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Men may feel a loss of self-esteem because they feel that they need a doctor's help to do what a "normal man" should have been able to do by himself. They also feel guilty about having to subject their wife to the pain and intrusion of insemination. Women may feel anger towards their husbands for having the fertility problem. The insemination may also make patients feel that someone has "intruded" into their sex life and this may affect their intimacy.
The success rate of IUI depends upon several factors. First of all, the cause of the infertility problem is important. For example, men with normal sperm counts who are unable to have intercourse have a much higher chance of success than patients who are undergoing IUI for poor sperm counts. In addition, female factors play an important role. If the female is more than 35, the chance of a successful pregnancy is significantly decreased. Generally, the chance of conceiving in one cycle is about 10% to 15%; and the cumulative conception rate is about 60% over 5 treatment cycles. (Remember, Nature's efficiency for producing a baby in one month is about 15 to 25%). However, if IUI is going to work for a couple, it usually does so within 4 treatment cycles. If a pregnancy has not resulted in this time, the chances of IUI working for them are very remote, and they should stop persisting with IUI and explore other possibilities.
The major risk of IUI today is that of multiple pregnancy. Since the patient is being superovulated, more than one egg may get fertilized, resulting in twins or even triplets or quadruplets. Because the doctor cannot precisely control how many follicles will grow or rupture, the risk of a multiple pregnancy is actually even more after IUI rather than IVF. In fact, most of the infamous cases of high-order multiple births (such as sextuplets and octuplets) have occurred after IUI. If you grow too many follicles, you may choose to cancel the cycle. Some clinics can also offer you the option of saving the cycle by converting it to IVF. This can be a cost-effective option, since it allows you to make good use of the eggs you have grown.
In poorly equipped clinics, there is also a risk of developing an infection after the IUI, if appropriate sterile precautions are not taken. This can tragically actually cause infertility!
While many gynecologists today offer IUI treatment, many of them are not specialized enough to provide a comprehensive service. This often means that patients need to run around from the gynecologist to the ultrasound scan center to the lab. Not only is this very time consuming and frustrating, it often means that the care becomes fragmented because of poor coordination. Try to find a clinic which offers all the services under one roof.
The cost of performing IUI varies from clinic to clinic, but is about Rs 3000 to Rs 8000 for the entire treatment cycle. Of course, if gonadotropin injections are used for superovulation, the treatment then becomes much more expensive - and can be as much as Rs 20000 for one month's treatment.
IUI is a simple, inexpensive, effective form of therapy, and can usually be tried first, before going on to more expensive and invasive options. However, it can be very stressful and close cooperation between the husband and wife (and the doctor) is essential!
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
