Why is iui success rate low

I thought I knew what I was getting into. But, despite all my prep work, I was surprised by some of the things that happened during and after my IUI. Success rates are low What is intrauterine insemination IUI?

IUI is one of the first lines of defence against infertility, especially for men with poor sperm quality and for women with unexplained, endometriosis-related or cervical factor infertility. So it was surprising to learn that its success rate is ridiculously low. In fact, the procedure is only slightly more likely to help you get pregnant than trying to conceive naturally.

The former increases the chance of conception because there are more eggs usually two or three for sperm to fertilize during a non-medicated cycle, there will only be one mature egg.

The latter deals with the law of averages. A fertility doctor will insert a catheter or needle full of semen into the uterus. The side effects are minimal minor spotting and cramping can happen , and Baratz says that most women are told to resume normal activities as soon as they leave the clinic. We had brunch and went for a long walk. This will tell them how drastically the wash impacts their TMCs.

Given the correlation between TMC when it's below 9 million and IUI success rates, one plausible option is to "pool" successive ejaculates which can nearly triple the TMC available for people who produce few sperm per ejaculate.

Here we address two types of patients: those unable to have a period called anovulatory and those with irregular periods. Amongst both groups those with no period or irregular periods there are three types of patients: those with hypothalamic dysfunction , those with PCOS , and those with no diagnosis but who have had hypothalamic dysfunction ruled out.

Patients with hypothalamic dysfunction are not producing signals within their brains to tell the ovary to mature an egg. Neither clomid nor letrozole will help them. For these patients, IUI must be accompanied by gonadotropin to be effective. Next we have patients who have either PCOS or no diagnosis.

The best study in the field enrolled women to receive clomid or letrozole, followed them for 5 courses of therapy and revealed that the group receiving letrozole had higher live birth rates and fewer multiple gestations.

A closer look at the data suggest that the benefit of letrozole over clomid depended on the BMI of the participants. Investigators concluded there was no statistically significant difference.

One might conclude there is thus no benefit to adding an IUI to a clomid cycle. However, the applicability of this study to all patients may be limited because it excludes women with a BMI over 30 common for women with PCOS and used outdated sperm washing techniques.

IUI preferably with letrozole instead of clomid is probably a good option for women with PCOS or irregular cycles in the event that:. There are multiple strategies for causing ovulation in clomid or letrozole resistant patients. Some of these include adding medications such as dexamethasone or metformin to the treatment regimen. Another approach is changing to gonadotropin injections. Rather than tricking the brain into sending a stronger signal to the ovaries to cause follicle recruitment, gonadotropins directly stimulate the ovary to recruit multiple follicles.

The available data on how effective a gonadotropin-plus-IUI strategy is in patients with irregular, or non-existent, cycles is limited and unfortunately includes other drugs. However, these studies give us a sense for how well a patient can expect to do if she has irregular, or non-existent, cycles and is using a gonadotropin-plus-IUI approach. The bad news is that gonadotropins produce a high multiple pregnancy rate, especially in this population. In the Palomba study, the IUI-plus-gonadotropin arm recorded over a third of pregnancies were multiple birth.

Doctors need to be careful to prescribe enough drugs to elicit a response but not so much that many follicles start growing at once.

This balance is hard to find and can take time. When one fallopian tube is blocked, IUI can still lead to live births, but the location of the blockage itself on the tube proximal or distal is likely a determinant of success. As you can see below, patients with a proximal-only blockage fare better than those with a distal-only block, and both fare worse on a per-cycle basis than similar patients who receive IVF. As a result, many of these proximal-only blockage patients actually have two fallopian tubes open and the eggs from both ovaries are able to migrate through the fallopian tubes, improving the prognosis for these patients.

Patients with one blocked tube who undergo IUI are at greater risk for an ectopic pregnancy than patients who have two open tubes. This is because most conditions that affect the health of fallopian tubes, like endometriosis or pelvic inflammatory disease, tend to impact both tubes.

