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sphinx - September 15th, 2005 5:32 AM

Hi there doctor

Hope you can advise me of my situation. We have had 4 failed ICSI treatments due to male factors. I have had my hormones checked and tubes checked and there is nothing wrong with me. We have decided to pursue donor sperm treatment and hopefully natural IUI. My clinic has suggested that IUI be the first option and cervical insemination as the second. They do not work weekends, so if ovulation falls then cervical insemination would be offered either Thurs and Fri or Fri and Mon depending on the day of ovulation whether its Fri/Sat.

I have read that IUI has a better chance than CI, but been told that 2 lots of CI can be just as effective as the sperm live longer. What is your advise on this?

My consultant here has suggested that I do 6 unmedicated cycles as there is nothing wrong with me.

I am reluctant to wait 6 cycles unmedicated because of my age and the financial issue. We have spent a fortune on ICSI trestments already and do not want to go down that road again. My body has had enough of this now. We now want to go the IUI road where we can have more 'chances'. I dont want to throw wasted money away if you see what I mean. We want the best shots at this as possible. Hope to here from you soon to help out of this confusion with IUI or ICI

Sphinx


Dr Smith - September 15th, 2005 8:25 AM

At 36, I would recommend medicated cycles. It will be the most efficient way for you to become pregnant and the timing of the insemination can be more closely controlled to avoid falling on a weekend. IUI is significantly more effective than ICI in women without fertility problems using frozen-thawed donor sperm (see reference below). Current thinking is that one, well-timed intratuterine insemination (IUI) is the most effective treatment (see reference below).

Carroll N, Palmer JR. (2001) A comparison of intrauterine versus intracervical insemination in fertile single women. Fertil Steril. 75:656-60.

Guzick DS. (2004) For now, one well-timed intrauterine insemination is the way to go. Fertil Steril. 82:30-1

Best of luck.



sphinx - September 18th, 2005 3:16 PM

Hi there

Thanks for answering me so soon, may I ask you one more question. When using frozen-thawed sperm, how does this make a lot of difference on the count used??? Do only half survive in other words??? Whether its used for cervical or IU insemination. Sphinx


Dr Smith - September 18th, 2005 4:36 PM

About one half of the original motile sperm survive the freeze-thaw process. Most banks guarantee approximately 10 million motile sperm per vial after thawing. The sperm that do survive have a shorter lifespan (around 24 hours) than fresh sperm. This is the same for IUI-ready and ICI-ready sperm.


sphinx - September 20th, 2005 11:08 AM

Thanks for answering me. I was told by my clinic that some sperm can only be used for IUI (as its washed) and other donor sperm can be used for straight DI and IUI.

My clinic has offered me ICI this month and I had 2 inseminations around ovulation. This was unmedicated and they say I have a 12% chance. Next time if this does not work they will do IUI (D) unmedicated as they say they do not want to mess with my cycle straight away as there is nothing wrong on my side. I can see what they are saying and I suppose they have a point. My fsh levels are good to excellent although I am 36. If I do IUI next month my chances are about 15% only 3% more than ICI!

My question is wouldn't ICI unmedicated be a better choice with 2 inseminations around ovulation than IUI unmedicated with 1 insemination? As ICI sperm live longer and although they have to travel further they would normally be at the right place in time for the egg. As I have been through a lot of ICSI cycles I now would prefer unmedicated for a couple of months so which is the better choice for me? Sphinx


Dr Smith - September 20th, 2005 3:04 PM

There are many published articles showing that IUI yields better results than ICI for both medicated and unmedicated cycles. As posted above, the concesus opinion is that one, well-timed insemination is more effective than two. My concern is that, at 36, the majority of your eggs are genetically abnormal and the majority of the resulting embryos will fail to develop into a term pregnancy. Because of this, I would not suggest more that two unmedicated cycles before increasing your chances with medication to stimulate the growth of multiple eggs on a given cycle. You are playing a numbers game here and the more eggs, the better your chances.

FSH values are an indirect measure of your ovarian reserve (egg quantity), but say nothing about the genetic normalicy of the eggs (egg quality). That is a function of age alone.


sphinx - September 21st, 2005 2:32 PM

Dr Smith thank you for your reply. I quite agree that medicated will give me more chance and more targets for the sperm so to speak. However, I worry that a medicated cycle may have to be abandoned because of too many follicles. Here in the UK they only allow a max of 4 follicles before abandoning. I dont want to be on the drugs for nothing in other words. If I have a medicated cycle how often should I be scanned to keep an eye on the follicles and drugs doses in your opinion. Sphinx


Dr Smith - September 22nd, 2005 7:07 AM

Wow, I didn't know that there was a maximum number of follicles for IUI in the U.K. (regardless of age?). I see your point. As to your question regarding medication dose and monitoring, I think I better defer to Dr Jacobs (a Reproductive Endocrinologist). Please post your question on Dr. Jacob's Infertility 101 Message Board. He'll be able to help you.

Best of luck.


sphinx - September 24th, 2005 8:02 AM

Thank you Dr Smith I have posted this similar question to Dr Jacobs. I have worked out that if this ICI should fail my ovulation will fall around the weekend in Oct and Nov. Most clinics in the UK dont work weekends unless they have too! This means that if ovulation falls at the weekend I wont get treated.

My clinic have given the cyclogest pessaries to take in order to delay my period a few days. This means that I can ovulate in the week and have IUI. I am on day 21 and taking 2 a day (each 400mg). Will this affect my natural cycle? Will the cyclogest delay my period a few days (want about 3/4 day delay)? Sphinx


Dr Smith - September 26th, 2005 9:44 AM

Sorry, but your last question is ouside my field of expertise too. I'm sure that Dr Jacob can help you out with this one.


sphinx - October 5th, 2005 6:51 AM

Hi Dr Smith
Thanks for answering me so soon. I have posted my same question to Dr Jacobs on the other forum too. Could you tell me from your expertise what is the best time to do 'insemination' in relation to ovulation for IUI?

Last time when I had ICI I surged on Thurs (7.30pm). I had tested on Thurs morning too, but no surge.

I re-tested on Fri morn and still had a surge. I was 'inseminated' at 4pm that day. I now am going for IUI(D) Hope to hear from you soon Sphinx.


Dr Smith - October 10th, 2005 10:22 AM

Sorry for the delay. I've been very sick with the flu.

Ovulation occurs approximately 40 hours after the onset of the LH surge or the hCG shot. A single insemination at around 36-39 hours after the onset of the surge or the hCG shot would be appropriate. However, its difficult to detect the actual onset of the LH surge with an ovulation predictor kit. Since patients are usualy testing resting twice a day, the detection is +/- 12 hours. So, when using a predictor kit, it is acceptable to perform the insemination around 24 hours after detection of the surge. Sounds like your insemination was appropriately timed.


LovesAStateOfMind - July 18th, 2010 5:03 PM

Hi there,

I am 20years old and Ive been with my partner for 3years now, we are the same sex couple and we are wanting our 1st child. Being 20 am I too young for IUI? Ive not gone to my gp because i want to find out things before i go. Be grateful if you could help me .
Thanks.
Sheryl


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