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When to Cancel Your IUI Cycle
Intrauterine insemination (IUI) is a fertility treatment that involves frequent monitoring of hormone levels and follicle growth throughout the cycle. However, it is not as controlled as more advanced reproductive technologies like in vitro fertilization (IVF), therefore patients must be informed and responsible when pursuing IUI. They should understand the risks and know when it is appropriate to cancel an IUI cycle.
What Is IUI
IUI may or may not include the use of fertility drugs for ovarian stimulation. When fertility drugs are used, a greater number of follicles develop and there is a higher chance of superovulation. After approximately two weeks of ovarian stimulation, a fertility doctor will verify the number of mature follicles via ultrasound. This is an important part of the procedure as a greater number of mature follicles stand the risk of becoming a multiples pregnancy. A Human chorionic gonadotropin (hCG) injection is administered which triggers ovulation to occur between 36 and 40 hours later. The patient is scheduled to report to the fertility clinic for insemination during that time frame.
A semen sample is collected from the partner or donor sample is used. It is washed to produce the best possible sample and inserted into the uterus using a syringe attached to a catheter, bypassing the cervix. After the procedure, the patient lies flat for approximately 15 minutes.
IUI success rates vary by age and diagnosis. IUI is not the best solution for severe male factor infertility or older patients as they may require advanced technologies for achieving pregnancy.
IUI and Multiples
The chances of having a multiples pregnancy depends on whether a cycle is medicated or natural. Laurence A. Jacobs, M.D., of Fertility Centers of Illinois states, “the primary myth [that patients have] is that an IUI can lead to multiples, but it does not. Rather fertility drugs will lead to the risk of multiples.”
Approximately 8% of pregnancies using oral fertility drugs like Clomid, combined with IUI, result in a twin pregnancy. Injectable fertility drugs, called gonadotropins, result in twin pregnancies about 20% of the time. Triplets or more occur in less than 1% cases.
Medical Director, Edward L. Marut, M.D., of Fertility Centers of Illinois says the risk of a multiples pregnancy decreases with age. “Older patients are less likely to deliver multiples as a result of treatment because of their lower implantation rate and higher miscarriage rate. If there is a tubal factor or male factor, the multiple risk is reduced as well, simply because the chances of even one embryo implanting is reduced.”
So, the odds of becoming the next "multiples mom" reality TV star are small, but it is still imperative to consider that multiple pregnancies can and do happen.
Current research cites 3 to 4 follicles as the maximum number at which to trigger ovulation. More than 3 mature follicles increases the risk of multiples which present increased health risks to the mother and babies. However, advanced maternal age or history of failed IUI may warrant triggering with 4 follicles. “The younger a patient is, the fewer the number of follicles that should be ovulated”, says Marut, “maybe 2-3 in someone under 35, but 3-4 over that age.” Dr. Jacobs believes 3 follicles is acceptable if the couple has received informed consent about triplets or is open to the possibility of selective reduction.
If a patient becomes pregnant with high order multiples (HOM), they should consider a consultation with a high-risk maternal fetal medicine doctor or initiate the conversation about selective reduction with their fertility doctor. Selective reduction, however, is not without risks in itself, Dr. Marut reminds us. “Selective reduction of a higher order pregnancy (triplets or more) has a small risk of losing the whole pregnancy, but is safer than having triplets or more. It should only be done by highly experienced physicians”, he says.
When To Cancel Your IUI
Patients should weigh the risks and benefits to triggering with more than 2 or 3 follicles. Despite the infertile couples’ strong desire to become parents, it is better to cancel a cycle than to jeopardize their physical and reproductive health. Dr. Jacobs encourages patients to truly understand the risks and why a cycle might be canceled. “It is vital that they have the knowledge BEFORE [beginning treatment]so there are no surprises if they are told to cancel their cycle due to too much risk.” Dr. Marut urges patients not open to the idea of twins to pursue IVF with a single embryo transfer. This type of treatment offers maximum control and minimal risks to the mother and babies.
Fertility doctors want their patients to achieve pregnancy, but ethically, the health of their patient takes precedence.