Pioneering Parenthood: Is Intrauterine Insemination for You?

In this enlightening episode of "Taco Bout Fertility Tuesday," we delve into the world of Intrauterine Insemination (IUI), a popular and often misunderstood fertility treatment. Join us as we unravel the mysteries of IUI, offering hope and clarity to those exploring their options on the path to parenthood.

We start by demystifying what IUI is and how it differs from other fertility treatments. Hear from a leading fertility specialists about who can benefit from IUI, and learn about the process. 

This episode is not just about the medical facts; it's a journey through personal stories and expert insights, aiming to empower and educate our listeners. Whether you're considering IUI, know someone who is, or just curious about fertility options, this episode offers a compassionate and comprehensive look at IUI's role in modern fertility treatments.

Tune in for an informative and supportive exploration into the world of IUI, and take a step closer to understanding your fertility journey.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.

Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.

Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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Today we talk about are IUIs for me? Should I waste my time or just. Go straight to IVF? I'm Dr. Mark Amos, and this is Taco About Fertility tuesday. When it comes to IUIs, I hear a lot of people always say that they don't think they should do it. Because it's a waste of their time. That they know friends who did them. And had to go on the IVF. And so they just want to jump straight to IVF. And why I wanted to do this. Episode is I want to really make sure people understand the chances of IUIs and who should go straight to IVF. And who should try IUIs. No one's ever going to be able. To tell you if the IUIs are going to work. But what I can tell you is they are more successful than you may think they are. And if the right person is doing them, they're actually very successful. The problem is a lot of places are like a factory mill. Everyone gets the same thing. They have to do six IUIs first and if they don't get pregnant, then they go on IVF. And so it can be very frustrating. Because you spend all this money and emotion and heartache on these IUIs and. When they don't work, you feel like. I should just put all that money towards IVF. And so we're going to go over. A couple things about this, talking about. What is an IUI, who are the candidates for IUI, talking about how IUI. Differs from other treatments. And then the last thing we're going to kind of go over is how. Many IUIs should you do? So the first question is what is an IUI? IUI stands for intrauterine semination. It means where we take the sperm and inject it into the uterus. Usually this is associated with what we. Call ovulation induction where we give you. Medicine to make more follicles. And so the way we improve your chances of getting pregnant is because we are bypassing the vagina by putting the sperm right in the uterus. So if there is sperm antibodies or. A hostile environment, it would bypass that. The other benefit is the sperm then is clean. It is the best of best sperm that's injected in the uterus. There's even more sperm being put in. The uterus than would be naturally. Naturally. There's millions and millions of sperm, but. Only 100,000 sperm get into the uterus. Now millions get in the uterus, which help improve even in a normal semen analysis, the sperm is not perfect. And so there could be problems where. The sperm struggles to get to where. It needs to be. And so the IUI helps that by removing a lot of the sperm that. Get in the way and by putting. The best sperm in the best position to have success. Anyone who has flopian tubes that are. Open and have sperm counts at least above 10 million per eaculate are going to be decent candidates for IUIs, but there are certain candidates that are better than others. For example, if you have low sperm counts, but they're not super low above 10 million, then you'd be a great candidate for IUIs. In fact, there are some men who have motility issues where the sperm quality. Isn'T that good, but they have plenty of sperm. They are fantastic candidates for IUIs. People with unexplained infertility where there's not an obvious cause, but they've only been. Trying for less than a few years. They are decent candidates for IUIs. Other candidates for IUIs are going to. Be people who sometimes have problems with. Ejaculation or have, problems with erections. Now, IUIs can allow the timing to be perfect because you can maximize the chances of the sperm and egg being. There at the same time. Same sex couples or couples using donor sperm are also great candidate for IUIs. Because there's really not infertility it's just. Needing to get the sperm in the right place. Now, out of that group, probably the. One that's not as great as the rest of the group is the unexplained infertility. And I usually break that into a. Couple years of trying to determine who's the better candidates. If someone's only been trying for a year, I think IUIs are fantastic. If someone's been trying for three years, I don't waste my time with IUIs. So I would tell people, if you. Have two years of trying and not. Getting pregnant, and it's not something wrong with the tubes, the sperm count isn't very severe, it's not unreasonable to try IUIs. But if it's been over two years, you're really on that line where it. May not be worth doing IUIs, and there's a good chance it may not work. Now, the question is, how much does it work? Well, this is going to depend a little bit about where you do the IUI cycles. So the IUI itself is cleaning the sperm injecting into the uterus. But the way you put the cycle. Together makes a difference, too. Someone who is 25 years old and. You give them Femara and you make a few eggs, that's going to be good enough. But if you are 42 years old and you're just getting Femara, it's probably not going to help you. So in general, we