ICSI Success Rates

ICSI (intracytoplasmic sperm injection) is a procedure that can be done in conjunction with IVF (in vitro fertilization) to increase its chances of success. In ICSI, a single, healthy sperm is injected into a mature egg using a very small needle. It is used to overcome male infertility. In cases where a man has a low sperm count, low sperm motility, or poor sperm morphology, ICSI eliminates the need for the sperm to find the egg by itself. A technician in a lab does the dirty work for it.

But how successful is ICSI? One must look closely at the statistics so as to be misled by the numbers. The success rate for ICSI is currently 70-80%. It is important to note that this is rate that the procedure results in fertilization of the egg only. After this part of the procedure is done you must still go through the embryo transfer and implantation portion of IVF which, as we know, has a much lower success rate. Make sure you are reading the data as live birth rates vs conception rates. However, the good news is that the success rate for IVF when done with ICSI is slightly higher than when done without. This is 25-25% in women under 35.

Of course there are other factors that determine the success rate of ICSI, and none more prevalently than the experience and expertise of the clinic and technician performing the procedure. Compared to IVF, this is a relatively new procedure so we just don’t have as much long-term data yet for it. But the techniques are improving all the time and as the knowledge and understanding of the science grows, so will the success stories

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IVF and Insurance Coverage

As we talked about in our section on the cost of IVF, it is an expensive process. Unfortunately, the cost is prohibitive for some couples. Currently there are 15 states that mandate employers (of over 25 people) to offer coverage on their health plan for fertility diagnosis or treatments. They are: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. Of these states, California, Louisiana and New York require coverage of fertility treatments, but specifically exclude IVF. Unfortunately, in states that are not mandated to offer coverage, insurance for IVF treatments is hard to find and plans can be expensive and of a limited scope. Whether you live or work in one of these states and are covered under an employer’s plan, or are seeking to purchase supplemental coverage on your own, we want to offer some tips and things to look out for as you navigate these murky waters.

  • Is there a waiting period on your policy?
    Some policies will state that you must pay the premium for a certain amount of time before you can seek the benefits. Read the fine print and plan accordingly.
  • This may seem obvious, but make sure that the woman is the one explicitly named as the beneficiary of the plan. She will be the one undergoing the bulk of the procedures.
  • Are drugs covered?
    The drugs are a HUGE portion of the total cost of IVF.
  • Are office visits covered?
    These will factor into the total cost.
  • Is pregnancy covered?
    If you do not have pre-natal or maternity coverage on your current plan, you may be able to add this in.
  • As with any insurance plan, take a look at the cost. What is the deductible versus the premium?
    Lower monthly payments will mean higher out of pocket costs at the time the benefits are used. Figure out what fits in your monthly budget.
  • As mentioned above, check the verbiage of the plan to see what fertility treatments are covered. Fertility injections? IUI? Costs associated with donor egg or sperm?
  • Even in the states where coverage is mandated, some will pay for testing for infertility, but will not pay anything further once a diagnosis is made. More fine print.
  • Where is your company headquartered?
    If the state where your employer has its headquarters is one that mandates fertility treatment coverage, you may be eligible. Contact your insurance company for details.
  • Even with insurance, it is common to see a maximum lifetime coverage of $10,000-$25,000. Even at the high end of this range, only one IVF cycle will come close to being covered. If your first cycle results in a successful pregnancy then that is great! If not, you may find yourself paying out of pocket for another attempt.
  • IVF may be tax deductible! Any medical expense may be tax deductible in an amount over 7.5% of your Annual Gross Income (AGI). Keep vigilant records of the expenses you incur during the process: doctor visits, hotel stays, mileage, etc.
  • More on tax deductions: You cannot claim any portion of the expenses that were paid for through a Flexible Spending Account, as this money is already tax-free. Contact your tax specialist for details.
  • Also keep in mind for tax deductions: You will only want to claim the expense for deductions if it is above the total for the standard deduction for your tax category. In cases of IVF this is not typically an issue. Contact your tax specialist for details.
The most important thing you can do when starting the IVF process is BE INFORMED! Do your homework. This is the most important decision you are likely to have made at this point in your life (and one of the most expensive!). There is money to be found out there to help you if you need it. Don’t be afraid to dig, but protect yourself in the process.
We hope you find this information helpful. Remember, talk to your fertility specialist and contact your insurance company to discuss your options.
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What is IVF

In Vitro Fertilization (IVF) is the process in which insemination and fertiization between egg and sperm take place outdside the body in a laboratory. The fertilized embryo is deposited into the woman’s uterus via catheter in a process called embryonic transfer. The desired result of an IVF cycle is successful implantation and the beginning of a healthy pregnancy.

