INTRAUTERINE INFERTILITY (IUI) TREATMENTS
Intrauterine insemination with your partnerâ€™s sperm can be used as a potentially effective treatment for infertility of all causes in women under about age 45 except for cases with tubal blockage, severe tubal damage, very poor egg quantity and quality, ovarian failure (menopause), and severe male factor infertility. In-vitro fertilization with the womanâ€™s eggs or IVF with donor eggs are alternatives for couples that are not candidates for artificial insemination.
It is most commonly used for infertility associated with endometriosis, unexplained infertility, anovulatory infertility, very mild degrees of male factor infertility, cervical infertility and for some couples with immunological abnormalities.
It is a reasonable initial treatment that should be utilized for a maximum of about 3-6 months in women who are ovulating (releasing eggs) on their own. It can be reasonable to use it for somewhat longer than this in women with anovulation that have been stimulated to ovulate.
It should not be used in women with blocked fallopian tubes. Tubal patency should be demonstrated prior to performing insemination. This is usually done with an x-ray study called a hysterosalpingogram.
It has very little chance of working in women that are over 40 years old, or in younger women with a significantly elevated day 3 FSH level, or other indications of significantly reduced ovarian reserve.
If the sperm count, motility or morphology is more than slightly low, insemination is quite unlikely to be successful. In that situation, IVF with ICSI is indicated and has high success rates.
Success rates for intrauterine insemination vary considerably and depend on the age of the woman, type of ovarian stimulation (if any) used, duration of infertility, cause of infertility, number and quality of motile sperm in the washed specimen, and other factors.
Rates for women over 35 drop off, and for women over 40 are much lower. For this reason, we are more aggressive in â€œolderâ€ women.
Pregnancy rates are lower when insemination is used:
- In women over 40
The rates are slightly higher for women that do not ovulate on their own (anovulation) that are stimulated to ovulate with medication and then inseminated. This is because it is likely that the sole cause of their infertility is their ovulation disorder â€“ which is overcome with the use of the ovulation stimulating medicine.
For a couple with unexplained infertility, the female age 35, trying for 2 years, and normal sperm
We would generally expect about:
- In women with poor
- With poor quality sperm
- In women with moderate or severe endometriosis
- In women with any degree of tubal damage or pelvic scar tissue
- In couples with a long duration of infertility (over 3 years)
- 5% chance per month of conceiving and delivering with clomiphene and intrauterine insemination for up to about 3 cycles (lower after 3 attempts)
- 8% chance per month of conceiving and delivering with injectable FSH (e.g. Follistim, or Pergonal) and insemination for up to about 3 cycles (lower after 3 attempts)
- 50% chance of conceiving and delivering with one cycle (month) of IVF treatment (at our center â€“ pregnancy rates vary greatly between IVF clinics)