Unexplained infertility is the term used by healthcare providers when they cannot find any obvious cause for your inability to get pregnant. Many couples experience unexplained infertility, accounting for 15 to 30% of cases. The first line of treatment for couples with unexplained infertility is IUI. But does it really work? Read to know its success rate, effectiveness and when to transition to the next treatment options like IVF.
When couples have done all the necessary tests and find no cause for their fertility issues, they are said to have unexplained infertility. The tests reveal:
● Regular ovulation
● No uterine structural issues or abnormalities
● The fallopian tubes have no obstructions
● The ovarian reserve is good
● Hormonal production is optimal
● The sperm count, quality, structure and motility are normal.
In some cases, hidden causes such as minimal hormonal imbalance, mild immune responses, or issues with egg-sperm interaction may lead to this condition. However, this diagnosis does not mean you can’t have kids at all; it only means the cause is unknown based on current test results.
IUI is intrauterine insemination, a simple fertility treatment where the sperm is put directly into the uterus when you are ovulating. This helps reduce the time and distance travelled by the sperm, making fertilisation easy. The steps performed in this procedure are-
● Stimulation of the ovaries through the medications.
● The partner's or donor's semen is collected, and the sperm is washed to isolate healthy sperm.
● The sperm is placed directly into the uterus.
● If the fertilised egg gets implanted into the uterine lining, pregnancy happens.
IUI is a treatment for unexplained infertility that helps bypass cervical mucus issues or low sperm transport and other minor fertility issues, increasing the chances of conception.
IUI is a fertility treatment that is the first option for couples who are under 35 years with unexplained infertility as it is a simple, less invasive and less expensive procedure., It is less aggressive and benefits couples with mild fertility issues that may have gone undetected during tests. Benefits include:
● Timed for the woman’s fertility window, improving fertilisation chances.
● The sperm washing process increases its motility and improves the chances of reaching the egg.
● Combining it with mild ovarian stimulation increases conception chances compared to a natural IUI cycle.
Does IUI work for unexplained infertility? Yes. If you are detected with unexplained infertility, it means you have a healthy uterus, good egg count, open fallopian tubes and good sperm quality. The success rate is 7-10% per cycle.
● Combine it with fertility drugs, and it improves to 15-25%.
● IUI success rate for couples under 35 is 10% and this rises to 20% if the mother undergoes hormonal therapy.
● Healthy sperm with slight male factor infertility have a success rate of 17%.
● Higher success rates are seen in women younger than 35 years, who have a short duration of infertility (< 3 years) and use fertility medications to stimulate egg production.
IUI success rate in the first cycle is 10-20% and the odds of conception increase when they undergo 3 to 6 IUI cycles before IVF.
● Age: A woman’s fertility decreases after 35 years due to poor ovarian reserve. So, younger women have a high IUI success rate.
● Duration of infertility: Longer duration of fertility issues negatively impacts IUI as the underlying cause aggravates.
● Egg quality and ovarian response: This can be enhanced with fertility medications and ovarian stimulation.
● Sperm quality: Healthy sperm increases the likelihood of an IUI success.
● Health of the endometrium: A thickness of 7-14 mm is the target thickness for implantation to have a chance at a successful implantation.
● Lifestyle: To improve the chances of pregnancy, maintain a healthy weight, don't smoke, drink alcohol, and reduce stress.
● Timing accuracy: The two success factors of IUI are the indication of ovulation and appropriately timing the introduction of sperm.
Therefore, improving eating habits and changing to a healthier lifestyle are factors that contribute to medical treatment.
● Advanced maternal age: Fertility is known to decline with age, making it difficult to conceive, but it also reduces treatment success.
● Long fertility history: If you have fertility issues for more than 3 years, it makes IUI less effective as the underlying cause aggravates.
● Poor sperm health: IUI may fail because of poor sperm motility, low sperm count, and sperm shape.
● Low egg reserve: Many women have irregular ovulation due to low ovarian reserve, lowering egg production, resulting in an inability to conceive.
The success rate reduces after 3 or more IUI cycles, and doctors might recommend IVF, as it is a more effective treatment.
● IVF: It combines a sperm and an egg in a lab to create an embryo, which is implanted into the uterus. A 40-60% success rate in women under 35 can be expected.
● ICSI: This is recommended for couples with sperm issues. Here, a sperm is injected into a mature egg, and the resulting embryo is transferred into the fallopian tube.
● Endometrial receptivity analysis, ERA: It evaluates the optimal time for embryo transfer, tailored to an individual, improving pregnancy chances.
● PGT-A: This test is done in IVF before embryo transfer to detect genetic problems that lead to implantation failure, congenital defects and miscarriage.
Experts recommend three to six cycles of IUI before pursuing the following treatment options. If you are over 40, one IUI cycle is tried before IVF, as IVF success is higher in that age group. In some cases, skipping IUI and taking IVF treatment is a better choice. Consult a fertility specialist for a personalised treatment plan based on your age, medical history and health conditions.
Many couples have unexplained infertility. For them, IUI is a simple, inexpensive and effective treatment that is the first choice. It is best for mild fertility issues and couples younger than 35 years. Various factors affect the IUI success, and its failure is not the end, as there are other treatment options. With the proper guidance and approach, many couples have achieved a successful pregnancy with persistence, and you will too.
IUI is the first line of treatment for unexplained infertility. Consult your doctor as the treatment depends on your health conditions.
Yes. IUI can be successful in the first try, especially if you are below 35 years old.
Mild cramping, vaginal spotting, OHSS and infection are risks of IUI for unexplained infertility.
Yes. IUI works for unexplained infertility, but the success depends on age, health and other factors.
