One aspect of fertility treatment that exacerbates the frustration of many couples is the uncertainty. They often don’t have a specific reason for their problem—even after their testing is completed. They also don’t understand the typical challenges that everyone faces on a monthly basis. Without this information, it can be difficult to create realistic expectations. I believe it also makes the most logical and simple recommendations seem very appealing.
Basic Fertility care is often introduced as ovulation induction (OI)—using medication to regulate the menstrual cycle and optimize the timing of the “fertile window.” This procedure is often combined with “sperm wash” where the partner’s specimen is processed to optimize its potential and then placing that into the woman’s uterus—known as intrauterine insemination (IUI). This treatment has been available for decades. There have been few changes in how this is done over the last 10 years.
I reviewed the subject of OI/IUI back in 2015 and those studies are still very relevant. So please check that out as well. More recently, we have had a couple of publications that provide even more data for us to guide patients through these important decisions. Please consider the watching the following video blog for a quick (less than 10 minute) summary ( https://youtu.be/GwmbkIpw3ek ) . In case you can’t access the link, here is a brief summary of findings;
- Ovulation Induction with intercourse wasn’t much better than trying to conceive naturally
- Insemination without ovulation induction had success rates comparable to natural conception
- In considering OI/IUI
- Success rates drop dramatically after three or four attempts
- Having more than two follicles is not recommended due to increased risk of multiple pregnancy
- The timing of the insemination is more flexible than most anticipate
- There is no greater benefit in having more than one insemination per cycle
- For women over 40, success rates were modest and associated with a lower risk of multiple pregnancy—even when three or more follicles were available
I hope that you find this information helpful and empowering as you consider your treatment options and plan your family.
With kindness and optimism
Robert Greene, MD, FACOG
Conceptions Reproductive Associates of Colorado
- Obstetrics and Gynecology 2020
- Fertility and Sterility 2020 Evidence based treatment review