Intrauterine Insemination (IUI) is a type of assisted reproductive technology, in which sperm is injected into the uterus to improve fertilization success rates. We will discuss the circumstances in which IUI isn’t recommended or effective. We will also go over the risks of multiple births associated with its use.
The Contraindications Associated With IUI
1. Advanced Age
After the age of 30, the probability of a woman conceiving naturally decreases significantly. It declines further after age 35 and rapidly after age 40. The reason for this drop is that a woman’s eggs become less viable after the age of 30. Women under the age of 35, who receive injectable fertility drugs have about a 10-12% chance of getting pregnant. At age 40, the same women would have about a 2% chance. Therefore, IUI is best suited for women under 35. Ages between 35 and 40 is a gray area.
2. Significant Infertility in Male
Despite what others may say, in cases of male infertility, IUI does not improve success rates compared to regular well-timed intercourse. The best method to increase the chance of pregnancy is through in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) when it comes to male infertility.
3. Tubal Damage
- Post –Pelvic Inflammatory Disease (PID): It should be known that fallopian tubes do not just provide a passage for the sperm, the egg and embryo, but instead are vital organs which serve an intricate purpose in the reproductive process. They ensure that the sperm is transported in the direction of the ovaries. Additionally, the fimbriae attach themselves to the ovaries from the point the egg is being released to carry it back down the tube towards the uterus. While on its way back the egg meets the sperm and fertilization occurs. The resulting embryo is then carried towards the uterine wall for implantation.
PID is the most common cause of Fallopian tube damage. If it is not treated early enough, it can cause permanent damage to the lining of the fallopian tubes. In severe cases the fimbria fuse, which compromises egg pick-up while completely blocking the tubes.
PID usually affects both tubes, and in some cases one can be more damaged than the other. But all of them are damaged to a certain degree. For this reason, even though they may be surgically repaired, the risk of tubal pregnancy and reduced fertility is still a reality. Hence, the use of fertility medications to induce ovulation or the use of microsurgery to open fallopian tubes and remove surrounding adhesions are often not curative of infertility. In cases where pregnancy occurs, the result is often an ectopic pregnancy. This also explains the fact that the pregnancy rate following ovulation induction is likely to be much lower in women with PID. Thus, women with a medical history of PID should consider IVF as the best option.
- Post-Tubal Ligation: The same can be said following the successful reconnection of previously tied Fallopian tubes. Even with successful surgical re-establishment of the tubes, there is a degree of harming the inner lining of the tubes or shortening them. Even when the tubes are normal, the birth rate for every IUI cycle is about 10%. Following any form of tubal damage the birth rate per IUI cycle is 5-10 times lower. Therefore, IUI cannot be justified in such cases, and IVF bec