Unexplained Infertility IUI: Success Rate, Procedure, Benefits & Risks

What Is Unexplained Infertility?

Unexplained infertility is a situation when the doctors are not able to identify the reasons for infertility based on tests and medical reports. At the time of screening, everything seems healthy and in working condition. They have no uterine abnormalities, with regular ovulation, open fallopian tubes, a normal semen analysis, and optimal hormone levels. But the couple is still unable to conceive.

What Is IUI (Intrauterine Insemination)?

Intrauterine Insemination (IUI) is a fertility treatment procedure where healthy and carefully selected sperm is directly placed inside the uterus for natural fertilisation.

In a natural conception, the sperm travels from the vagina, through the cervix, into the uterus, and the fallopian tubes. When the ovary releases an egg, it travels through the fallopian tube. This is where the sperm and egg meet and fertilisation occurs.

In the case of IUI, the sperm is directly placed into the uterus with the help of a thin tube (catheter). This helps sperm reach an egg more quickly by reducing the time and distance required in the natural process, which increases the chance of pregnancy.

Who Is a Good Candidate for IUI?

A person can be a good candidate for IUI in the following circumstances:

• When they are dealing with unexplained infertility.
• They have at least one healthy and open fallopian tube, allowing the egg and sperm to meet for fertilisation.
• They have enough ovarian reserve.
• They have enough healthy motile sperm after washing and preparation.
• They don't have any serious male fertility issues.

These criteria help to make sure that IUI is the best possible chance of a successful pregnancy.

Note: For women over 35 years old, age and ovarian reserve are the most important factors in determining the success rate.

Step-by-Step IUI Process for Unexplained Infertility

The IUI process is really simple and gets completed in a single menstrual cycle, and the treatment process generally includes the following steps:

Ovulation

• The doctor will need to know the exact timing of ovulation. This is very important to make sure sperm is injected at the right time.
• Ovulation time can be determined with a home ovulation kit that detects luteinizing hormone (LH). Doctors can also detect LH through blood tests or with the help of a transvaginal ultrasound.IUI is, at times, combined with fertility medications, which encourage the ovaries to produce eggs.
• The sperm is inserted into the uterus within 24-36 hours after LH detection, or after an injection of human chorionic gonadotropin (hCG)

Semen Sample Preparation

• Fresh sperm samples are taken on the day of the IUI procedure, and in some cases, previously frozen sperm samples are prepared for the next step.
• Sperm is prepared for insemination by a process called sperm washing, which pulls out a concentrated amount of healthy sperm. In the case of donor sperm, the sperm bank already washes the sperm before sending them over.

Insemination

• The insemination process is very simple and takes only a few minutes. The patient lies down on the examination table, and then the doctor inserts a speculum into the vagina. After that, the doctor inserts a catheter into the uterus through the cervix, and then injects the washed sperm into the uterus.
• The patient can be asked to lie down for 20-30 minutes after insemination.
• Patients might be given progesterone after IUI. This helps to maintain the lining of the uterus and support early pregnancy.
• Patients can take a pregnancy test after two weeks of IUI.

What to Expect After IUI Treatment?

After IUI Treatment, patients can expect things like mild cramps and spotting for a few days. Most people return to their normal activity right after the treatment. Doctors advise avoiding things that can make them feel uncomfortable.

Does IUI Work for Unexplained Infertility?

Yes. If someone is diagnosed with unexplained infertility, it means they have a healthy uterus, good egg count, open fallopian tubes and good sperm quality. IUI success rate for couples under the age of 35 may rise if the mother undergoes hormonal therapy.

IUI is generally advised for unexplained fertility because of several benefits, such as -

• Timed for the woman’s fertility window, which improves chances of fertilisation
• Sperm washing procedure enhances the motility rate and also increases the chance of reaching the egg.
• Can be combined with mild ovarian stimulation, which increases the chance of conceiving

Factors That Affect IUI Success

Factors affecting IUI success are listed below:

• Age: Due to poor ovarian reserve, women's fertility decreases after the age of 35. So, younger women have a higher success rate.
• Duration of infertility: A longer duration of infertility might reduce the chances of an IUI success.
• Egg quality and ovarian response: This can be easily improved with fertility medications and ovarian stimulation.
• Sperm quality: Healthy sperms can significantly improve the chances of an IUI success.
• Health of the endometrium: The required thickness for implantation is 7-14 mm, which increases the chance of implantation.
• Lifestyle: To improve the chances of an IUI success, a healthy lifestyle is recommended, such as maintaining a healthy weight, not smoking, not drinking alcohol, and reducing stress.
• Timing accuracy: The two major factors of an IUI success are the indication of ovulation and the correct time of sperm introduction.

Hence, improving eating habits and adopting a healthier lifestyle are key factors that complement medical treatment.

Risks and Side Effects of IUI

IUI is considered a safe and minimally invasive fertility treatment with a low risk of complications. Still, because it is a medical treatment, it can have side effects and risks, like any other medical procedure.

Common Side Effects of IUI

Most common side effects are mild and temporary, like:

• Mild cramps
• Light spotting for a few days
• Little pelvic discomfort

These minor side effects resolve over time and do not affect pregnancy.

Risks of IUI

Potential risks of IUI can include:

• Multiple births: The patient might release more than one egg due to fertility medications, which increases the chances of having twins, triplets or more. A pregnancy with multiple babies can have a higher risk of preterm birth and low birth weight.
• Ovarian Hyperstimulation Syndrome (OHSS): A rare side effect caused by the consumption of too much fertility medication.

IUI vs IVF for Unexplained Infertility

Doctors generally advise IUI treatments before IVF because it's affordable and less invasive. In cases where IUI won't work, doctors suggest IVF treatment. This can be due to age or any underlying reason for infertility. In IVF, the sperm and egg are both obtained, fertilised in the lab under optimal conditions, and then the developed embryo is transferred into the uterus (womb).

When to See a Fertility Specialist?

If someone is taking fertility medications for IUI, then they should contact their doctor if any of the following happen:

• Severe pelvic or abdominal pain
• Nausea and vomiting
• Shortness of breath
• Dizziness or lightheadedness

Conclusion

Unexplained infertility can be emotionally frustrating, but it does not end the hope of becoming parents. Effective treatment options like IUI are recommended as the first step, and they have helped many couples to achieve a successful pregnancy.

Every journey of becoming a parent is unique and differs from person to person. With proper medical care and support, the path towards parenthood can be encouraging.