When Is IUI an Appropriate Option?
The inability of a couple to conceive may be the result of a variety of factors. IUI is most appropriate for fertility issues such as:
· Mild male factor infertility - The semen analysis shows below-average sperm concentration, weak motility (movement), or abnormal morphology (shape and size of sperm). Sperm washing, which is done in preparation for IUI, ensures that the strongest normal sperm are used.
· Cervical factor infertility - In cases where cervical fluid, that normally is the right density for the sperm to swim through, is too thick, IUI is used to bypass the cervix, depositing the sperm directly into the uterus where is able to swim up to the egg in the fallopian tube.
· Semen allergy - In rare cases, a woman is allergic to her partner's sperm. If contact is made, the vagina may swell, burn, or itch in the places the semen has touched. Bypassing the vagina ensures the allergic reaction is avoided.
· Unexplained infertility - There are two situations that are thought to be connected to unexplained infertility, one is a mild form of endometriosis and the other is ovulation problems. PCOS is also a condition that may prompt IUI.
· Donor sperm - IUI can be used to achieve pregnancy in the case of using donor sperm. Frozen donor sperm that are acquired from credible sources are thawed and then used.
When Should a Couple Use IVF?
In vitro fertilization is generally used by couples who have tried for a year without success to conceive a pregnancy. They also have one of the following conditions that either contribute to or cause infertility:
· Blocked fallopian tubes or pelvic adhesions - These conditions are usually caused by pelvic infections, such as PID (pelvic inflammatory disease), endometriosis, or scar tissue from a previous pelvic surgery.
· Severe male factor infertility - In cases where the sperm is especially slow moving or is severely misshapen then IVF is used.
· Failed IUI - It the couple has failed 2-4 rounds of ovarian stimulation and IUI with no result, then the next step is usually IVF.
· Advanced maternal age - A woman over the age of 38 is usually treated with IVF because egg production drops by this point.
· Low egg supply - A reduced ovarian reserve is deduced through screenings that determine egg quality and quantity.
· Severe endometriosis - Although a woman with mild endometriosis may be able to conceive with IUI, if the condition is severe, then IVF is used.
Over the years the success rates for IVF have increased while those for IUI have remained static, for the most part. This means that the number of IUIs done prior to moving to IVF has decreased over the last decade or more. In the early 1990s couples would have between three and six cycles of IUI before moving to IVF.
These days, if there has not been conception in two or three cycles, they move to IVF. Costs for both IVF and IUI change over time, making the availability of IVF more affordable.
If you are undergoing IUI, you may have questions that haven't been addressed here. See our IUI FAQs article in this section for more information about intrauterine insemination.