The IUI process is simple and involves minimum discomfort. It consists of two steps which include the doctors obtaining a sperm sample and “washing” it to eliminate debris and sperm that are not motile (moving) or healthy. Doctors then utilize a catheter (thin tube) to insert the washed sperm straight into the uterus (womb) of the woman. The woman has to take fertility-inducing medications, as prescribed by her doctor, to regulate ovulation and release healthy eggs for successful conception.
While the process of IUI is simple and comparatively less expensive than other fertility treatments, it is not always helpful in certain cases of infertility. These are the conditions in which IUI will not be considered as the correct line of treatment for you:
Issues with Fallopian Tubes
- Tubal blockage: The fallopian tube carries the egg from the ovary to the uterus. Blocked fallopian tubes arise when the fallopian tubes are too thin to allow an egg to move down to the uterus and meet sperm, affecting the capacity to conceive. With one Fallopian tube open, you can conceive naturally or through IUI. However, if both tubes are blocked, it is necessary to avail in vitro fertilization (IVF) for a successful conception.
- Hydrosalpinx: Hydrosalpinx is a condition in which a fallopian tube gets clogged with watery fluid. Pregnancy is potentially conceivable if one of your fallopian tubes has hydrosalpinx and the other does not. It does, however, carry the potential for problems. A damaged fallopian tube, for example, can cause fluid to flow into the uterus during pregnancy. In vitro fertilization (IVF) is an infertility treatment in which the egg is fertilized by sperm in a laboratory setting, outside of the body. IVF can help bypass the role of the fallopian tube in sperm-egg interaction, which is why it is recommended over IUI in situations of Hydrosalpinx.
- Tubal ligation: Tubal ligations include a surgeon sealing or tying the fallopian tubes to prevent eggs from entering the uterus for implantation. Because tubal ligation prevents fertilized eggs from implanting in the uterine wall, intrauterine insemination is ineffective for women who have undergone this procedure.
Issues with Sperm
- Oligospermia: Oligospermia is a term used to refer to low sperm count. If a person has a low sperm count, intrauterine insemination is one option. This treatment is used for people with mild to moderate Oligospermia who require a certain amount of sperm to aid in the fertilization process, which is not possible in situations of severe Oligospermia. If natural pregnancy and IUI have failed in certain mild to severe Oligospermia cases, in vitro fertilization (IVF) is the preferred treatment option.
- Obstructive azoospermia: Azoospermia is a condition in which there are no sperm in the semen because sperm production is impaired or unusual. Obstructive Azoospermia is caused by an obstruction in the reproductive tube, which prevents sperm production. In such cases, only donor sperm may be utilized for IUI. Otherwise, methods such as TESA are employed to extract the sperm directly from the testicle, and in almost all cases where sperm is retrieved directly from the testes or epididymides of men with obstructive azoospermia, ICSI is required to achieve fertilization. This is because sperm retrieval techniques in such men rarely produce enough motile sperm to allow intrauterine insemination (IUI) or standard IVF.
Issues with Eggs
- Poor ovarian reserve: The ovarian reserve is the number of eggs a woman has left in her ovaries. IUI is a viable treatment option for patients with low ovarian reserve and low AMH; however, if the ovarian reserve is poor, the chances of IUI treatment success are reduced. The couple must understand that achieving the desired result may need numerous rounds, which may not be good for your ovarian reserve as Letrozole is administered during an IUI. If you take letrozole for more than 7 months straight, it can hinder your reserve by pushing the capacity of your eggs, which is why it is preferable to do IVF if your AMH levels are really low, such as 1 or 2.
- Menopause: When you undergo menopause, you have reached the end of your fertility and your hormone levels are no longer suitable for ovulation and natural pregnancy. However, you still have a chance of becoming pregnant with in vitro fertilization (IVF), by using donor eggs. IVF after menopause has been successful in several situations, but pregnancy with IUI after menopause is unattainable.
- Severe Hormonal imbalances: Conditions such as PCOS can induce hormonal imbalances that disrupt ovulation and may result in IUI failure. Even having a large number of eggs available, none might get ruptured due to severe PCOS. IUI requires appropriate follicular rupture, hence IVF yields better results in such cases than IUI.
Knowing when to opt for IUI and when to go for other treatment options can save you a lot of time and money. If your first IUI does not result in a successful pregnancy, do not give up hope. First, speak with your reproductive specialist to determine what caused the failure and discuss potential future measures. This may include additional diagnostic tests, modifications to medication or treatment procedures, or looking into other reproductive treatments. Your fertility care team will be available to help you and offer advice that is specific to your needs so that you can successfully fulfill your parenthood dreams.