For a number of patients coping with unexplained infertility or mild male subfertility, an intrauterine insemination is one of the first treatment options available. Patients have a number of questions that I can hopefully answer below. How does the IUI work? What can I do to improve the odds of this working? Do I have to stay laying flat after the IUI? What if it doesn’t work?
How does IUI work?
The premise behind an IUI as a treatment option is to increase the amount of total moving sperm that reaches the fallopian tubes by placing sperm in the uterine cavity. There, it should penetrate the egg. When coupled with medications taken by mouth (ovulation induction agents) or injectable medications, the success rate per cycle may be 15-20% per cycle. The use of high doses of injectable medications may confer a slight increase in pregnancy rate but is associated with a higher risk of multiple pregnancy, a suboptimal outcome for both mom and babies.
What can I do to improve the odds of an IUI working?
In general, stress reduction is important when undergoing attempts at conception. In addition, as the procedure entails placing a small catheter via the cervix and into the uterus, a few uterine contractions are not uncommon. At times, relaxation techniques can help, particularly as the procedure, which is typically very quick, can be made more difficult when the patient is tense. Anatomical challenges such as cervical stenosis may make an IUI more difficult when a patient is very anxious.
How long do I stay laying flat after my IUI?
Recently, the answer to this question has come under scrutiny. While older literature suggested a benefit to resting in a flat position for 5-10 minutes after an IUI, a more recent study failed to show such benefit and possibly lower pregnancy rates following immobilization. Studies have shown that sperm cells can reach the fallopian tubes within 5 minutes of intra vaginal insemination. Once sperm has been placed in the uterine cavity, a patient can immediately get up and leave without resting. Dr van Rijswik, lead author of latest study, says “Why should bed rest affect that? There’s no biological explanation for a positive effect of immobilization”. Although this recent study was randomized, it did not analyze per cycle pregnancy rates. Moreover, immobilization time was 15 minutes, a few minutes more than most would recommend. Take home point: rest is probably not necessary.
What if the IUI does not work?
The rate of success per cycle significantly declines after 3-4 IUIs have failed. Moreover, the emotional toll associated with repetitive negative pregnancy tests can make patients feel hopeless and defeated. In vitro fertilization has a much higher pregnancy rate per cycle. Current technological advances allow patients to screen for a normal embryo, which can be placed, back in the uterus at the time of implantation and expect an associated 50-60% pregnancy rate.
Dr. Jessica Salas Mann serves as the Director of Third Party Reproduction at IRMS. She is board certified in both Reproductive Endocrinology and Infertility and Obstetrics and Gynecology. She is a fellow of the American College of Obstetrics and Gynecologists, and is a Diplomat of the American Board of Obstetrics and Gynecology. Dr. Mann and her team deliver exemplary care and service to patients throughout Central and Southern New Jersey at her office in Old Bridge.