Infertility is defined as the inability to become pregnant after 1 year of unprotected sex, 6 months if over the age of 35. For many couples, the decision to use IVF to start or grow their family comes after months or even years of struggling with infertility.

The journey starts with a visit to the OB/GYN or primary care physician and then to a Reproductive Endocrinologist or fertility specialist. First steps include attempting to improve fertility using hormone treatment, medication or minimally invasive procedures. Intrauterine Insemination (IUI), in which sperm is placed inside the uterus to facilitate fertilization, is typically attempted before going with the fully assisted reproductive method of IVF.

Deciding to try to conceive through IVF is a big decision, as the procedure is more invasive than other methods, and the emotional and financial impact is much higher. However, the reward can be great, and we want to help make the process more clear and eliminate some of the fear that comes with the unknown.

There are 6 basic steps to In Vitro Fertilization:

Step 1: Ovarian Stimulation

Fertility drugs are prescribed to stimulate the ovaries into producing multiple eggs on the desired schedule. There are varying levels of hormones used in conjunction with a woman’s natural menstrual cycle to achieve this step. Some of the medication will be given by injection, administered by you and/or your partner at home. During this process, a woman will undergo frequent ultrasounds and blood tests to see how the ovaries are responding to the hormones.

Step 2: Egg Retrieval

When the eggs have reached full maturation they are ready to be retrieved. This is done through a minor surgical procedure using an ultrasound-guided needle to pierce the vaginal wall to reach the ovaries. This process is called follicular aspiration, and is done under conscious sedation or general anesthesia.  Ideally, at least 12-15 eggs are retrieved. This is a short procedure, lasting around 20 minutes, and may result in minor abdominal cramping and light spotting.

Step 3: Sperm Collection

On the day of egg retrieval the sperm is collected through ejaculation or testicular aspiration. It is then put through a process called “washing” to remove inactive sperm and seminal fluid and isolate the best candidates for fertilization.

Step 4: Fertilization

The sperm and eggs are incubated together, and after 12-24 hours are inspected for signs of fertilization. In 70% of cases, the egg will be fertilized during this process. In cases of male infertility resulting from low sperm count or motility, a procedure called Intracytoplasmic Sperm Injection (ICSI) is used. Here, an embryologist will inject a carefully selected healthy sperm directly into the egg using a thin needle. When fertilization occurs, the egg is transferred to a special incubator and monitored closely for 2-5 days until it consists of 6-8 cells.

Step 5: Embryonic Transfer

In this phase, a predetermined number of embryos are transferred into the uterus. This is done through a thin catheter inserted into the uterus through the cervix. This procedure is typically not done under anesthesia. After the transfer, the patient will lie on her back for a couple of hours before going home for more rest.

Step 6: The Waiting Game

Even with all of the injections, exams and procedures you’ve endured in the IVF process, this last step can be the hardest. Now you will rest and look for early signs of pregnancy. This is known as the “Two Week Wait”. Within these two weeks after the transfer, you will take a pregnancy test. This will be a blood test administered by the doctor. They will also test progesterone levels at this point, and possibly over the next few days.

If the test is positive, you will continue to be monitored closely throughout the early pregnancy. While women who conceive naturally will have only a few ultrasounds throughout pregnancy, you will have them very frequently, especially in the first trimester.

If the test is negative, you and your partner will need to make a decision as to how you will proceed. Remember, no one can make this decision except you.

Assisted Hatching

Assisted hatching is a relatively new technology used in the IVF procedure. It is performed to help in the implantation of the embryo. In the initial stages of development, the embryo is enveloped in a layer of proteins called the “zona pellucida”. This forms an outer shell that protects the embryo until it reaches the blastocyst stage. To successfully implant in the uterine wall, the embryo must hatch out of the shell. It was determined that some embryos have a difficult time hatching, either due to lack of energy or a somewhat thicker shell.

