Why did my IUI fail?

There are a number of reasons why sperm and egg do not meet to create an embryo. — KRT

Intrauterine insemination (IUI), also simply known as insemination, is one of the options for fertility treatment.

Couples who undergo an IUI treatment often have an acceptable or normal semen analysis, good egg reserve, an open Fallopian tube and no other significant fertility problems that necessitate other treatment options.

However, even in a good-case scenario, the success rates are in the range of 10-15% per IUI procedure.

I am sure you are wondering why the success rate is so low when all the fertility tests are “normal”.

Allow me to explain the reason.

In an IUI procedure, the woman is usually given medications either in the form of tablets or injections to enhance the growth of her follicles – small, fluid-filled sacs in the ovaries that contain one immature ovum (egg) each.

This follicular growth is monitored via ultrasound.

Ovulation – when an ovum or ova are released from one of the ovaries – can either be induced with medication at the appropriate time, or allowed to occur naturally and detected via urine ovulation test kits.

On the day of ovulation, processed or filtered sperm is injected into the uterus (womb).

After the IUI procedure, which is typically done in a clinic, the woman can carry on with her usual daily routine.

A home pregnancy test is done after two weeks to confirm if the procedure has produced a pregnancy.

The uncertainties

IUI is a treatment method that increases the probability of fertilisation of the ovum by a sperm.

However, there are several aspects throughout the whole process that cannot be specifically controlled.

Firstly, the medication administered to enhance the growth of the follicles does not ensure that the affected follicles all contain “normal” ova.

Furthermore, there is no guarantee that a “normal” ovum will be produced during ovulation.

A “normal” ovum, along with healthy sperms, is vital to ensure that fertilisation is successful and an embryo can be formed.

There is also no mechanism or technique currently available to ensure that the ovulated ovum is picked up by the woman’s Fallopian tubes and propelled forward towards the womb for fertilisation by sperm despite a successful ovulation.

The structures within the Fallopian tube may fail to function as expected.

Next, the sperm injected into the uterus need to fulfil their function by penetrating the walls of the ovum and fertilising it.

However, there is no guarantee that the sperm will fulfil this task in the presence of the ovum.

Finally, there is no method to detect the formation of an early embryo in the uterus.

A positive pregnancy test concludes that an embryo was formed and has successfully implanted in the uterus.

However, if an abnormal embryo is formed during the IUI and did not implant in the uterus, you will have a negative pregnancy test.

The couple may not know that they have actually made an embryo.

Based on the above mentioned uncertainties, an IUI procedure may fail due to:

• Ovulation of an abnormal egg
• Failure of the egg to be drawn into the Fallopian tube
• Failure of the sperm to fertilise the egg, or
• Failure to form an embryo that can implant in the uterus.

Correct mindset

IUI is a simple and potentially effective fertility treatment method for some couples.

However, every couple considering an IUI procedure should be aware of the advantages, and more importantly, the disadvantages of this treatment.

This is crucial in order for the couple to have the correct mindset and level of expectation.

A fertility journey can be both physically and emotionally draining, especially if the treatment has failed.

It is not advisable for couples to have the wrong expectations about their treatment choice, which may lead to wrong conclusions about their fertility.

A positive and well-directed mindset will help ensure a successful journey for couples towards parenthood.

Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email [e-mail]. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.