Intrauterine Insemination (IUI) With Clomid
Infertility Treatments Artificial Insemination & Clomiphene Citrate
Nov 14, 2009
Infertility is a common yet frustrating problem. Many couples fear that they’ll need to do expensive infertility treatments to have a baby. But there are low cost methods of achieving pregnancy that should be tried first if possible. One frequently used method is ovulation induction with a pill called clomiphene citrate, or Clomid, followed by intrauterine insemination with the partner’s sperm at the time of ovulation. Clomid and IUI won't work for couple with severe male factor infertility or blocked fallopian tubes.
Clomid and Ovulation Induction for Anovulation
Clomid is a low cost pill which helps women who aren't ovulating to start ovulating. Clomid is taken for five days during the first half of a woman’s menstrual cycle. Some doctors prescribe Clomid from day two to seven; some from day five to nine. Clomid helps produce a mature egg containing follicle (sometimes more than one) by fooling the body into thinking that its estrogen levels are low. As the hypothalamus responds by producing GnRH (gonadotropin releasing hormone), it stimulates the production of follicle stimulating hormone (FSH), which in turn stimulates the ovary to produce estrogen.
Clomid is very effective; around 80 % of women will ovulate after taking Clomid. But Clomid does have drawbacks. One is that it can hyperstimulate the ovaries, causing the maturing and release of more than one egg. Clomid can also affect cervical mucus, making it thick and inhospitable to sperm.
Intrauterine Insemination (IUI) for Male Factor Issues, Low Sperm Count
Men with a low sperm count and motility issues may be helped to achieve pregnancy through IUI. Sperm are washed, to remove the seminal plasma, which can cause painful contractions if injected directly into the uterus. Then they’re spun down on a centrifuge, and the fastest (and hopefully, most vigorous) sperm are collected by one of several methods.
The sperm are finally deposited directly into the uterus via catheter, bypassing the cervix, which gives them a “leg up” on their journey to the egg. IUI normally won’t improve the chances of pregnancy in men with normal sperm count and motility, and it probably won’t help men who have severe male factor issues.
Using IUI to Bypass Thick Cervical Mucus
Because Clomid can damage cervical mucus, doctors may suggest combining IUI and Clomid ovulation induction. Ultrasounds and blood tests will be done to pinpoint the time of ovulation, and an IUI will be done. Sometimes IUI will be done twice, to help ensure the best timing for fertilization.
The main risks of IUI with Clomid ovulation induction are infection and the possibility of multiple births. If too many follicles are seen on ultrasound before insemination, many doctors will do in vitro fertilization instead of IUI, to decrease the chance of more than two babies.
Intrauterine Insemination Clomid Cycle Success Rates
For women under age 25, the chance of pregnancy after a Clomid IUI cycle is around 10%. Many doctors feel that if Clomid and IUI haven’t been successful after trying for six months, it may be time to move on to in vitro fertilization. A study done in Scotland and reported in the British Medical Journal in 2008 caused a stir by suggesting IUI and Clomid had no benefit as fertility treatments. However, the study did not look at the two methods as combined therapy, but only as used separately, and only for unexplained infertility.
Fertility Options: Combining IUI with Clomid
Clomid and IUI used together is a reasonable treatment for women with ovulation issues and men with mild sperm issues.
Source:
British Medical Journal, "Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial;" S Bhattacharya et al; 2008;337:a716
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