Failed IUI

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) procedure. Many of the gynecologists can do it in their clinic. It is preferred as the first-line treatment before IVF as it is 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 – But after washing the sperm, the count should be more than 10 million.
  • 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 a 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 for IUI failure might be due to:

· The quality of eggs –

Poor quality eggs can have chromosomal problems and so will be unable to divide after fertilisation.

· Age –

Increasing maternal age decreases the quality of the egg.

· The quality of sperm –

Poor quality sperm will not be able to fertilise an egg.

· 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 -

An IUI can also fail 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 result in IUI failure as it is initially necessary to support a pregnancy.

Are there any symptoms of IUI failure?

There are no specific symptoms of a failed IUI. 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.

What should be the next step after a failed IUI cycle?

It is recommended that if a woman has:

  • History of 3-4 failed IUI cycles,
  • Is above the age of 35 years,
  • Has a low ovarian reserve,

then she should consider IVF as the next line of treatment. And in cases of severe male factor infertility, one should consider ICSI.

References

1) https://www.fertstert.org/article/S0015-0282(97)81497-5/abstract
2) https://www.fertstert.org/article/S0015-0282(07)02194-2/abstract