How is Assisted Hatching Performed?

The procedure is done on the 4th day of embryonic development. The embryologist uses micromanipulation to hold the embryo in place while a pipette holding an acidic solution is placed against the wall of the zona pellucida. As the acid is released a small hole or defect in the shell. The embryo is then washed in a solution and then held in an incubator for a few hours awaiting transfer to the uterus.

Who Can Benefit from Assisted Hatching?

This procedure may be recommended for the following cases:

  • Advanced maternal age (over 37)
  • Women with elevated FSH on day 3 of their menstrual cycle
  • Couples who have had failed IVF attempts
  • Poor embryo quality

What are the Risks of Assisted Hatching?

As with any assisted reproductive technology there are associated risks. The procedure can cause damage to the embryo with a reduction in viability. The likelihood of identical twins is also higher, as the procedure can cause the embryo to split into two identical halves.

Success Rates

Assisted hatching has fairly high success rates, but they vary greatly between clinics. This is due to the very specialized procedure and skill required. Talk to your doctor to discuss whether assisted hatching is right for you.

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Blastocyst Transfer

The blastocyst phase of a developing embryo takes place at day 5-6 after fertilization. At this phase, the embryo has 70-100 cells and is much more complex than its previous forms.

Traditionally in in vitro fertilization, the embryo is transferred to the uterus on day 2-3 after fertilization. One reason for this is the inability, until recently, to create a culture environment that could house the embryo and facilitate its growth during the next 3 days to reach the blastocyst phase. Medical technology has made great strides in this development and we are seeing much higher percentages of embryos making it to the blastocyst phase in the cultures. Blastocyst Transfer

Blastocysts are more likely to implant than 2-3 day embryos since it is not until day 5 that a naturally conceived embryo makes it to the uterus. At the 2-3 day stage, the embryo is still in the fallopian tubes, and may not be as equipped or ready for implantation as it will be with the added development time. Only about one third of embryos make it to the blastocyst phase, so the ones that do are stronger and better equipped to result in a viable, healthy, full-term pregnancy.

There is a lower chance of multiples when doing blastocyst transfer, because in general fewer blastocysts than embryos are transferred. This is because fewer blastocysts make it to the 5-6 day period, but the ones the do are more viable and have a higher chance of successful implantation. It should be said that there is still a chance that a blastocyst can split and create identical twins, but this is rare and the rates are in keeping with the rates of naturally occurring identical twins.

It is becoming more and more common for blastocyst transfers to be offered as an option for those going through IVF. However, not all clinics offer it. As the technology improves and the necessary equipment to conduct the procedure becomes more available, we should start seeing it more. Talk to your doctor about your options and to get more information about blastocyst transfer.

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IVF and Sex

One of the major issues that couples face when going through fertility treatments to start a family is what the process will mean for their sex life. We know that most of you out there have your eye on the prize, so to speak, and the main objective in this journey is a baby. Balancing your needs, the needs of your partner, and the large amount of (often conflicting) information on the subject can be overwhelming. We want to talk a little bit about the implications of fertility treatments, and specifically IVF, in the bedroom, both clinically and emotionally.

 

Let’s Talk About Sex

If you are reading this, you have probably been doing a lot of talking about sex, or at least thinking about it. We learn as young people that this is how babies are made. When did it get so difficult?! We want you to know that it is a very common thing for couples to not be able to conceive a child naturally through intercourse. In fact, infertility affects nearly 12% of the reproductive-age population in the US—that’s around 7 million people! You are not alone! Infertility is defined as the inability to conceive after 1 year of unprotected sex (6 months if over 35).

