conceive. it is often to be treated in the least invasive way possible, and IUI offers that option. There is a diverse path to pregnancy and every journey to build a family is different. The goal of the fertility journey is to produce a healthy, live child.
