Reasons For An IUI
In my previous blog post, I discussed what an IUI is, what the protocol options are, and..
You have to know why you are getting an IUI and what your chance of success is based on the implication before you decide to move forward. Let’s go through all the scenarios where we may do an IUI.
Donor or Partner Sperm
Using donor sperm or partner sperm is going to give you the highest rate of success. We are taking you to your age related chance of success which is typically fifteen to twenty percent depending on your age. The older you are, the lower the chance of success. If you are a young lesbian couple using donor sperm to get pregnant, your chance of success could be twenty to twenty-five percent. Mild male factors is another reason for using IUI. This is hard for some people to understand because we get sperm abnormalities and you want to believe that an IUI will solve that problem. Again, an IUI gets players further down the field but we cannot guarantee they’ll make the shot. In a sperm analysis, we are looking at the amount of sperm per milliliter (concentration), how the sperm moves (motility), and the shape of the sperm (morphology). IUI is best in cases of poor motility because we are helping it move. We still need enough sperm. The sperm are like an army working together to put enough force on the egg and crack the egg to get inside. For this, you need millions of sperm. We like to see a total motile sperm count of at least ten million sperm. Otherwise you will not have high enough sperm counts for success with IUI most of the time. When your counts are more than ten million total moving sperm, your chances of success is going to be between three to ten percent for male factor abnormalities. This is an acceptable treatment option, but it’s important to know that nine times out of ten an IUI may not result in a pregnancy. When the shape of the sperm is the issue, most likely IVF with ICSI is often going to be the best case. It’s complicated because you cannot distinguish the normal sperm from the abnormal sperm and only put the normal sperm in. It doesn’t work like this. However, some of the normal sperm are more likely to survive. I tell my patients that if everything is normal besides the morphology, we can try IUI. IVF with ICSI is our best chance.
Unexplained Infertility
Unexplained infertility means that you go through the basic workup and you ovulate, sperm is normal, and open fallopian tubes yet you are still unable to get pregnant. Your chance of pregnancy per month with unexplained fertility if you have been trying for one year is four to five percent per month. If you have been trying for two years, it is two-three percent per cycle. None of those numbers are zero. So if you go through all the workups and decide you want to keep trying, that is a fine option. It is easier to accept that option if you are young because you have normal ovarian reserve and time. If you are older, want lots of kids, or have low ovarian reserve, waiting is likely not the best option. With unexplained fertility, the options are two-fold. One is controlled ovarian hyper-stimulation with IUI. Essentially this is purposefully over-ovulating someone. You would take Clomid, Femara, or injectable hormones then you can get two or three eggs. With this option, your odds go up to eight to ten percent per cycle. This is not a worthless treatment option, but you have to be prepared for what the possibilities are. Typically if we are doing IUI for unexplained fertility, we don’t do more than three cycles. For male factor, we consider up to six. It all depends on what your doctor is going to tell you based on your indication and why you are doing IUI. Depending on your age, IUI may not be a great option for you. The Fort-T trial looked at women thirty-eight and older with unexplained fertility. They put them into two groups looking at doing IUI versus going straight to IVF. The group that went straight to IVF saved money as well as time. That’s because most of the women in the IUI group ended up going to IVF. There was another trial which compared ovulation induction with oral medications versus a combination of injectable hormones and it showed no benefit of the injectable hormones.
What to think about before
When we start thinking about IUI, you want to make a decision using all the data you have. This means you have tests that measure your ovarian reserve, you know if your fallopian tubes are open or not, and a semen analysis has been done. You want to understand your chance of success with all of the factors and know how many cycles you are willing to do before moving on. We also have to take into account the cost of sperm if you are using donor sperm.
Common Questions
I always get asked “Do I have sex before or after the IUI?” I usually do recommend it when I trigger patients. I have them have intercourse the day of the trigger so there is a two day pause before we get the sample for the IUI. Sex the same day or the next day is fine. Otherwise, I always say sex is recreational. We do have our patients lay flat after the IUI not because it’s show to help. More than anything it’s a calming moment so we can hopefully lower the stress hormones at this important time. I tell my patients not to let their heart rate get over 150 beats per minute after the IUI. I want all the good blood supply to go to the uterus. I recommend no alcohol afterwards and up to one cup of coffee is okay. I recommend healthy habits at all times while trying to conceive. Eat as many plants as you can. Take your vitamins and supplements including a prenatal vitamin. Avoid environmental toxins and smoking. Try to overall control what you can control in the cycle. I see a lot of couples do way too many IUIs without knowing their probability of success. Before you get deep into the journey, know your boundaries and have appropriate expectations. Make the best decision for you from the beginning. Seeing a urologist and taking medications can help sperm parameters. Healthy lifestyle factors for the male can make a difference. Consume less sugar. Eat more foods with antioxidants. Take a daily multivitamin with zinc, selenium, and vitamin D, C and E. Avoid smoking cigarettes and marijuana. Limit alcohol use.
As always, I ask “What is your goal?” and make sure your plan aligns with your goals.