 

Throughout the process of fertility treatments—from diagnosis to assisted reproductive technologies like IVF—you and your partner will be poked, prodded, and tested more than you can imagine. A woman going through IVF will be injected full of stimulating hormones, and chemically placed into menopause, all before the eggs are retrieved. For most couples, sex is the last thing on their minds during this stressful period. But many ask, “Can we have sex?” The answer to this question will differ from doctor to doctor, and clinic to clinic. The most common instruction is to abstain from sex between the embryo transfer/implantation and the first beta. This is the first blood test taken two weeks after transfer to check for early signs of pregnancy. One main reason to not have sex in this period is that uterine contractions during orgasm could interfere with implantation in the early stages. For this reason, some doctors say sex without orgasm is OK, and some recommend condom use and “gentle” intercourse if the couple is eager to resume intercourse. This is a very critical step in the IVF process, where you want to maintain the most conducive environment possible for implantation and early pregnancy. To many, this is just too critical a time to introduce any other factors. Some women are advised by their doctors to abstain for only 24-48 hours after transfer, and you will find women who have been told everything in between. You should get as much information as you can on this topic, but ultimately you will make the decision based on what feels right for you and your partner.

Sex Before Transfer

As we have learned, the IVF process begins with hormone injections to stimulate the follicles to produce multiple, viable eggs. This period is commonly called “stimming.” Many women experience tenderness and pain as the ovaries will become physically larger while they are working overtime producing eggs. There is a risk of ovarian torsion during this period. Ovarian torsion occurs when an ovary is twisted in such a way that the ovarian vein is distressed, resulting in severe abdominal pain and only resolved through surgery. Enlarged ovaries are at particularly high risk for this. It is for this reason that all torso-twisting activities and other abdominal exercises are not advised during stimming.

In the days after egg retrieval, it is advised to abstain from intercourse due to the risk of infection. The wall of the cervix and uterus will be sensitive from the retrieval procedure. Most women experience discomfort from the enlarged ovaries and the Procedure itself. You will see anything from 24 hours to the entire period between egg retrieval and embryo transfer to wait to have sex. This is up to you and your comfort level, and the advisement of your doctor.

Just to make things confusing, many doctors actually advise that you have sex the night before the embryo transfer, with many specifying sex with an orgasm. The seminal fluid has some hormones that some say can soften the cervix and make transfer easier. Orgasm increases blood flow and could help with implantation. On a personal level, you may opt to have sex at this point if you plan on abstaining during the period between transfer and first beta, as is the most common recommendation. Once again, this is up to you. The bottom line is that sex at this point is unlikely to have negative effects, providing you are feeling up to it, and it may actually have a positive effect on the process.

Sex after Transfer

And then comes the big day….embryo transfer. This is for what you have been waiting and prepping your body for weeks, probably longer. The period after the transfer is a very sensitive time for your body. The healthy young embryo(s) have been implanted into your uterus and it is now up to your body to create a welcoming and healthy environment in which they will thrive.

Once again, you will find different guidelines on sex during this period from different doctors. The overwhelming majority say no sex between transfer and first beta, the blood test to detect signs of early pregnancy given 2 weeks after transfer. In addition to sex, it is recommended that you abstain from baths and hot tubs, all exercise, lifting anything over 5 lbs, alcohol, and various other things. This issue of extended bed rest is a heavily contested one, with most practitioners believing it to be too extreme and actually detrimental to the process as it limits blood flow to the uterus. What most all do agree on, however, is at least a 24 hour period of limited bed rest, no showers, nothing strenuous.

After the dreaded two week wait, you will have your first beta HCG test, which will test your blood for the hormone beta human chorionic gonadotropin. It is the most accurate and reliable pregnancy test you can take. Depending on the results, you may have more beta tests until the doctors determine that you are pregnant and safely out of the danger of an ectopic or chemical pregnancy. You may be advised to abstain from sex until the first beta, or throughout all of them, or until the first ultrasound or confirmation of heartbeat. Some women opt to wait until they are through the first trimester. After you are released by your doctor for sexual activity, it is up to you and your partner how long you will wait.

Bottom Line …

For each doctor or clinic you talk to, you will likely hear a different set of recommendations on sex during IVF. We have heard just about all of them! Our goal here is not to tell you what is right or wrong, but to offer as much information as we can to help you make that decision yourself. It ultimately comes down to what you and your partner are comfortable with.

And for the Men?

We have talked a lot about what is going on inside the woman’s body during IVF and how it is affected by sex. What about the man? What are the instructions he will hear as you go through the IVF process? If you and your partner are using a fresh semen sample, he will produce this through ejaculation on the same day as the egg retrieval. He needs to not have ejaculated for 3-5 days before giving his sample. It is a small window between waiting too long and not waiting long enough. He needs to have clean pipes but a few days buildup so the most optimal sample is produced! After that his work (as far as this goes!) is done.

