When Does Artificial Insemination (IUI) Really Help?

IUI is a fertility treatment that uses a small catheter to insert “washed” sperm directly into the uterus in a process similar to a pap smear. The goal of IUI is to increase the number of good sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. IUI is usually selected as a treatment for conditions including:

• unexplained infertility
• low sperm count
• decreased sperm motility
• donor sperm
• hostile cervical condition such as cervical mucus that is too thick or cervical scar tissue from past procedures
• ejaculation dysfunction and timing issues

First of all, it is important to note two important facts:

1. IUI does NOT really help pregnancy rates in the absence of male or cervical infertility.
2. In the presence of male factor infertility, the female partner does NOT need to be loaded with ovulation drugs.

For unexplained infertility, i.e. couples with normal semen analysis, regular ovulation and open tubes by HSG, the approach is quite empiric. The hope is to provide a “statistical boost” by addressing all “possible” factors. That is why statistics are frustrating when this type of infertility is treated conservatively.

I usually propose a trial of clomiphene with or without IUI over 3-6 months prior to trying IVF. We already covered the lack of value of injectibles/IUI vs. clomiphene/IUI in a separate blog topic above. After trying the same treatment for 6 months, there is little value in repeating further what has not been working so far, and IVF is the best next option.

In the context of unexplained infertility, IUI only provides a 5% monthly chance of pregnancy over the next 3-6 months, the same as clomiphene alone. When both clomiphene and IUI are combined, a 7% monthly chance of conception is achieved over that same period. This illustrates that in most cases, normal sperm does not really need help. In other words, IUI is not so cost-effective for unexplained infertility, especially when it is not a covered benefit.

For male factor infertility, the issue is quite different because IUI actually does help, especially in mild cases. With a male factor, it is important to determine the severity of the problem. A good general index is to calculate the Total Motile Sperm count or TMSC. For example, if the total ejaculate is 2ml with a count of 20M/ml and a motility of 50%, the TMSC would be 2 x 20 x 50% or 20 million. For couples in which the male had a TMSC below 10 million, IVF with direct injection of sperm into each egg (ICSI) is not only more effective but is also more cost-effective than IUI cycles.

For cases when the TMSC is normal but quality (morphology) is low, 6-8 weeks of anti-oxidant therapy can help. These can easily be purchased over the counter at your local nutrition store with names like Male Fertility Supplements, Fertile Aid, etc. Avoiding negative lifestyle factors like smoking is also key.

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2 Responses to “When Does Artificial Insemination (IUI) Really Help?”

1. virginia williamz says:

   January 2, 2013 at 11:04 pm

   My.name is.virginia.i.am 28 and what i am trying to find out is if you have any programs for.cancer patients after chemo i have been given 2 years off of chemo so that i can start a family have went theough several types of chemo and have been told i still have eggs but i also have pcos i am trying to make my life complete plese contact me if you can help in.any way

   Reply
   • Geoffrey Sher says:

     January 3, 2013 at 10:59 am

     Indeed, if you still have eggs and can respond to stimulation with the production of several follicles, you can still do IVF. However, you would be advised to consider Embryo banking with CGH embryo selection and Staggered IVF.

     Please go to the home page of this blog (www.IVFauthority.com ). When you get to the look for a “search bar” in the upper right hand corner. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

      “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
      “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
      “Agonist/Antagonist Conversion Protocol”
      “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
      “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
      “IVF success: Factors that influence outcome”
      “Staggered IVF”
      “Embryo Banking”

     Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

     Geoff Sher

     Reply