IUI or intrauterine insemination is one of the commonest infertility treatments available. It's a fairly low-cost inexpensive treatment, and because it does not require much technical expertise to offer, most gynecologists will offer IUI as the first treatment option for their infertile patients, after doing a laparoscopy for them.

IUI seems to be a very logical treatment, which is why most patients readily agree to do it. After all, if all you need to make a baby is eggs and sperm; and if the doctor is washing the sperm and putting them inside the uterus at exactly the same time at which ovulation is occurring, then how can the IUI treatment possibly fail?

This is the reason why many patients happily agree to do IUI. It's not very expensive - and they have very high expectations of success. This is actually the biggest problem!

What doctors will often not share with their patients is that the success rate in a perfect IUI cycle is only about 10 to 15 percent. This means that about 90 percent of IUI cycles will fail, no matter how good the eggs and sperm – or how good the doctor!

Because patients are not adequately counseled when the IUI cycle fails they get very shaken up. They cannot understand the failure, and will often blame the doctor for not doing a good job.

However, you need to remember that human reproduction is not very efficient enterprise - and that even in the bedroom the natural fertility rate for fertile couples ( what is called their fecundity ) is only between 20 to 25 percent per cycle. The fact remains that it takes nature time to make a baby, and this is true, whether you're doing it in your bedroom or whether the doctor is doing an IUI ( though couples don’t mind as much when it takes time in the bedroom !)

Some of the problems occur when gynecologists overuse and misuse IUI for patients who cannot possibly benefit from it – typically, patients with poor sperm counts. Remember that if the sperm are functionally incompetent, there’s no way an IUI cycle could help. However, doctors will often mislead patients by telling them that since only one sperm is needed to fertilize the egg, there's no reason why the IUI should not work, no matter how poor their sperm, because the doctor is washing” the sperm to improve its quality and injecting it directly into the uterus!

The problem is that when patients get fed up with doing IUI treatment with one doctor, they will then move on to a second doctor. If this second doctor is also a gynecologist, then all he has to offer is some more IUI cycles, which is why we will often see patients who done over seven or eight IUI cycles with two or three different doctors. This makes no sense at all. After all, you're changing the doctor, but the patient remains remaining the same, and it's pointless repeating the same treatment again and again. The important thing is to move on - otherwise, you are likely to get fed up and frustrated.

Please remember that the vast majority of IUI cycles will end in failure and you need to be prepared for this. If three IUI cycles have failed there's very little point in continuing with the IUI treatment; and it's time to move on to considering alternative options. For patients with unexplained infertility the next logical choice is IVF, whereas, for those with a low sperm count, the best choice is ICSI. The good news is that no matter how many IUI cycles you may have failed, this will not affect the success rate with IVF/ICSI.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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