Have sex

From the Clinic to the Bedroom

As we all know, there is a lot more to the question of sex during IVF than a doctor’s recommendation. The journey you will go through is long and can be stressful. You are hyper-focused on one thing: having a baby. It is important to keep your needs and the needs of your partner in mind. it is easy for your relationship to be pushed aside as you put all your time and energies into IVF.

IUI Cost 2012

The total cost (explained below) of and IUI procedure, assuming you have no insurance and are paying everything out-of-pocket, and that everything is included, ranges from about $1200 to $2000. This is based on a survey of many couples who have recently undergone IUI. The picture below shows the range of IUI costs in 2012. The rest of this article breaks this cost down into its various parts.

As you can see from the above picture, the total costs may vary significantly depending on your Obstetricians (OB) or Reproductive Endocrinologists (RE) practices, especially when it comes to the cost of ultra-sounds, medications and the number of appointments. For more specifics, keep reading.

IUI Cost 2012 Breakdown

Here is a typical breakdown of the total out-of-pocket IUI cost.

  • The collection, sperm washing and IUI procedure itself averages about $350. This can be broken down further into the IUI procedure itself at around $250 and the sperm wash at about $100.
  • The blood work is around the $150 mark.
  • Ultrasound costs vary a lot, from about $65 to $450 and you can expect between 2 and 3 per IUI.
  • HCG trigger (Ovidrel or equivilant) will be about $110.
  • Other medications like Clomod are generally the cheapest part being about $5 to $50.

In the research we have done, it seems that there is no real standard for how much of these costs your insurance will cover. Also, you may want to keep in mind, that for each cycle of IUI you may need to go in to see your doctor or specialist several times, each incurring a co-pay cost. Furthermore, if your workplace has a religious affiliation, e.g., a Catholic hospital, your insurance may not cover infertility treatments at all. It is always best to contact you health insurance provider prior to treatments so you are sure of what the cost to you will be.

Cost of IUI Associated Medications

For each IUI cycle, your OB or RE will most likely recommend that the woman take a hormone therapy designed to increase the number of eggs produced, thus increasing the chances of a successful fertilization (while also increasing the chances of twins!). This medication is sometimes called the “trigger” as it helps trigger the release of multiple eggs. The cost of the trigger, and other associated medications can vary wildly and it may well be worth your while shopping around some, asking others, and doing some investigating within (or even outside of) your local area for some significant savings. E.g., some REs may charge several thousand dollars per cycle for IUI medications, which is on par with IVF medication costs.

“Clomid” or “Inject” IUI Cycles

In general there are two types of IUI cycles. The first uses the medication “Clomid” and is generally cheaper. This is associated with the $1200 total cost peak in the picture above. The “Inject” IUI cycles are more involved with take home medications that require injections. These are associated with more expensive $2000 peak in the cost statistics picture.

Please let us know in the comments below how much you’ve spend on IUI in 2012.

What is IUI

For couples experiencing infertility, there are several, proven assisted reproductive technologies that differ in their invasiveness, success rate, and cost. IUI, which stands for Intrauterine Insemination, is typically the first of the assisted techniques suggested by a doctor since it is the lease invasive, has high sucess rates for certain causes of infertility, and is by far cheaper than IVF (In Vitro Fertilization) and ICSI (Intracytoplasmic Sperm Injection). Basically, IUI uses a medical device to deposit the sperm very close to the egg, much closer than during intercourse, so that they don’t have far to swim to fertilize the egg. Think of it as a head start for the sperm. The fertilization process still occurs naturally within the woman’s body, not like IVF where fertilization occurs outside the body in the laboratory. In this article we will discuss more details about IUI, which causes of infertility it may be successful in overcoming, and its relation to other, more invasive assisted reproductive technologies like IVF and ICSI.

