Causes of failure of intrauterine artificial insemination

What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI), commonly known as artificial insemination, is a type of fertility treatment. During this process, a man’s sperm sample is washed, treated, and the mobile and immobile sperm are separated. The more mobile sperm are then inserted into the woman’s uterus via a catheter during ovulation to facilitate fertilization. The goal is to increase the number of sperm reaching the fallopian tubes, thereby increasing the chances of fertilization. The procedure only lasts a few minutes and is not very bothersome.

When is IUI recommended?

The most common reasons to undergo an IUI are as follows:

• Low sperm count
• Reduced sperm motility
• Ejaculation problems
• Unexplained infertility
• Hostile cervical mucus

IUI is not recommended in severe cases of male infertility or when a woman has a blockage of the fallopian tubes, endometriosis, or a history of pelvic infections.

What are the causes of IUI failure?

The success rate of IUI is not very high. However, success depends on the cause of infertility, the woman’s age, and the length of time the couple has been trying to conceive. Studies have shown that the pregnancy rate for each natural cycle is about 4-5%, and when the cycle is stimulated with fertility drugs, the pregnancy rate is 7-16%. The possible reasons for IUI failure can depend on each individual, age, egg quality, and many other factors.

Here are some of the reasons for IUI failure:

• Poor quality eggs: Poor quality eggs tend to have chromosomal abnormalities and may not divide after fertilization or give rise to weak embryos.
• Age: The chances of IUI success are 15-20% for each attempt in women under 35 years of age and decrease after this age. IUI is not recommended for women over 40 years of age.
• Poor quality sperm: Poor quality sperm may not be mobile and strong enough to reach the fallopian tubes.
• Timing: If there are no sperm present within 12-24 hours of ovulation, the egg in the fallopian tube deteriorates.
• Endometrial lining: If the endometrial lining is not right, the fertilized egg will not be able to implant in the cavity.
• Ovulation-related problems: In case of ovulation-related problems or absence of ovulation, there will be no egg production for fertilization.
• Progesterone: A deficiency of this hormone can cause IUI failure, as it is essential for supporting a pregnancy.

Are there symptoms of IUI failure?

There are no specific symptoms of an IUI failure. An IUI failure can lead to a miscarriage or, if the treatment didn’t work, it will cause the menstrual cycle. If the quality of the egg and sperm is not good, they may present a chromosomal abnormality, which leads to a miscarriage. And in 85% of cases, this is the cause of early pregnancy losses. However, it is important to pay attention to any abnormal vaginal discharge and consult a doctor immediately in case of severe cramping or discomfort.

Next steps following an IUI failure

After an IUI failure, what is the next step?

If a woman has already experienced 3 or 4 failures of IUI cycles, has a low ovarian reserve and is over 35 years old, she should consider IVF as the next step after IUI failure. Various research and studies have shown that IVF (In Vitro Fertilization) and ICSI (Intracytoplasmic Sperm Injection) can significantly increase in cases of severe male infertility, the chances of conception, and overcome IUI failure.

It’s important to keep in mind that IUI may be less expensive compared to IVF, but it is in no way economical. The cost of attempts and medications continues to rise, as does the impact of IUI failure on infertility. Moreover, the symptoms of pregnancy following an IUI failure also have a lower success rate compared to other assisted reproductive procedures. Therefore, it is strongly advised that after 3 or 4 failed attempts, a couple does not continue trying to conceive naturally following an IUI failure; if pregnancy symptoms are absent, they should instead consult an IVF specialist.