When patients present for fertility treatment they often ask about IUI. Insemination can be an effective treatment for select patients. A small catheter is passed through the cervix and sperm is placed directly into the uterus. It is more advanced and works better than the “Turkey Baster” method of putting semen in the vagina. It is generally painless.
While IUI is one of the first treatments to consider, it is not appropriate for everyone. To have any chance of success the couple need to have functional fallopian tubes and decent sperm. In cases with blocked tubes or severely abnormal sperm, IUI has a low chance of success and treatment with in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) will be a much better option. Age of the female partner is another major factor to consider. Insemination works best in women aged
For young women with normal tubes, IUI can be a good place to start. However, studies have shown that the pregnancy rate from IUI is better if there are at least 10 million motile sperm in the sample. Insemination can sometimes work with lesser quality sperm, but if the samples are persistently poor quality or if there is no sperm at all, donor sperm from a sperm bank or designated donor is a reasonable alternative. Insemination together with Clomiphene Citrate (Clomid) is a good next step for women with irregular periods who have not conceived with Clomid alone, as well as the first line for those with unexplained infertility.
The pregnancy rate from IUI depends on the diagnosis. Couples with male factor can expect 20% pregnancy per month. However with unexplained infertility, the pregnancy rate from IUI alone is only 4% per month. Adding Clomid to IUI can increase the pregnancy rate to 8-10%. For this reason we expect it may take several tries before it works. Without insurance coverage, a CC/IUI cycle may cost $1500. Over time the costs can add up so it is important to periodically reevaluate the treatment plan and move on if things are not working fast enough.
Insemination can also be done using injectable gonadotropins (FSH), but is more risky. There is a 20% rate of multiple gestations from FSH/IUI, which may be triplets or more because we do not have control of how many eggs will fertilize or implant. In addition, injectable FSH can cause ovarian hyperstimulation syndrome (OHSS), which can be a serious problem if not managed carefully. The medication and monitoring are also more involved and expensive for FSH/IUI than for Clomid/IUI, costing as much as $3000 a month. While the FSH/IUI pregnancy rate is higher than with Clomid/IUI, it is still only around 15%, meaning it may also take multiple tries. In general, couples who have not conceived with CC/IUI should consider skipping FSH/IUI because of its risks and move on to IVF.
The bottom line is IUI can work in young couples with functional tubes and decent sperm, but pregnancy rates are lower than for IVF. Costs and risks of IUI are reasonable with Clomid, but become questionable when using injectable FSH. Results from IUI are slow to see and if not successful in 3-4 tries, it is time to move on to more effective treatments. Women with blocked tubes and men with poor sperm should not waste time, emotion or money on IUI. Those planning to do FSH/IUI should consider the risks carefully and should consult with a fertility specialist.