IUI Procedure

IUI is a technique that basically gives a man’s sperm a bit of a head start by bypassing much of the path to the woman’s egg. By injecting “washed” sperm directly into the woman’s uterus (this is what the “IntraUterine” part of IUI means) using a catheter, much closer to the eggs, the chances of fertilization are much improved. The sperm used can be from a partner or donor, but in all cases the sperm is “washed”. What this means is that a semen sample is taken from the man and much of the non-sperm material that makes up the semen is removed. Sperm only makes up about 1% of the composition of semen, the rest is mostly fructose (sugar), water, protein and enzymes. All that is needed for ferilization is the sperm, so the rest is removed for the IUI procedure.


The steps in the sperm washing procedure. The semen sample is placed
in a centrifuge to separate out the spem from the surrounding fluid.

The injection procedure itself is quite simple. A tube, or catheter, is inserted vaginally into the woman’s uterus as shown in the figure below. The inserted end of the tube is quite close to where the eggs are produced. Once inserted, a syringe containing the washed sperm is attached to the external end of the catheter and the sperm injected.

IUI procedure showing how a catheter is used to inject washed
sperm directly into the uterus. The inset shows the sperm must still swim a short distance
and fertilize the egg in the natural way.

IUI Procedure Preparation

The first thing to know about preparing for an IUI cycle is that timing is everything. If you’ve been trying to concieve for some time prior to your first IUI, you are probably already used to calculating the optimal time to try and conceive. The right time is immeadiately after, or with, ovulation (i.e., when an egg is released by the ovaries down the fallopian tube). In general, the egg(s) can only be fertilized with one day (12 to 24 hours) following ovulation. As such, ensuring that the sperm reach the egg at the correct time requires some preparation.

A preliminary step to IUI is determining if there are any infections, hormonal issues, or obstruction problems. Such issues may reduce the chances of IUI succeeding, or prevent IUI all together. More on this in the next section.

So back to the timing. The first step is to determine exactly when a woman is ovulating. To do this doctors use an ultrasound (transvaginal) to monitor the ovaries and signs of egg growth. The technical name for this is ultrasound follicular monitoring and can be one of the largest costs associated with IUI, especially if 3 or 4 of these are required per cycle. The doctor can determine when mature follicles have been produced. These follicles turn into eggs. Another method for determining the precise timing of ovulation is to monitor the levels of luteinizing hormone (LH). This hormone is produced by the pituitary gland at the mid-point of the menstrual cycle and triggers ovulation to begin. The typical over-the-counter ovulation tests simply measure the LH level to let you know you’re about to ovulate. You may also be placed on oral contraceptives for a couple of cycles. This may seem counterproductive to the process, but this allows the doctor to control the timing of the egg realease. Once the doctor has detected an increase in the LH levels and determined that you are ready to ovulate , you can expect an IUI to be scheduled for the following morning. As you can see, there will be lots of doctor’s appointments, testing and scheduling when attempting IUI.

So what about the men? Well up until ovulation, the man has to do only one thing. That is to NOT ejaculate for 3 to 5 days before ovulation is scheduled to occur. He will be required to produce a semen sample, either at home or in the doctor’s office on the day of the IUI procedure. If you are using donor sperm, you will want to coordinate with either your donor, or donor bank such that the sperm is provided to your doctor by the scheduled day.


An actual IUI catheter used in the IUI procedure.

Ovulation Stimulation

To increse the chances of a successful fertilization, IUI (and other techniques like IVF and ICSI) is typically done in conjunction with ovulation stimulation. This is the process of using medication to stimulate the woman’s body into producing more than one egg per menstrual cycle. If there are more eggs, the sperm have more targets and the chances of pregnancy go up accordingly. The medications used to stimulate multiple egg production are usually Clomid (Clomiphene Citrateor) or a class of drugs called gonadotropins (e.g., hMG). These drugs prevent the natural increase in LH from the pituitary gland to give the body time to continue producing eggs, so an injection of another medication called hCG is used to “trigger” ovulation within 36 hours. If a hCG “trigger” shot is used, the IUI is typically scheduled for 36 hours after the shot, mark your calender accordingly.

When is IUI Appropriate?

Doctors will not recommend IUI for everyone experiencing infertility. This is for two basic reasons. The first is that some causes of infertility cannot be overcome by the IUI assisted technology, and the second is if the probabiity of success is so low that it would make more financial succes to go straight to IVF or ICSI. For example, women who are older than 43 are typically recommended to go straight to IVF as the success rates of IUI drop with age. Other causes on infertility in which IUI will not be helpful are blocked fallopian tubes, severe fallopian tube damage, very low egg quality, menopause, or motile sperm count less than 5 million. For cases where IUI is appropriate (the majority of cases), read on.