like to give numbers such as Femara only IUI cycles or clomid only IUI cycles are somewhere around a twelve to 14% live birth rate, which is pretty low. I honestly only use that type of protocol in people who are very high candidates for IUIs, such as six steps couples, or people who don't want twins, or people who just have a low sperm problem. It's going to fix it. We don't need to make lots of eggs. But in people who are more mature or who have been trying for a year and a half, they may benefit. From making more eggs. Now, again, we don't want to get crazy here and be the next Octomom. But on the same token, you have. To also think about who you're treating. If you're under 35, we know 60% of eggs are going to be normal. You don't need to make more than two eggs. You can even get away with just two or three. But we know at 42, over 80%. To 85% of eggs are going to be abnormal. It takes four to eight eggs potentially to get a couple of good ones. And so someone who is at 40, I'm wearing a minimum of three to four eggs. By 42, I'm shooting for four to five eggs. And so when we talk about chances of getting pregnant, it depends on the aggressiveness of the protocol and the appropriateness of the protocol. Appropriateness matters based off of the person's age and situation. I would never give that strong of a protocol to someone who's 26. But if that 26 year old happened to have severe dementia, ovarian reserve, like. That 42 year old has been trying for a long period of time, I'm. going to be more inclined to be more aggressive. Now, again, aggressiveness means just to help improve chances. You don't just make a lot of. Eggs if it's a sperm problem, because. Once you do the IUI, you fix the sperm problem. In that situation, you want to back. Off a little bit. But if it's an egg issue, you need to adjust. In my experience, people who are great. Candidates, such as single SEPs couples, people who have low sperm issues, but the sperm counts are good in those situations. I find 50% of people eventually get. Pregnant when doing IUIs. If it's couples that are not good. Candidates, it tends to be lower, even around 25%. So I'm not a big fan of. IUIs and those cans who are not good candidates. But if you fall into the good. Candidates, about 50% of people will get pregnant. Now, what's interesting is that if you. Are more aggressive, like I was saying. And you're giving the right protocol, I. Tend to get pregnancy rates between about 15% to 22%. Now, the important part here is, again. Making sure it's appropriate for you. So I don't want you to feel like you should be asking your doctor to be more aggressive. You may not need that. If it's just a male factor problem. Then you can probably get away with. Just Femar or clomid, and that's going to be enough, and you'll probably have success. Now, the question is, how many times. Do you do it? Do you just keep doing until you get pregnant? Well, there's been studies out there have. Shown that if it's going to work, it's really going to work. In the first three to four cycles. About 90% of people who are going to get pregnant are pregnant in the first three to four cycles. That doesn't mean you can't do more. If your insurance covers it, keep doing it. Why would you want to pay to go on the IVF? Give it a few more tries, but understand that the chances of getting pregnant. Are probably going to be lower after those three to four cycles, because if. It was going to work, it's probably. Going to work right away. Now, it doesn't mean that if you. Get pregnant and let's say you have a miscarriage, well, you already done two cycles, so you only have one more left. It starts over again at that point. It'S now another three cycles. The reason it seems like IUIs aren't that good is because when you hear 15% to 22%, you're like, wow, what is Dr. Amelin so excited about? But keep in mind, the cumulative pregnancy rate is going to be close to 50%. So after doing three cycles, you'll be. 50% or even higher. Whereas with IVF, it's one cycle and. You have this high percentage, 60, 70% or higher. And so it's easy to compare those. But you have to understand that there's more involved with IVF, there's more costs with IVF. And so I think IUIs aren't used enough. I see patients skip it many times. Matter of fact, I see these patients. For second opinions who jumped to IVF too fast and then didn't have success. And come see me for a second opinion. And I tell them, why not just. Try an IUI and I get them pregnant. And they're like, I wish we didn't. Do the IVF and they jumped into it too fast because they were scared or someone told them that they needed. To do it when they really didn't. Matter of fact, patients with polycystic ovarian. Syndrome tend to do very well with IUIs if done correctly. But a lot of doctors sometimes don't. Want to spend the time of having to watch everything so closely, adjusting with injections and everything to get the right protocol to get to work. But most people just try for monoclonal. If it doesn't work, they say, okay, go on IVF. But IVF isn't always the greatest treatment. For people with PCOS. PCOS patients do actually very well with inseminations. It's just trying to find that right protocol and that's another topic for another day. But the point is, IUIs are very. Useful and I think the main thing. Is before you go jumping straight to. IVF, understand that most people are pretty. Good candidates for IUIs. And I do agree no one should just do them to do them. I think that's a waste. And I see clinics all the time, do like time intercourse first and then do IUIs, and then they go on IVF. And why did you go through all that? There was no reason. Sperm was too low. You should have went straight to IVF. But there are times it is worth doing that. And that's where you need to talk. To your doctor and you need to. Find out what is best for you. And if you have any questions and. You feel like, maybe that isn't right for me, ask them. And if you need to get a second opinion, I do the things the way I do them because I believe in