by Dr. Agilan Arjunan, Fertility Specialist & Gynaecologist, KL (Malaysia)
Intrauterine insemination or simply known as IUI or insemination is one of the options for fertility treatment. Couples who underwent an IUI treatment often have an acceptable or normal semen analysis, good egg reserve, an open Fallopian tube and no other significant fertility comorbidity that necessitates other treatment options.
However, even in a good case scenario, IUI success rate is in the range of 10-15% per IUI procedure. I am sure you are wondering why then the success rate is low when all the fertility tests are ‘normal’.
Let me explain why .
What do we know about IUI
In an IUI procedure, the woman is usually given some medications in the form of either tablets or sometimes via injections to enhance the follicle or egg growth. This follicular growth is monitored via the ultrasonography method. Ovulation may be induced with medication at the appropriate time. On the other hand, instead of inducing it, ovulation is identified via urine ovulation test kits. On the day of ovulation, a processed or filtered sperm is injected into the uterus or womb. After the IUI procedure, which is typically done in a clinic setup, the woman can carry on with her daily usual routines. Home pregnancy test is done after 2 weeks to confirm a successful pregnancy.
What we do not know about IUI
IUI is a treatment method that increases the probability of fertilisation by the egg and sperm. There are several aspects in the whole process that cannot be controlled within the IUI procedure itself.
Firstly, the medication administered during the treatment to enhance the growth of the follicle or egg does not necessarily ensure that a ‘normal’ egg is being recruited. Furthermore, an induced ovulation does not ensure that a “normal” egg is being ovulated at that time. A ‘normal’ egg is vital to meet healthy sperms to be fertilised and form an embryo. Next, there is no mechanism or technique available currently to ensure that the ovulated egg is picked up by the Fallopian tubes in a women and propelled forward for fertilisation by the sperm despite a successful ovulation. The structures within a fallopian tube may fail to function as expected.
The sperm injected into the uterus needs to fulfil its function by penetrating the walls of the egg and fertilise the egg. However, in an IUI procedure there is no guarantee that the sperm will fulfil this task in the presence of the egg. Finally, there is no method to detect formation of an early embryo in the uterus. A positive pregnancy test concludes that an embryo was formed and has successfully implanted in the uterus. However, at this final crucial step if an abnormal embryo is formed during the IUI and the embryo did not implant, you will see a negative pregnancy test . The couple may not know that they have actually made an embryo.
What could have gone wrong in an IUI
Based on the above mentioned ‘uncertainties’, we can conclude that an IUI could have failed due to ovulation of an abnormal egg, failure of the egg to be drawn into the Fallopian tube, failure of the sperm to fertilise the egg and failure to form an embryo which has the capability to implant in the uterus.
IUI is a simple and possibly an ‘effective’ fertility treatment method for some couples. However, each and every couple who are considering an IUI procedure should be aware about the advantages and more importantly the disadvantages of an IUI treatment. This is crucial to set the CORRECT mindset and level of expectation for the couples. A fertility journey can be both physically and emotionally draining especially if the treatment had failed. It is not advisable for couples to set the wrong expectation based on the wrong treatment option and make a wrong conclusion about their fertility journey. A positive and well directed mindset ensures a successful journey for couples towards parenthood.