Intrauterine insemination is an extremely common infertility treatment that is also fairly inexpensive. Since not much of technical expertise is required for it, most gynecologists offer IUI as the first treatment option for patients who have been identified to be infertile patients. Typically, they will recommend this treatment option after doing a laparoscopy for them.

High expectations

It’s true that this seems to be an extremely logical treatment; it’s also why a number of patients are more than willing to give it a shot. The only things required to make a baby are eggs and sperm. And if the doctor is first washing the sperm before putting them into the uterus at the very same time that ovulation occurs, then there is no question of failure of the treatment now, is there?

When the doctor explains it in this manner to their patients, it seems like an excellent option. The fact that it’s not too expensive and that they harbor high expectations of success, the patients find this treatment to be an excellent choice. In many ways, this becomes the biggest problem.

Poor success rates

What doctors tend to omit to share with their patients is that even in a perfect IUI cycle, the success rate is in the range of 10-15 percent. It also means that almost 90 % of IUI cycles will fail, regardless of how good the eggs and sperm are, or even how good the doctor is, for that matter. Very few doctors take the effort to counsel their patients and when a cycle fails, the patients are no doubt, very shaken up. 

They can’t understand what caused the failure and in most instances, they end up blaming the doctor for not doing a good job. The one thing that patients should keep in view is that the human reproduction process isn’t super –efficient. Even in the bedroom, the natural fertility rate for fertile couples (what is called their fecundity) is only in the 20 to 25% range per cycle. The simple fact is that it takes time to have a baby, regardless of whether you are trying to make one in your bedroom or it’s the doctor doing an IUI.

The problem also occurs because many doctors use IUI for patients who won’t really benefit from it at all, like in cases where the male partner has low sperm count. Doing several IUI cycles at different clinics isn’t going to change the outcome- after all the patient and his condition is the same, isn’t it?

The logical choice

The important thing is that the patient has to learn to move on, or else, she or he is bound to get frustrated and fed up of the entire exercise. The thing to keep in mind is that most IUI cycles end in failure and you have to be prepared for this. If 3 IUI cycles have failed, it’s futile to continue with the same line of treatment; you should consider other alternatives.

For patients who have unexplained infertility, IVF is the next logical choice. In case a patient has low sperm count. ICSI is the best choice. The good news is that regardless of the number of IUI cycles you may have failed, it 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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