Posts Tagged ‘IUI’

How many IUIs to do? One or two?

Monday, September 20th, 2010

This is a question that reproductive endocrinologists have studied and debated since the technique of intrauterine insemination was first developed.

A study reported in the September 2010 issue of Fertility and Sterility again looks at the effect of timing of an IUI on the success rate.

They divided the patients into three groups: patients in group 1 underwent a single preovulatory intrauterine insemination (IUI) performed 24 hours after hCG administration. Patients in group 2 underwent two IUIs performed 12 and 36 hours after hCG administration. Patients in group 3 underwent a single periovulatory IUI performed 36 hours after hCG administration.

The total pregnancy rate per patient was 14.2 % ; group 1 had a rate of 11.3%, while groups 2 and 3 had 14.0% and 17.2% pregnancies, respectively. The difference between the three groups in regard to pregnancy rates was not statistically significant.

So there was no significant difference and maybe that's why it's been so difficult for reproductive endocrinologists to come up with a universal strategy. It simply doesn't matter. We employ a strategy which we think makes sense: if the follicle is still present at the first IUI, we do a second. If the follicle has disappeared there is no need for a second IUI. Any better ideas?

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For unexplained infertility-IUI with drugs or IVF, which is best?

Monday, August 30th, 2010

Conventional treatment for couples experiencing unexplained infertility has usually consisted of three cycles of clomiphene (CC) with IUI, followed by three cycles of gonadotropins (FSH) with IUI and then IVF if those conservative measures did not work.

A study in the August 2010 issue of Fertility & Sterility looks at the time it took to establish a pregnancy that led to a live birth and cost-effectiveness of either conventional treatment with three cycles of clomiphene citrate CC/IUI, three cycles of gonadotropins FSH/IUI, and up to six cycles of IVF or an accelerated treatment that omitted the three cycles of FSH/IUI.

An increased rate of pregnancy was observed in the accelerated arm compared with the conventional arm. Median time to pregnancy was 8 and 11 months in the accelerated and conventional arms, respectively. Per cycle pregnancy rates for CC/IUI, FSH/IUI, and IVF were 7.6%, 9.8%, and 30.7%, respectively. Average charges per delivery were lower in the accelerated arm compared to conventional treatment. The observed incremental difference was a savings of $2,624 per couple for accelerated treatment.

In my experience many couples are bypassing the option of FSH/IUI, not only because of the increased time and expense to success, but also because IVF provides more control over high-order multiple pregnancies as we transfer fewer embryos.

Arthur L. Wisot, M. D.

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IVF or IUI for Women Over 40?

Monday, June 7th, 2010

Selection of a treatment method for women over 40 whose main limitiation in conceiving is their age can be difficult. If they are in the "unexplained infertility" group with open tubes, no significant gynecologic problems and a partner with normal sperm parameters the common choices are to try injectable fertility drugs (COH) with artificial insemination (IUI) or in vitro fertilization (IVF). A recent study in Fertility & Sterility compared groups of women aged 38-39 with a group over 40.

The women who were 38–39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women  over 40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle. These data suggest that the efficacy of COH/IUI cycles significantly decreases with age, but women aged 38–39 years had reasonable success during the first two cycles. However, for women aged over 40 years, no benefit after a single cycle of COH/IUI was observed. Women over 40 years should be considered for in vitro fertilization as the first choice or after one failed COH/IUI cycle.

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How long to abstain before an IUI?

Saturday, May 22nd, 2010

Traditionally a two day period of abstinence has been recommended prior to ovulation or an IUI. A recent study in the March 2010 issue of Fertility & Sterility suggests that shorter period of absintence results in better pregnancy rates. In this study an ejaculatory abstinence period of less than 2 days before IUI produced the highest pregnancy rates per cycle compared with longer intervals of ejaculatory abstinence. This higher conception rate occurred despite a lower total number of motile spermatozoa inseminated.

This may be explained by the observation that shorter periods of abstinence can result is less fragmentation in the DNA of the sperm. This is another demonstration of the fact the quality can be more important than quantity. It's important that those trying to conceive consult their doctors to determine the best period of abstinence in their case.

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