IUI or intra uterine insemination is a common infertility treatment and is sometimes employed “first line” treatment in younger women with ovulatory problems, the physician may initiate a trial of Clomid therapy. Clomid is most effective during the first three ovulatory cycles and extended therapy rarely results in pregnancy.
Stimulated IUI using follicle stimulating hormone (FSH) is often the next treatment step after Clomid. For women in their late twenties or early thirties, stimulated IUI may be the treatment of “first choice”. The appropriateness of IUI in women aged over thirty depends on many patient specific factors including her FSH level, treatment history, cause(s) of infertility, and others.
Women in their thirties can have rapid declines in fertility so time is usually not spent on Clomid therapy, which is less likely to result in pregnancy than other procedures such as IUI or IVF.
If the FSH level is significantly elevated, in vitro fertilization (IVF) may be the best treatment choice. When the FSH is severely elevated the best treatment choice is usually our Florida donor egg program. Dr. Shaykh has an active and very successful donor egg program.
IUI involves placing specially washed and prepared sperm directly into the uterus. “Unprepared” sperm must never be used as severe allergic reactions can occur. The partner provides semen at our laboratory or it can be collected at home if strict storage and transportation procedures are followed. We strongly encourage collection at our laboratory to provide the best chance for pregnancy.
IUI can be used in couples who have mild male infertility. The sperm are concentrated during the IUI procedure increasing the chance that a sperm can fertilize an egg. Couples with moderate to severe male factor are candidates for IVF with ICSI or donor sperm. Since prepared sperm are placed directly into the uterus, IUI avoids exposure of the sperm to the cervical mucus. This is important in women with poor cervical mucus or those who have antisperm antibodies. Poor cervical mucus can prevent the sperm from swimming from the vagina to the uterus and antisperm antibodies can “kill” or incapacitate sperm.
Stimulated IUI involves the use of fertility medications (FSH) such as Gonal-F, Follistim, Repronex, Menopur and others. These drugs should only be administered by a trained reproductive endocrinologist infertility specialist thoroughly familiar with their use, like Dr. Shaykh. FSH stimulates the recruitment and development of follicles and care must be taken to avoid high order multiple births and drug side effects.
The stimulation cycle is monitored and sometimes ovulation predictor kits are employed. Most often an injection of hCG will be given and the insemination is scheduled 32-36 hours. Often more than one insemination will be performed over several days. Most of the high order (>3) multiple births reported by the media are the result of IUI cycles, most often administered by non-specialists. Once the follicles mature, an injection of hCG is given and the IUI is scheduled.
The specialist is trained to monitor the number of eggs likely to “ovulate” and will cancel the cycle if the risk of multiples is too great or the physician may convert the IUI to an IVF cycle. Conversion to an IVF cycle can only occur if the cycle is administered by a reproductive endocrinologist, infertility specialist. IVF is much less likely to cause high order multiple births. This is because a known number of embryos are placed into the uterus which varies dependent upon couple specific factors. If only 3 embryos are replaced in the uterus, the chance of quadruplets is very low.
Most couples try 3-6 ovulatory cycles of IUI prior to moving to IVF. This is highly dependent upon the couple, the cause(s) of their infertility, treatment history, and many other factors. Many move to IVF sooner as it produces significantly higher per cycle success rates; however, IVF is more expensive.
Dr. Shaykh is always available to discuss treatment options with his patients. He will recommend the procedure(s) most likely to result in pregnancy while considering many couple specific factors and cost.