Intrauterine insemination (IUI) is the primary infertility treatment preferred by couples who are unable to conceive over the course of a year. This procedure does not require much technical expertise. It takes a few minutes to complete the process and does not cause much pain and discomfort. IUI can be performed as a simple OPD (Outpatient Department) procedures. Many of the gynaecologists can do it in their clinic. It is preferred as the first-line treatment before IVF as it is believed to be cost-effective and less invasive.

What is intrauterine insemination (IUI)?

IUI (Intrauterine insemination), also called artificial insemination, is a type of fertility treatment. During the process, a semen sample from a male is washed, processed, and the motile and immotile sperm are separated. Then sperm of higher motility are placed inside a woman’s uterus through a catheter during ovulation to facilitate fertilisation. The motive is to increase the number of sperm reaching the fallopian tube, thereby increasing the chances of fertilisation. It takes a few minutes for the procedure and does not cause much discomfort.

When is IUI recommended?

The most common reasons for doing IUI are:

  • A Low Sperm Count – After washing the sperm, the count should be more than 10 million. IUI is usually recommended to men with low sperm count.
  • Decreased Sperm Motility - For a successful IUI, the total motile sperm count should at least be 10 million post washing of the semen.
  • Ejaculation Problem – IUI can also be recommended when a male has ejaculation dysfunction.
  • Unexplained Infertility - IUI is also done in cases of unexplained infertility.
  • Hostile Cervical Mucus – A sperm needs to stay for as a sperm needs to stay for a couple of days within the cervical mucus. So, if a woman has hostile cervical mucus, it becomes acidic, and the change in pH can restrict the sperm’s survival in the cervix.

IUI is not recommended in severe male infertility cases and when a woman has a tubal blockage, endometriosis, or a previous history of pelvic infections.

What is the reason for IUI failure?

The success rate of IUI is not that great, though success would depend on the cause of infertility, the age of the woman, and the time since the couple is trying to conceive. Studies have shown that pregnancy rate for each natural cycle is about 4-5%, and when the cycle is stimulated with fertility drugs, the pregnancy rate is 7-16%. The possible reasons why IUI fails might depend on person to person, their age, egg quality and a number of other factors

Here are some of the IUI failure reasons or for unsuccessful IUI are:

  • Poor Quality Eggs Poor egg quality symptoms can be related to chromosomal problems and are thus related to one of the reasons for failed IUI.
  • Age Increasing maternal age decreases the quality of the egg. And the deteriorated egg quality impacts the embryo and its implantation. This, in turn, becomes one of the major reasons why IUI fails.
  • The quality of sperm Poor quality sperm will not be able to fertilise an egg, resulting in one of the IUI failure reasons.
  • Timing After ovulation the egg stays in the fallopian tube for 12-24 hours, if there is no sperm present at that time to fertilise the egg, then it will disintegrate. So, the timing should be perfect.
  • Endometrial lining Another possible reasons IUI fails might be if the endometrial lining is not proper, and the fertilised egg cannot get embedded in the cavity.
  • Ovulation There might be a mild ovulation problem.
  • Progesterone Deficiency in progesterone may also be one of the failed IUI reasons as it is initially necessary to support a pregnancy.

Are there any symptoms of IUI failure?

There are no specific symptoms of IUI failure. An IUI failure will lead to an abortion, or if the treatment hasn’t worked, it will bring in your periods. If the quality of egg and sperm are not good, they may have some chromosomal abnormality, which will result in spontaneous abortion. And in 85% of cases, this is the reason for early pregnancy losses. But one should look out for any unusual vaginal discharge and consult a doctor immediately in any case of severe cramping or discomfort.

Next step after failed IUI!

If a woman has a history of 3-4 failed IUI cycles, has low ovarian reserve, and is above 35 years of age, then as the very next step after failed IUI, she should consider IVF in that case as a significant treatment. It has been proved through various researches and studies that IVF (In-Vitro Fertilisation) and in case of severe male factor infertility, ICSI (Intracytoplasmic Sperm Injection) can considerably increase the chances of conception and overcome IUI Failure.

It must also be kept in mind that IUI might be less expensive than IVF, but it’s not inexpensive by any means. The cost with the number of tries and medications keeps increasing, along with the impact of IUI failure on infertility. Moreover, pregnancy symptoms after failed IUI also has low success rate as compared to that of other ART procedures. Therefore, it is highly recommended that after 3-4 failed attempts, a couple should not keep continuing on trying for their babies naturally after IUI pregnancy symptoms if nil, rather should consult an IVF Specialist.

Frequently Asked Questions

Why does IUI fail?
What to do after first failed IUI?
How many times should I try IUI before IVF?