How many iuis should you do

There are many studies comparing success rates between clomid, letrozole, or gonadotropins for patients with unexplained infertility, but two stand out as the best and most informative. In this study, gonadotropins produced the highest pregnancy rate, followed by clomid, and then letrozole. However, almost one third of all pregnancies in the gonadotropin arm was either a twin or triplet gestation. This was significantly higher than the clomid or letrozole arms. The second study by Huang et al.

Furthermore, the twin risk was not significantly elevated in any of the three groups. The key difference between these studies is that the dose of gonadotropins was higher in the AMIGOS study units than the Huang study 75 units. A higher dose often means more eggs ovulated and a greater risk of twins or more. This is important because clomid and letrozole are also cheaper to purchase hundreds vs.

For this reason, many clinics have moved away from using gonadotropins in IUI cycles. The AMIGOS study suggested that clomid provided the best balance of a high pregnancy rate with a reasonably low multiple rate among couples with unexplained infertility. However, the authors of the Huang study concluded that on balance letrozole was better. From our vantage point, given that clomid more commonly causes multiple eggs to be ovulated, it seems like the slightly better option between the two because the whole point of treatment in unexplained infertility patients is to increase the odds of delivery by increasing the number of eggs ovulated.

IUI can be a successful treatment strategy for patients with mild not severe male factor infertility but its rate of success is dramatically lower than what is achieved with IVF for this group. TMC is an equation combining 3 parameters from the semen analysis : volume, concentration, and motility.

The data we have available is conflicting. A much larger study from Shady Grove, performed on over 46, patients reveals far higher rates of success with three additional observations:. IUI pregnancies are indeed possible using sperm with TMCs below 9 million and in this study, as low as , Below 9 million TMC, the rate of decline for success is shallow , calling into question the wisdom of arbitrary TMC cutoffs study authors: "a specific cutoff threshold should not be utilized as an absolute contraindication for performing IUI For a number of reasons e.

As we've mentioned, IUI rates of success also vary dramatically by the age of the patient receiving the insemination, which drugs accompany the insemination, follicle count and more. Unfortunately, a person cannot look at the TMC from a semen analysis and know precisely where they fit into this rubrik.

This will tell them how drastically the wash impacts their TMCs. Given the correlation between TMC when it's below 9 million and IUI success rates, one plausible option is to "pool" successive ejaculates which can nearly triple the TMC available for people who produce few sperm per ejaculate. Here we address two types of patients: those unable to have a period called anovulatory and those with irregular periods.

Amongst both groups those with no period or irregular periods there are three types of patients: those with hypothalamic dysfunction , those with PCOS , and those with no diagnosis but who have had hypothalamic dysfunction ruled out. Patients with hypothalamic dysfunction are not producing signals within their brains to tell the ovary to mature an egg. Neither clomid nor letrozole will help them. For these patients, IUI must be accompanied by gonadotropin to be effective.

Next we have patients who have either PCOS or no diagnosis. The best study in the field enrolled women to receive clomid or letrozole, followed them for 5 courses of therapy and revealed that the group receiving letrozole had higher live birth rates and fewer multiple gestations.

A closer look at the data suggest that the benefit of letrozole over clomid depended on the BMI of the participants. Investigators concluded there was no statistically significant difference. One might conclude there is thus no benefit to adding an IUI to a clomid cycle. However, the applicability of this study to all patients may be limited because it excludes women with a BMI over 30 common for women with PCOS and used outdated sperm washing techniques.

IUI preferably with letrozole instead of clomid is probably a good option for women with PCOS or irregular cycles in the event that:. There are multiple strategies for causing ovulation in clomid or letrozole resistant patients. Some of these include adding medications such as dexamethasone or metformin to the treatment regimen.

Another approach is changing to gonadotropin injections. While there are lots of factors that influence IUI success rates, provider type does not appear to be a significant one.

With natural conception, we tend to look at success over 6 months to a year of trying repeatedly month after month. This is somewhat true of IUI as well, but only up to a certain point. Knowing when to move on to more advanced treatment like IVF is important for your emotional and financial well-being.