Treating Male Infertility

This fertility enhancement technique can be used to overcome both male and female based fertility problems. For example, in male infertility the problems are typically a low sperm count and / or decrease sperm motility, i.e., not many sperm, or not many strong and fast sperm. In such a case, the IUI procedure makes the distance the sperm must travel to find an egg much smaller, essentially placing the sperm very close to the finish line. Once inside the uterus, the sperm still must compete to be fertilize any available eggs.

Treating Female Infertility

In female based fertility difficulties, for example cervical scar tissue or above average cervical mucus viscosity, the IUI procedure uses the catheter to allow sperm to bypass these difficult regions, once again increasing the chances of successful fertilization.

Types of IUI

There are a couple of medication regimens that can accompany an IUI cycle. These are usually referred to as “Clomid” and “inject” type IUI cycles. The Clomid type is just what we have described above. Below we descrive how the “inject” type cycle differs, and also a somewhat newer approach known as “twice a cycle” IUI.

Inject IUI

As we discussed above, there are two types of medication used to stimulate ovarian production giving multiple eggs. These are the gonadotropins and Clomid. The gonadotropins (e.g., hMG) are typically self-injections that you or your partner do at home throughout the menstrual cycle. Your doctor will help you decide whether oral Clomid, or “inject” type IUI is right for you. Some deciding factors are age and if there is a history of ovulation problems. The “inject” type IUI is considered to be more a aggressive treatment and as such is usually recommended only to younger women. However, it is also true that the “inject” type IUI may be recommended for women over the age of 35, also because it is more aggressive and may allow fertilization sooner rather than later. An example of an “inject” type IUI is using Follistim instead of Clomid. Follistim consists of highly purified rFSH Rec, which is a recombinant follicle stimulating hormone and may have higher success rates than the normal Clomid IUI.

Twice-a-Cycle IUI

In recent years “twice a cycle” IUI has become popular. As we discovered above, timing is everything in IUI. The twice a cycle method basically tries to improve the chances of getting the timing right, by trying the IUI procedure one day following the trigger shot, and again at two days following the trigger. There have been several studies that suggest this approach increases the chances of fertilization. However, it does cost more, but usually only double the IUI procedure cost itself, i.e., an extra $350 or so.

IUI Cost

The cost of IUI can be a little confusing. Mostly because people mistakenly think the cost of the “IUI procedure” is the “total IUI cost”. It is not. The total IUI cost covers the entire IUI cycle, not just the IUI procedure (the actual injection of the sperm using the catheter). This includes doctor’s appointment costs, blood work, ultrasounds, medications, sperm washing, and other costs. You can expect the total IUI cost to be between $1200 and $2000 per cycle. It will depend on your particular circumstances, for example, the number of ultrasounds needed, or whether you use a sperm donor or not. For more information please read our article on the cost of IUI.

IUI Sucess Rates

The success rates vary, especially with age, but in general the odds of a successful IUI procedure is about 1 to 2 in 10 (10 to 20 %). While this is much less than IVF and ICSI, the cost of IUI and the overall difficulty of the procedure is less. It is often recommended that IUI be tried before IVF. Also, it is common that the doctor prescribes some type of additional hormone treatments for the female to increase egg production, hopefully giving multiple eggs for the inserted sperm to target and increasing the success rate.

A Note on Post IUI Pain

While the IUI is a relatively non-invasive technique, it does still involve inserting a catheter quite a long way into the uterus, near to the fallopian tubes themselves. As such, the day of, and perhaps several days after you can expect some discomfort. The level of discomfort can range quite a lot, with those having a sensitive uterus possibly experiencing pain that will require medication and confining you to bed. Others will barely notice they had the procedure. A special note for those who do not ovulate regularly, or whom have never ovulated, the trigger shot that induces the ovulation may further induce ovulation pain that your body is not accustomed to.

