IUI Pregnancy
What is IUI ?
IUI, or intrauterine insemination, is a procedure done in a doctor’s office that places sperm directly into a woman’s uterus to aid in conception. During normal intercourse, only a small percentage of a man’s sperm will make it past the woman’s cervix and enter the uterus to fertilize the woman’s egg. Most of the sperm that is ejaculated during intercourse remains in the vagina. A small percentage of the ejaculated sperm will travel, with the help of the woman’s cervical mucous, through the vagina and into the cervical canal where it is released gradually into the uterus. But, this amount is only a fraction of the total amount of sperm ejaculated. IUI increases a couple’s chance of conceiving because it does a few things. First, it removes any obstacles that could keep sperm from entering the uterus, such as hostile cervical mucous or antisperm antibodies. It also places the sperm closer to the egg. Moreover, it improves the odds of conception by simply putting more sperm into the uterus than would be possible through normal intercourse. Logically, the more sperm that is in the uterus during ovulation, the higher the chances are of conceiving.
Reasons to have IUI
IUI is less expensive than assisted reproductive technology (ART) treatments like IVF. IVF is also more invasive and may be objectionable to some couples because it involves artificially fertilizing the woman’s eggs outside of her body. Because of this, IUI may be a good choice for couples who can not afford IVF or would prefer not to have IVF. Even though IUI is not as effective as IVF, it is still more successful than just trying to time intercourse well. Often couples will try IUI first before pursuing IVF or other ART treatments.
IUI Pregnancy Rates by Age
For couples that have no difficulty achieving a pregnancy, the natural chance of pregnancy per month of ovulation depends on the age of the woman. For women up to the early 30s, the natural pregnancy rate is about 20 – 25% per cycle. This drops off significantly through the mid and later 30s; by the early 40s, the chance of pregnancy is about 5% per cycle. This age related decrease is primarily due to a decline in the quality of the eggs within the ovaries.
For couples having difficulty achieving a pregnancy, unless both tubes are completely blocked, there is no sperm, or the woman never ovulates, their chance of achieving a pregnancy is not zero, it is just lower than average (to a greater or lesser degree). Ovulation induction or superovulation with IUI helps patients to achieve pregnancy rates closer to the natural per cycle chance of pregnancy for women in their age group who do not have infertility.
IUI Pregnancy Rates by Diagnosis
In addition to age, a couple’s prognosis for success with OI/IUI or superovulation/IUI depends on their diagnosis (see figs 2 and 3). This treatment is most successful in couples where the primary cause for infertility is ovulatory dysfunction or failure of regular ovulation such as with polycystic ovary syndrome (PCOS). In these cases, the treatment comes closest to restoring the natural per cycle pregnancy rate.
Superovulation/IUI is also quite successful for the treatment of mild male factor or unexplained infertility, although the success rates are slightly lower than for those couples where ovulatory dysfunction is the only problem.
Superovulation/IUI is less successful if the cause of infertility involves diseased fallopian tubes, endometriosis or decreased egg quality. This is due to a couple of reasons. First, superovulation does nothing to improve the quality of the eggs within the ovaries. Even with IVF, the chances for pregnancy with poor egg quality are quite low. Next, if the fallopian tubes are damaged, there will be a decreased chance for fertilization and early embryo growth to occur properly. The fallopian tubes are where fertilization takes place and where the embryo grows for its first few days before making its way to the uterine cavity for implantation. If one of the fallopian tubes is blocked, it may be due to inherent disease involving both fallopian tubes; even if the other fallopian tube is open, it may not be able to provide the appropriate nurturing environment for fertilization and early embryo growth to take place. As with advanced age, it may be advisable to move to IVF earlier in the treatment timeline with these diagnoses.
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