If after IUIs you have not been successful, success rates flatten out and it is statistically unlikely to work for you. At this point, the cost of IUI per live birth begins to skyrocket making IVF the more cost-effective treatment on a per live birth basis.

IUI with paired with fertility medication carries a significant risk of multiple pregnancies. With IVF, you can choose how many embryos to transfer one or potentially two is standard protocol. As a result, the risk of multiple pregnancies with IVF is much lower than it used to be, but IUI offers no such controls. Ovarian stimulation used in tandem with IUI is designed to produce additional eggs to help boost the chances of conception.

While your pregnancy chances do improve, so too does your likelihood of conceiving multiples. Studies comparing the efficacy of various ovarian stimulation drugs can achieve widely different results due to the variability in dosages used in each study. Timing, egg quality, and sperm quality are pretty important when it comes to IUI. Most fertility specialists will recommend that you remain flat on your back immediately after your insemination.

In addition, changes to your lifestyle are some of the best ways to improve your overall health as you look to improve your chances of a successful IUI. IVF techniques have significantly improved over the last two decades, but IUI success has remained largely unchanged. But IVF success comes at a cost—both physical, as IVF is a far more involved process than IUI requiring several different medications and surgical procedures—and financial.

According to a huge study of close to a million single embryo transfers, when a single embryo is transferred, there is just a 1. A second study of patients who had one blastocyst versus two blastocysts transferred found no difference in live birth rates, no incidence of twins in the single transfer group, and a twin birth rate of In the infancy of IVF, doctors had no way of knowing which of the embryos or how many embryos would survive and implant.

To ensure success, they transferred more embryos. Now embryologists have cutting edge technology and techniques to better assess and ensure embryo quality. For the health of both mother and baby, the goal is always to have one healthy baby at a time.

Because doctors are transferring fewer embryos with each IVF cycle, multiple births are not as frequent as they were several years ago. IUI or artificial insemination is one of the least invasive fertility treatments out there and can be pretty successful in certain situations. Your likelihood for success depends on many factors, most importantly your age, diagnosis, and the medication protocol used.

Paul C. IVF and the difference in the process, medications, costs, success rates, and side effects. IUI is often the first step in fertility treatment for many patients, and can be a great option for those dealing with PCOS , other anovulation, cervical mucus problems, or sperm health issues; same-sex couples; single mothers by choice; and patients with unexplained infertility.

Then, the resulting embryo s are transferred back to the uterus in hopes of achieving pregnancy. It also requires just one sperm cell for each egg, allowing for successful fertilization even in the most severe cases of male infertility. Generally speaking, IVF is the most powerful and successful treatment for all forms of infertility, including age-related infertility and unexplained infertility. Like most fertility treatments, an IUI cycle begins with the first day of your period.

Then, for about 12—14 days, your doctor will use bloodwork and ultrasound to monitor your menstrual cycle, ensuring that an egg is maturing properly for ovulation.

Ovulation is when a mature egg breaks free from the ovary and begins its journey down the fallopian tubes, where it can be fertilized in an attempt at pregnancy. This monitoring leads up to the culmination of the cycle—the actual IUI, which typically happens on the day of ovulation either just before or just after ovulation.

The first step of the IUI is for a male partner or sperm donor to provide a semen sample. Finally, the sperm sample is inserted into the uterus via a thin catheter, and fertilization is allowed to happen as it would during a natural cycle—the sperm swim toward the egg and, hopefully, find and penetrate it.

Some IUI cycles do not use medication. This may be appropriate for those without fertility issues who are using donor sperm, or for hetero couples in which the female partner does not have any ovulation issues. An unmedicated cycle requires less monitoring, but may be less effective.

Depending on your diagnosis, your doctor may recommend an IUI cycle that uses medication to prompt ovulation. This method is often used for women who have difficulty ovulating on their own perhaps due to PCOS or for those who want to increase their chances of getting pregnant with a single cycle. An IUI cycle may use oral medications, such as Clomid or letrozole, or may use the type of injectable hormone medications called gonadotropins typically associated with IVF.

Because IVF is most successful when doctors can attempt fertilization on a larger number of eggs, a female patient is typically placed on a course of injectable, ovary-stimulating medications to prompt her body to produce multiple eggs in one cycle.