IUI is a good option for many infertile couples. It can be performed in conjunction with a woman’s natural cycle or can be combined with the use of fertility drugs. IUI can also be effectively used in couples who have sexual dysfunction or infrequent coitus for either medical or nonmedical reasons. For example, some couples may have busy work schedules such that one or the other partner is frequently out of town around the time of ovulation. If the male partner’s sperm is obtained and cryopreserved (frozen) in advance of ovulation, the physician (or nurse) can perform an IUI and, ideally, facilitate pregnancy without the woman missing a menstrual cycle.
The best candidates for IUI are those couples without tubal disease or severe male factor infertility. Women with severe endometriosis or a history of pelvic adhesions are not good candidates for IUI. Although couples with male factor infertility can attempt IUI, the success rates are fairly low in such cases, and prompt consideration should be given to IVF (and ICSI) if pregnancy fails to occur after three or four attempts.
IUI, in combination with fertility medications, may provide a reasonable treatment option for some patients. There appears to be a synergistic benefit to the combination of fertility medications (either Clomid or injectable gonadotropins) with IUI compared to either treatment by itself. For this reason, most infertility experts recommend IUI to their patients when treating them with fertility drugs even if the semen analysis is normal.
In women who fail to ovulate regularly, the goal of drug therapy is to induce the growth and release of a single mature egg. This treatment is known as ovulation induction. In contrast, the treatment goal for women with regular menstrual cycles is to induce the growth of multiple follicles with the subsequent release of multiple eggs. Hence the term superovulation (also called controlled ovarian hyperstimulation) is used to describe this treatment. During a cycle of superovulation and IUI, the goal is to develop 3 to 5 mature follicles, whereas the goal in an IVF cycle is to produce more.
Clomid is usually the fertility drug of first choice for both ovulation induction and superovulation with IUI. Women who fail to respond to Clomid or who fail to conceive may be candidates for treatment with injectable fertility medications (gonadotropins) combined with IUI. In some cases, it is best to skip the treatment with Clomid and instead proceed directly with gonadotropin therapy; this decision depends on the severity of the couple’s infertility situation.
In women who have normal menstrual cycles, it would appear on the surface that IUI alone without fertility drugs would be as successful as IUI with fertility drugs. Unfortunately, this simply is not the case. Instead, the combination of IUI and fertility drugs to induce superovulation yields a synergistic benefit over either treatment alone. However, superovulation (either with or without IUI) can lead to multiple pregnancy. Historically, nearly all of the multiples (such as sextuplets and more) have been the result of superovulation. Unfortunately, there is really no way to control the outcome of this game of reproductive Russian Roulette. Patients must understand that if there are more than two follicles present, then the possibility of a high order multiple pregnancy is a reality. In such cases, a frank discussion with the patient needs to be held to review the risk and alternatives to avoid a poor outcome.
I began actively seeking treatment for my infertility issues at the age of 40. My RE was very open with me and explained the limitations of IUI (in combination with injectable gonadotropins) for a woman my age. However, my husband and I opted to go through two IUI/injects cycles before we moved on to IVF. Despite the fact that IUI didn’t work for us, our IUI experience was helpful for the RE, as well as for my husband and me. The RE could see how I responded to the medications and he used these experiences to develop our IVF protocol. For my husband and me, the IUI provided us with a less invasive and costly way (as compared to IVF) to be proactive in addressing our infertility issues. It was a good way to ‘ease’ into the process of medical intervention. We experienced the shots, being at monitoring appointments, having bloods drawn, getting to know the fertility center staff/routine, and the process of getting my husband’s ‘contribution.’ And when the cycles failed, we experienced the sting and frustration of treatment failure. I know that for us, going through the IUIs prepared us for our subsequent IVFs.