Benefits and Disadvantages of IUI – Why Do I Have to Choose It?
Infertility is not only frustrating experience which steals dreams, breaks hearts, and brings grief. It is also expensive and exhausting physically, emotionally, and mentally. If it brought you more tears than you ever thought you could shed, it is the time to schedule an appointment with the respected reproductive endocrinologist. But before entering the doctor’s office, glance through the Fertility Treatment Options. Because when you are recommended for the first time any Fertility Treatment, it sounds confusing and not conclusive. Or just weird. And you are mentally entrapped into all those medical abbreviations without any thought what you should start with…Embarrassed, frustrated and lost you cannot choose your individual Treatment because you just don’t know what you are involving yourself in.
If you are not sure should you choose IVF Treatment, or ICSI Treatment, or IUI Treatment, or something else, it is essential to ‘GLIMPSE’ through the basic information about all these Treatments, to analyze their benefits, complications, and risks. And only after that to consult with the doctor and to choose the one. Even if you have already chosen the IUI, there are still several things I wish you had known before your first IUI (before the day you will get knocked up via Intrauterine Insemination).
1. What is Intrauterine Insemination (IUI)?
Intrauterine Insemination (IUI) is the non–invasive procedure where sperm are washed (to remove dead sperm and proteins), concentrated (to increase the volume of the viable sperm), and placed in a woman’s uterus via catheter (a very small tube that is passed up the cervix and into the uterus) around the most optimal time of ovulation. This procedure is done as close to the time of ovulation as possible.
2. What is generally accepted about Intrauterine insemination (IUI)?
It is generally accepted that Intrauterine Insemination (IUI) should be preferred to more invasive and expensive techniques of Assisted Reproduction. That is why IUI is one of the first Assisted Reproductive Technologies typically recommended by the doctors (reproductive endocrinologists). IUI is proven easier to perform, less invasive and less expensive than other methods of Assisted Reproduction.
3. When should the Intrauterine Insemination (IUI) Treatment be recommended as the Fertility Treatment?
It is proposed as a first–choice Treatment in cases of unexplained and moderate male factor subfertility (when the male partner is experiencing low sperm count, decreased sperm motility, or decreased sperm viability), Endometriosis, Polycystic Ovarian Syndrome, cervical mucus issues, for most cases of non–tubal infertility, unexplained infertility (with potential male factor), combined male subfertility and ovulatory dysfunction, and immunologic causes.
4. In which cases Intrauterine Insemination (IUI) is not only recommended but effective treatment?
Cervical factor subfertility
Bypassing the hostile cervix, it increases the probability of conception because the sperm is injected directly into the uterus.
Unexplained infertility
IUI is effective only when Controlled Ovarian Hyperstimulation (COH) is used.
Male factor infertility
IUI in natural cycles should be the Treatment of choice in case of male subfertility, providing an Inseminating Motile Count (IMC) of more than 1 million can be obtained after sperm preparation and in the absence of a triple sperm defect.
5. WHAT BENEFITS DOES IUI HAVE?
1) Washing procedures enhance sperm quality
The washing procedures clinicians perform to remove prostaglandins, infectious agents, antigenic proteins, non–motile spermatozoa, leucocytes and immature germ cells. As a result, the sperm quality increases. This may also enhance sperm quality by decreasing the formation of free oxygen radicals after sperm preparation.
2) Natural (unmedicated) cycle IUI is possible to perform
With IUI you have options with medications. You can do a natural cycle (no medications), with Clomid (a pill to stimulate follicles) or with low stimulation medications. Natural cycle IUI and minimal dose regimen with gonadotrophins are valuable options to prevent the unacceptable high multiple gestation rates described after Ovarian Hyperstimulation.
3) Less invasive method: more physiological
Intrauterine Insemination is the procedure where sperm are washed (to remove dead sperm and proteins), concentrated (to increase the volume of the viable sperm), and placed in a woman’s uterus via a catheter (a very small tube that is passed up the cervix and into the uterus). You don’t have the Oocyte Retrieval [surgical procedure which is performed under the anesthesiology on the operating table] like you do with IVF.
4) Reduced psychological burden
After the Oocyte Retrieval [the whole procedure only takes about 15 minutes, so you wake up about 20–30 minutes later in recovery], at first you don’t feel any pain because they give you some good pain medications through the IV, but once those wear off the pain is terrible. Apparently, the amount of pain a woman feels after Oocyte Retrieval depends entirely on pain tolerance and the amount of oocytes retrieved.
