IUI, Intrauterine insemination, is the oldest and most cost effective procedure available for many causes of infertility. IUI involves collecting and concentrating sperm to place high into the uterus, resulting in many more sperm reaching the egg in the fallopian tube.
Success rates with IUI have increased dramatically over the decades, partly due to the process of preparing the sperm for IUI, and partly due to improving protocols to induce ovulation in the female.
Many doctors offer IUI as a fertility treatment, but it is most likely to be successful when done by a doctor who specializes in the procedure, does it very often, and who has specialized staff who are formally trained and have a great deal of experience doing sperm preparations.
The lab staff at RCC has over 40 years combined experience doing sperm preparations for IUI. The process involves washing the sperm with special media, centrifuging the sperm, and collecting them in a catheter to transfer into the uterus.
One reason an infertility specialist should be chosen to perform IUI is that high order multiple births can result if too many eggs develop and the cycles are not carefully monitored. When it is not safe to induce ovulation because of the risk of multiple births, the eggs can be retrieved for use in an IVF cycle. This can only be done at a fertility center that has an IVF program like Reproductive Care Center.
Another important factor contributing to success with IUI is the ovulation induction drug protocol used, if any, to prepare the female for the IUI. If there is no ovulatory dysfunction, IUI can be attempted without any medications, but if this doesn't work, or there is ovulatory dysfunction, then the protocol makes a big difference in the success rates.
Clomiphene Citrate (Clomid) has been used for many decades to help women ovulate in preparation for IUI, and it is still used today. However, the proper use of Metformin, myoinositol and Femara has been shown to increase pregnancy rates in some women who don't ovulate regularly. Femara may produce fewer side effects in some patients.
FSH (follicle stimulating hormone) is also used to facilitate ovulation, especially when oral medications don't work. At RCC, we have found that using a combination of oral medications and FSH injections actually doubles the pregnancy rates in women with ovulatory dysfunction, and is much safer and less expensive than using FSH injections alone.
In women under 35 years old, IUI using Clomid resulted in a pregnancy rate of 16% per cycle at RCC since 2009. This is similar to the success rates when using Femara with IUI. Sixteen percent is considered a normal success rate per month for fertile couples trying to get pregnant on their own.
When FSH is added to the protocol for a few days at the right time, success rates jump to 23% per cycle. These numbers are very encouraging for couples who have a mild to moderate male factor and who are using their husband's sperm.
In cases when donor sperm are needed due to male sub fertility, the success rate using IUI with oral medications plus FSH injections was 40%, compared to about 20% using IUI with pills but without FSH injections. The benefit of using FSH can clearly be seen when using ovulation induction for IUI, but is not always used as first line therapy because of its increased cost and need the need for more monitoring.
IUI, either alone or in conjunction with various ovulation induction protocols, has proven to be the most cost effective form of therapy for many causes of infertility. When done at a center with extensive experience, success rates can meet or exceed the chances of a young fertile couple trying on their own.
If initial attempts at IUI with oral medications, or no medication fail, then adding FSH injections can boost the odds of success significantly, providing another good option with IUI before moving on to more advanced treatment options.