For couples struggling with infertility, assisted fertility techniques can help achieve a successful pregnancy. However, multiple factors influence the outcome of such treatments. IUI is one such fertility treatment that helps increase the chances of the sperm reaching the egg. Like any other treatment, IUI is not free of failures. When an IUI fails, what can or should the couple do? Can they try again, or can they get pregnant naturally? Find your answers here!
IUI – Intrauterine Insemination is a fertility treatment that aims to help couples struggling with infertility. In this treatment, the male partner’s semen is collected. After a sperm wash – a technique to remove all fluid and non-motile sperm, the concentrated motile sperm are injected into the uterus. This gives the motile sperm a better opportunity to travel up the fallopian tube and fertilise the egg successfully.
IUI is a pain-free quick treatment for couples having trouble conceiving. In many cases, this is the first line of treatment before IVF. IUI can be helpful in the following conditions:
● When the sperm is unable to enter the uterus due to a hostile environment in the vagina, inserting the sperm directly into the uterus makes it easier for the sperm to reach the egg.
● When sperm count or quality is very low, the sperm wash can help concentrate the motile sperm in the little HTF liquid and inject it into the uterus.
● If the male partner has HIV, sperm washing and directly inserting the sperm without any sexual contact can reduce the risk of transferring the infection to the partner and baby.
● If there is an issue with vaginal intercourse or erection, the sperm can be withdrawn and injected directly into the vagina.
IUI treatment involves the following steps:
1. Sperm collection – The male partner’s sperm is collected by either asking them to ejaculate into a sterile container at the clinic.
2. Sperm Wash – The semen goes through a sperm wash to remove the mucus, dead or non-motile sperm, and other contents to separate the motile sperm. This motile sperm is concentrated into a special liquid known as the HTF.
3. Insertion – The separated sperm is inserted directly into the uterus through a plastic catheter. This gives it easier access to the egg. There are more number of motile sperm, thus increasing the chances of it going up the fallopian tube easily.
4. Wait and Leave – The woman has to wait a few minutes after the insertion before leaving. After this, it is just a wait-and-watch period to see if the sperm successfully fertilises the egg and an embryo implants in the uterus.
It can take about 2 weeks to know if the IUI was successful or not. IUI is done on the day of ovulation by tracking the female partner’s menstrual cycle. Waiting 2 weeks after this ovulation and IUI date will avoid getting any false negatives.
The IUI success rate on the first try is less than 20%. Fertility specialists may suggest you try 3 cycles of IUI if you are below 35 years of age. The number of cycles recommended can decrease for older women as the success rate decreases. Apart from age, various other factors also influence the outcome of the IUI.
Many IUI cycles fail on the first attempt. The fertility specialist will perform only one insertion per cycle. Hence, if your IUI fails the first time, you can give it a try another 2 or 3 times, depending on your health condition and other factors.
It is difficult to confirm the result of the IUI until you take a pregnancy test after 2 weeks. Some signs and symptoms of a failed IUI are:
● Regular Period – If you get your period as per schedule, it means there is no pregnancy, and the IUI has failed.
● Negative Test Result – If you get a negative result on your home pregnancy or clinical blood test for pregnancy, then it means the IUI did not succeed.
● Lack of Symptoms – If you do not experience any of the common pregnancy symptoms like breast tenderness, nausea, sensitivity to smells, change in cervical mucus, increase in body basal temperature, or fatigue, it could indicate you are not pregnant as the IUI did not succeed.
An IUI cycle can fail for various reasons. Some common reasons are:
● Irregular Periods – When the menstrual cycle is irregular, it becomes difficult to track the ovulation dates. In one round of IUI, sperm insertion is done only once and on the day of ovulation. When the dates are not clear, calculations can go wrong.
● Wrong Timing – If the ovulation date is miscalculated, the IUI cycle can be a failure.
● Tubal Blockage – If there is a block in the fallopian tubes, the sperm cannot travel up to fertilise the egg, thus resulting in the failure of the IUI cycle.
● Sperm Quality – Sperm wash can only help isolate the better sperm and remove mucus and other fluids in the semen. It cannot improve sperm quality. So, if the sperm morphology or quality is low, it can affect the IUI outcome.
● Structural abnormalities – In case of issues like fibroid, cysts, polyps in the uterus, or endometriosis, IUI cannot help in increasing the chances of pregnancy.
● Pelvic Inflammatory Disease – PID is a complication that arises from STDs like Chlamydia and gonorrhoea, which can affect a woman’s reproductive system.
● Others – The impact on fertility by lifestyle factors like smoking, alcohol consumption, and exposure to harmful chemicals cannot be reversed or improved by IUI.
If your first IUI cycle does not succeed, you can always go in for another round. Many couples can take up to 3 IUI cycles to get a positive result. Remember, the higher the maternal age, the lower the success rate.
You can start tracking your menstrual cycle from the first period after a failed IUI. Start tracking your basal temperature to help narrow down the time of ovulation and also improve your diet and overall health. Though there is no guarantee or an established link between these factors and the success of an IUI, these can help improve your chances for a successful IUI.
If multiple IUI attempts fail, you have the following options for pregnancy:
● Take Tests – Take various fertility-related tests for both partners. These will include blood tests to check for hormonal balance and ultrasounds to check for structural issues in both partners’ reproductive systems. A test to check the ovarian reserve is also necessary to decide the next step in treating infertility.
● Other Treatments – Talk to your fertility specialist and consider other treatment options like IVF, ICSI or surrogacy. Discuss in detail the pros and cons of each one of these methods and choose the most feasible one for you.
● Improve Lifestyle – Take note of your health and lifestyle. If necessary, make changes to your diet, fitness regime, and exposure to harmful toxins like nicotine, other drugs or even alcohol. Sometimes, the food you eat and the exercise you do can impact your fertility.
A failed IUI is not the end of your fertility journey. You don’t have to give up on your dream of having more children. Failure of IUIs is common and can be due to multiple factors. If other issues are interfering with the IUI outcome, you can treat that underlying condition and give IUI another try. If IUI does not work out, you have various other options.
You can re-track your dates to be absolutely sure of your ovulation dates and try another round of IUI. Both partners can undergo fertility tests, and if there are fertility issues, you can talk to your doctor and opt for other fertility treatments like IVF, ICSI, donor sperm or egg, or surrogacy.
Yes, you can get pregnant naturally after a failed IUI. Multiple factors contribute to a successful pregnancy, and just because you undergo some fertility treatments does not mean natural conception is not possible.
Ask your doctor what you can do next, If you want to try another round of IUI, find out what changes you can make to improve the chances of a successful IUI. Gather details about alternate options, their advantages, limitations, financial requirements, time the treatments can take to succeed, etc.
Yes, it is very normal for IUI to fail, especially in the first cycle. Many couples opt for IVF after multiple failed IUI cycles.