them, but doesn't mean I'm always 100% correct. And so second opinions are great, and. So get yourself a second opinion if needed. The next part is that it's not. Just IUI or IVF. There are other things in between. So for some people, there could be things where seeing a urologist to help. Sperm levels maybe get to the point where you don't even need IUIs or IVF. You can end up maybe needing a. Laparoscopy because maybe you have endometriosis and. You need to clean it up. But there's also other treatments. For example, not every clinic does this. But there's called IVC intravaginal Culture, which. I will be doing the episode on in the future. And there it's kind of an in. Between IUI and IVF. And that's perfect for couples who maybe say, like, listen, we just want one kid, we have donor sperm. We'd, rather do something that has a higher chance with IVC. You basically do a low stem, like. An IUI, but you extract the eggs. From the body like an IVF cycle. But then we put the eggs and sperm into a little pod that then goes into the vagina and sits there. For the next five days. Then you come back in, we open it up. If we find embryos in it, we then put up the two embryos back into the uterus. And so here's something that has a much higher chance than IUIs. Each cycle can have up to like. A 60, 70% chance, but it also. Doesn'T deal with all the IVF stuff you have to do with high doses of medications. Now, it is less than IVF, but. It'S definitely better than an IUI. But again, not even everyone needs to jump to that. But I want you at least know. There are those options. In the end, no one's ever going to tell you that IUIs are better. Than or equal to IVF. If IVF was free, everyone would do IVF. But it's not free. It's also not easy. It's very stressful. And for that reason, IUIs definitely have a place. But the reason you keep hearing they're. Not as good is because rarely do people go and talk about things that are good. Usually people talk about things when they don't go well. For example, everyone's always heard about the. Patient who did IVF and then got. Pregnant on their own. Yeah, it happens. But that's not the norm. I've heard that story, too. And my wife have never had an accidental pregnancy, and most of my patients haven't. So when you hear about people going, oh, I wasted my time, I did IUIs. It could be one, they probably never should have done IUIs. Two, the other clinic wasn't maybe appropriately. Aggressive enough of the IUI, but three. The other thing is that it just. Didn'T work in that time, but there. Are many people it works for, and. Usually they don't go around saying, oh, I did one IUI and got pregnant. Because that's really not a great story. What's the cool story is that, oh, I did this and I had to go on this, and then I got pregnant. You hear about that more. But iOS do work, and if done correctly, they're a very good source of fertility treatment, and they're very easy. They can be frustrating because when they. Don'T work, you don't know why they don't work. Your doctor doesn't know why they don't. Work either, but they're a very affordable, cost effective treatment that has a very. Good pregnancy rate when done a few tries. I would never recommend anyone to just. Do one IUI unless it was like. Trying an IUI first before going to IVF. That's not unreasonable. I see it all the time. Patients come in, they say, I want to go to IVF, and I practically beg them to do an IUI. I'll even say them sometimes, I will. Literally do the IUI for free if it doesn't work. I'm so convinced you can get pregnant with IUI because they've been told they. Have to do IVF and they do. It, and they get pregnant like, oh, well, thank you for doing that. But most time, if you're just going to try one IUI, it's probably not worth it. Because if 15% to 22% chance is. Not that high of a chance, I would just do one. You really want to commit to at. Least three IUIs to give it an actual valid chance. The last part I want to go into are people who are not the. Greatest candidates for IVF. There are some women out there who. Just have such poor egg quality and. Make so few eggs that sometimes IUIs may be better than IVF. Because I look at it from the standpoint of if you only have so. Much money, let's say you have $10,000. And you can only do one IVF. Cycle and only get four eggs, but you can do ten, IUI cycles and Get 30 Eggs Over that time, then. It makes more Sense Sometimes, to do IUI if the problem can be Fixed With IUI. Clearly if the tubes are blocked, the sperm is severely low, it's not an. Option, but sometimes IUI can even be better for some people. So I'll give you example. Like with my wife, she didn't make a lot of eggs. We were not great candidates for IVF, but unfortunately, my sperm was so severe, we didn't have another option. But I can guarantee you, if we could have done IUIs, she only needs to make one egg per month. So even with a few eggs she. Made, we would have had a much. Better chances doing IUIs and getting multiple kids in the future. But unfortunately, we had to go to IVF, because IVF, although it's good nature, is always a little bit better. And so if you're the right candidate for IUI, it's a great option for you. Don't be afraid to do it. But also, it does make sense to. Look at the financial considerations. If it costs more than an IVF cycle to do three IoIs, don't do it. That doesn't make sense. But if you're a good candidate and it's affordable at your place, it's definitely worth trying. Hopefully, this episode was helpful to some of you who are maybe considering doing IUIs, or maybe you have a friend who's going to do them. let them know about this podcast, and maybe that might help them make decisions or decide to maybe try otherwise before jumping to IVF because someone told them they should go straight to IVF. As always, greatly appreciate everyone who listens to this. You love us. Give us a five star review on your favorite podcast medium. Tell your friends about us. And as always, I look forward to talking again next week on Talk About Fertility. M.