5) The procedure is performed under the transvaginal ultrasound guidance
The IUI is performed under an internal ultrasound [a transvaginal ultrasound] and as soon as the technician performed an external ultrasound, the doctor inserts the catheter into vagina and cervix. Using the ultrasound screen as the guide, the doctor pushes the catheter through the cervical canal and points it toward the top of the uterus and right or left Fallopian tube (the side with the mature follicle). Ultimately, the doctor injects the sperm through the catheter and into the uterus.
6) The timing of the procedure performance is surprisingly short
The process lasts only about 60 to 90 seconds. After that, you will be advised to stay seated for a few minutes.
7) Less expensive Treatment
In comparison with IVF and ICSI, IUI is less expensive Fertility Treatment Option. The whole IUI Treatment cycle cost around $2,000–$4,000 including medications where the average IVF Treatment cycle costs around $10,000–$36,000. So, you can get a few IUI Treatment cycles in for the rate of 1 IVF Treatment cycle.
8) Low risk for Ovarian Hyperstimulation Syndrome (OHSS)
Ovarian Hyperstimulation Syndrome (OHSS) occurs in 1%–10% of women undergoing Ovarian Hyperstimulation with exogenous gonadotrophin administration and is a recognized and potentially life–threatening complication. Ovarian Hyperstimulation Syndrome (OHSS) may complicate all methods of treatment in which gonadotrophins are used; however, OHSS seems to be rare after Controlled Ovarian Hyperstimulation–IUI (COH–IUI) compared with IVF due to the fact that lower dose Stimulation Protocols are more often used.
9) Low risk of thromboembolism
Deep venous thrombosis (blood clots) has been reported extensively following ovarian Hyperstimulation syndrome during In–Vitro Fertilization (IVF) Treatment cycles. The thromboembolic event is dangerous because it is a prominent cause of maternal deaths. It is also unpredictable because there is no clinical marker to reveal it early. The site of the thromboses, the timing of thromboses relative to Oocyte Retrieval, and possible predisposing factors are hard to diagnose.
10) More effective than Intracervical Insemination (ICI)
If you are proposed ICI, you should know that IUI is more effective. Wondering why? ICI involves placing the sperm into the cervix. Once placed in the cervix, the sperm then make their way to the uterus where they can fertilize the oocyte, mimicking the action of natural fertilization. IUI involves placing the sperm directly inside the uterus. Because this technique bypasses the cervix and does not rely on the sperm traveling to the uterus themselves, the chances of fertilization are increased.
6. WHAT SIDE EFFECTS DOES IUI HAVE?
1) Most women experience little to no pain during IUI procedure.
2) Some women may experience mild cramping with IUI procedure.
3) Severe side effects, like infections, can occur following IUI, but these are very rare.
4) Most IUI side effects are caused by the fertility drugs taken during the IUI cycle, not the IUI procedure itself.
When you begin an IUI cycle, your doctor may prescribe you fertility medications to increase your chances of IUI success. These drugs will stimulate your ovaries to produce multiple oocytes for the insemination. These medications have the side effects: Mood swings, Depression, Hot flashes, Breast tenderness, Nausea, Bloating, Headaches or visual disturbances, Swelling or a rash around the injection site (if you are given the injections), Swollen and painful ovaries, signaling Ovarian Hyperstimulation Syndrome (OHSS), Pelvic discomfort, Ovarian cysts. IUI side effects caused by fertility drugs should disappear once the medication is stopped. Always call your doctor if any uncomfortable symptoms develop during an IUI cycle.
5) The risk of conceiving multiples
The risk of conceiving multiples (becoming pregnant with twins, triplets, or even more) with IUI is small, but it increases because of taking fertility drugs. Therefore, the internal ultrasound is highly recommended.
As the conclusion note, it should be underlined that IUI Treatment has minimal side effects (mostly all side effects are caused by the fertility drugs taken during the IUI cycle, not the IUI procedure itself) and most women find the IUI procedure to be painless. If you are still nervous about your IUI (especially about the transmission of life–threatening Sexually Transmitted Diseases, infectious diseases such as HIV, HCV, and Hepatitis B), you should discuss your concerns with your doctor, schedule the blood test and other medical examinations.