A tube that is open, but has issues, is more likely to have difficulty passing the embryo into the uterus, so the embryo can become embedded in the tube. While ectopic pregnancies are typically caught early in patients seeking fertility care, they can be life threatening emergencies if the tube ruptures and begins to bleed.

As we alluded to in the second lesson, all things being equal, IUI success rates are higher with fresh sperm than with frozen and thawed sperm. For women obtaining sperm from a sperm bank, IUI with frozen and thawed sperm can absolutely still work. As you can see in the data below, IUI continues to be somewhat productive for some patients after a few cycles, while in others it stops offering any benefit and patients should consider an alternative.

One study tried to assess this in women over the age of 38 who had unexplained infertility. Ultimately the group that began with IVF saw success much more quickly, but after 6 cycles either 6 IVF cycles for the first group or 2 IUI and 4 IVF cycles for the second group there was no statistical difference in the number of women who had a live birth. The implication here is that if you are focused on having a child as soon as possible, advancing to IVF is preferable.

A similar study to the one above measured this by enrolling two groups of patients with unexplained infertility: those who would do 3 IUI cycles and then proceed to IVF and those who would continue on with an additional 3 IUI cycles doing 6 in total before undergoing IVF. In essence, both groups enjoyed high rates of success, but the group that started IVF after only 3 failed IUI cycles were successful about 3 months earlier than the group that underwent 6 IUI cycles before transition to IVF, if necessary.

If a woman has one blocked tube and one open tube, pregnancy can still occur, although conception rates can vary based on where the blockage is located in the blocked tube. Women with a blockage in the distal portion closest to the ovary of her tube tend to not fare as well as women with a blockage in the proximal portion closest to the uterus. Women under age 38 undergoing IUI with a proximal tubal blockage and one open tube can expect to have conception rates of around Women undergoing IUI with a distal occlusion have around a A study depicted above in the graph shows that lesbian women have higher pregnancy rates from IUIs.

After one cycle lesbian women had a After 3 cycles, that shot up to Researchers concluded that IUI was less effective for single women in the study because they were older and likely reflected the fact that single women tend to have failed to conceive for a period of time prior to seeking treatment from a fertility specialist.

The goal of ovarian stimulation with medications is to produce additional follicles so that there are more eggs available for fertilization, thereby increasing the chances of conception that month.

Singletons involve much lower risk to both mother and fetus and are the goal for most doctors and fertility practices. Most women pairing a medicated cycle with IUI will not be allowed to proceed with IUI if they are growing 4 or more follicles. Studies have shown that multi-follicular growth is associated with increased pregnancy rates in IUI with controlled ovarian hyperstimulation COH. Be warned however that more follicles also equals a higher rate of twins, triplets, etc. Most, but not all, IUI cycles are paired with fertility medications to stimulate the follicles to produce additional eggs.

What your fertility specialist recommends will be based on your medical history, diagnosis, and preferences. Using medications, the specific type, and the dosage used all affect IUI success rates.

Clomid and Letrozole are both oral medications that message the brain to send stronger signals to the ovaries to ovulate, while Gonadotropin is an injectable medication that stimulates the ovaries directly to produce more follicles. The goal is always to maximize the number of eggs hence boosting chances for conception while limiting the risk of multiple pregnancies.

It is however important to note that although Clomid and Letrozole have similar odds of producing a live birth, letrozole generally has fewer side effects and more importantly, produces more singleton births. Both fresh and frozen sperm can be used successfully with IUI. When fresh is an option, it is preferred. In part, because there is an expected loss of sperm in the thawing process, but also because timing is even more critical with washed thawed sperm.

Washed fresh sperm survive about hours, while washed thawed sperm only have a lifespan of hours. Fresh sperm tend to live a bit longer which can improve the chances of conception. One study compared pregnancy rates using fresh sperm versus cryopreserved sperm for IUI. After one cycle, pregnancy rates were higher for fresh sperm vs.

Many fertility specialists would agree that the timing of the IUI and an adequate concentration of sperm, or total motile count TMC , are really the more important factors.