Lessons Learned After Four IUIs

Within the span of one year, I underwent four intrauterine inseminations (IUIs) in an attempt to become pregnant. The reproductive endocrinologist who treated me had all the right credentials, plus a high success rate in making many couples happy. More importantly, my uterus appeared healthy, and so did my ovaries. The only thing I had going against me was my age. I was in my late 30s, and the quality of my eggs proved to be the one unknown that made all the difference.

Lesson #1: It’s All About the Odds

The timing of ovulation and the chance of successful fertilizing of the egg(s) with the help of IUI is greatly enhanced in comparison with natural conception. The quality of a woman’s eggs (and hence of the future embryos), however, is equally uncertain in both cases.

Statistically, as a woman ages beyond her late 20s, the quality of her eggs starts to quickly deteriorate. Although IUI can increase the number of eggs that mature and ovulate in a given cycle, it has no control over the health of these eggs. The success of the procedure often lies in the numbers—the more eggs get released, the greater the chance that at least one will result in a healthy pregnancy.

In my case, egg quantity was rarely a problem. Egg quality, however, was another matter. Out of the six eggs I had released during IUI #2, only one was able to implant after fertilization, but even it wasn’t healthy. (Trisomy 13 was detected at my tenth-week blood test.)

Thus, particularly if you are older than 35, IUI would not guarantee you a successful pregnancy right away. Provided that nothing is wrong with you anatomically, you could theoretically conceive with IUI even after several miscarriages. You just may have to repeat the procedure a number of times. (I gave up after IUI#4.)

If you do not want to rely on chance and go through the same process month after month (for who knows how many months) until you end up not only pregnant but having a fetus with the right number of chromosomes, talk to your doctor about in vitro fertilization (IVF). Albeit for an extra cost, this more complex procedure allows you to test the fertilized eggs and find out if they are chromosomally normal. You can then implant only the healthy ones and thus highly increase your chance of success.

Lesson #2: The Definition of Successful IUI Is Fuzzy

Consider the following situations involving IUI: (1) You undergo one or more procedures but fail to get pregnant. (2) You manage to get pregnant but suffer a miscarriage later on. (3) You manage to get pregnant and stay pregnant, but your fetus is diagnosed with a genetic or chromosomal abnormality, and the baby will most likely be stillborn or die soon after birth.

In situation #1, the IUI is undoubtedly unsuccessful. True, it is possible that your next IUI will result in a healthy pregnancy, but then again, maybe not. Until you have some confirmation that fertilization and implantation have occurred, you can consider the procedure a failure.

Situation #2 is trickier. Yes, the procedure has helped you ovulate one or more eggs and fertilize them successfully, but your goal is not merely to achieve pregnancy—it is to give birth to a baby (or babies). To me, if you have to try again soon, the IUI has failed. (Note that many clinics do not include chemical pregnancies when they tally their numbers of successful IUI attempts.)

Now let us consider situation #3. Clearly, the problem with the health of the fetus has nothing to do with the IUI itself. So was the procedure successful? Some would argue that yes, it had accomplished what was expected of it—help a woman have a child. But again, was the woman’s goal to merely give birth or to produce a healthy child? I’ll let you decide for yourself.

Lesson #3: IUI Might Rob You of Time You Do Not Have

If you are in your late 30s or older, chances are you will need several IUIs before you get pregnant (assuming you do get pregnant). If your ovaries and uterus are in good shape, you can start a new IUI immediately after the previous, but if you are having miscarriages after several weeks of pregnancy, the time between attempts can stretch to several months. In the meantime, your ovarian reserve is only getting smaller, and the health of your eggs continues to deteriorate.

To achieve pregnancy faster, you might want to consider IVF directly (or after a couple of failed IUIs). Don’t let quoted prices prevent you from making this decision.

Lesson #4: IUI Isn’t As Cheap As You Think

If your insurance covers most or all of the IUI procedure, including the cost of the medications, you have nothing to worry about. If you are paying out of pocket, I recommend you read my posts “IUI vs. IVF: Cost Factor Revisited” and “IUI Cost.”

The bottom line is, you need to consider the high likelihood of having to repeat the procedure. The cumulative cost of all IUIs that you might need to undergo before you achieve a successful pregnancy could equal or exceed the cost of IVF. Plus, don’t forget you would be spending not only money but time. Time is directly proportional to the quality of your eggs and thus to your chance of becoming a mother. Spend it wisely.