Ovarian Hyperstimulation Syndrome

Ovarian Hyperstimulation Syndrome (OHSS) is a potential side effect of fertility medications used to stimulate the ovaries into producing multiple eggs in an IVF cycle. About 30% of women going through IVF will experience some level of OHSS, with 10% experiencing moderate to severe cases. It is found to be much more common in cases where injectable medications are used, as opposed to Clomid or other drugs taken orally.

If the ovaries become overstimulated during treatment, they can swell, causing a build up of fluid. This fluid can leak into the belly and chest area causing bloating, mild weight gain, mild nausea, mild pain or abdominal discomfort and/or diarrhea. More serious symptoms include: rapid weight gain (more than 10 lbs in 3-5 days), severe bloating, severe abdominal pain, severe nausea, shortness of breath, and accelerated heartbeat.

Prevention and Treatment

OHSS can only occur after ovulation. If a risk is suspected, the doctor may cancel the IVF cycle and freeze any fertilized embryos for a future cycle. They may also decide to try to delay ovulation using a medication such as a GnRH antagonist, or to delay administering the hCG trigger shot. Delaying ovulation by a few days will greatly lower the risk of OHSS, but may decrease the chances of achieving a successful pregnancy.

Close monitoring during the early stages of an IVF cycle through blood tests and ultrasounds is necessary to prevent OHSS. Rapidly increasing estrogen levels or many visible larger follicles are indicators of the condition.

If mild OHSS is suspected, you can most likely alleviate the symptoms at home and avoid a more serious case. Take an over the counter pain reliever, monitor weight gain, avoid overexertion but maintain light activity, avoid sex, alcohol and caffeine, drink plenty of fluids, and put your feet up.

More extensive treatments include IV fluid replacement and removal of fluid from the belly through needle aspiration. These are rare cases, and usually through close monitoring and prevention they can be avoided.

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Improving Fertility with Clomid

Clomid is the marketed name for the medication clomiphene or clomifene. It is a medication used to stimulate ovulation to reverse oligoovulation (light or irregular ovulation) or anovulation (absence of ovulation). It is taken as a fertility treatment by itself or in preparation for other procedures, such as intrauterine insemination (IUI). Taken in pill form, it is not normally used in conjunction with IVF, in which injectable fertility drugs are more commonly used. Clomid is one of the more inexpensive treatments as is therefore widely used. The standard dose is 50mg taken for 5 days, on days 3-7 or days 5-9 of the menstrual cycle. Dosages may be up to 150mg, but will not be higher than that.

Side Effects and Risks

Some reported side effects are blurred vision, hot flashes, nausea, and irritability. The most common risks are multiple births. There is a 10% chance of twins when taking this drug. At dosage levels at 150mg or higher, the cervical mucus is thinned, making it more difficult for the sperm to make its way to the egg. The uterine lining can also become thinner and less ideal for implantation. For these reasons, the dosage should stay around 50mg. Six cycles of Clomid are all that is typically recommended. If pregnancy is not achieved after this, alternative methods will be discussed with your physician.

Success Rates

Clomid will induce ovulation in 80% of women, and 40-45% will get pregnant within 6 cycles of use.

Clomid for Men

While only FDA-approved for women, Clomid is frequently prescribed for men dealing with infertility, in the form of low sperm count or poor sperm motility or morphology. The pituitary gland controls the production of testosterone in the testes by releasing a luteinizing hormone (LH) to stimulate the cells to make testosterone. Testosterone is converted to estrogen in women, and the estrogen tells the pituitary to stop making the LH. Clomid works in men by blocking estrogen to the pituitary. It sees less estrogen, responds by making more LH and therefore more testosterone is produced. The reported side effects in men are similar to those in women.

Clomid is commonly used by anabolic steroid users to block the effects of estrogen and increase the natural production of testosterone. For this reason, it is on the World Anti-Doping Agency’s list of illegal drugs. What does this mean? If your partner is undergoing infertility treatments and is prescribed Clomid, he will have to hang up his dreams of winning the Tour de France or an Olympic medal.

Bottom Line

While Clomid is not FDA-approved for use in men, it is still prescribed as an “off-label” drug by doctors in many cases. Keep the dosage as low as possible and keep track of side effects. Altering the hormonal balance of your body is serious and great care must be taken to prevent negative results.

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