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3.5 Minute

02-08-2024 Team Medicover fertility

Written by Medicover Team and Medically Reviewed by Dr Kunuku yamuna, Gynecologist

IUI Failure: Causes, Symptoms And Treatments

Intrauterine insemination (IUI) is the primary infertility treatment preferred by couples who are unable to conceive for over a year. This procedure does not require much technical expertise.

It takes a few minutes to complete the process and does not cause much pain and discomfort. IUI can be performed as a simple OPD (Outpatient Department) procedure. Many of the gynaecologists can do it in their clinic. It is preferred as the first-line treatment before IVF as it is believed to be cost-effective and less invasive.

What Is Intrauterine Insemination (IUI)?

IUI (Intrauterine insemination), also called artificial insemination, is a type of fertility treatment. During the process, a semen sample from a male is washed and processed, and the motile and immotile sperm are separated.

Then, sperm of higher motility are placed inside a woman's uterus through a catheter during ovulation to facilitate fertilisation. The motive is to increase the number of sperm reaching the fallopian tube, thereby increasing the chances of fertilisation. The procedure takes a few minutes and does not cause much discomfort.

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When Is IUI Recommended?

The most common reasons for doing IUI are:

A Low Sperm Count

After washing the sperm, the count should be more than 10 million. IUI is usually recommended for men with low sperm counts.

Decreased Sperm Motility

For a successful IUI, the total motile sperm count should at least be 10 million post-washing of the semen.

Ejaculation Problem

IUI can also be recommended when a male has ejaculation dysfunction.

Unexplained Infertility

IUI is also done in cases of unexplained infertility.

Hostile Cervical Mucus

Sperm needs to stay for as sperm needs to stay for a couple of days within the cervical mucus. So, if a woman has hostile cervical mucus, it becomes acidic, and the change in pH can restrict the sperm's survival in the cervix.

IUI is not recommended in severe male infertility cases and when a woman has a tubal blockage, endometriosis, or a previous history of pelvic infections.

Causes of Failed IUI in Unsuccessful Treatment

An intrauterine insemination (IUI) is a fertility treatment designed for specific situations, but it may not work for everyone. Understanding when IUI is unlikely to succeed can save time, effort, and emotional stress.

IUI may not be suitable for patients with:

Completely blocked or surgically removed fallopian tubes: Sperm cannot reach the egg.
Advanced stages of endometriosis: Can affect egg quality and implantation.
Untreated pelvic infections: May damage reproductive organs and reduce the chances of conception.
Severe male infertility (no viable sperm production): IUI cannot bypass the need for healthy sperm.

Reasons for IUI Failure

IUI (Intrauterine Insemination) doesn’t always guarantee pregnancy, as many factors can affect its success. Understanding the common IUI failure reasons can help in planning further treatment. Here are some common causes of unsuccessful IUI:

Poor Quality Eggs: Poor egg quality symptoms can be related to chromosomal problems and are thus associated with one of the reasons for failed IUI.
Age: Increasing maternal age decreases the quality of the egg. The deteriorated egg quality impacts the embryo and its implantation, becoming one of the major reasons why IUI fails.
Poor sperm quality: Poor quality sperm will not be able to fertilise an egg, resulting in one of IUI failure reasons.
Timing Issues: Timing after ovulation, the egg stays in the fallopian tube for 12-24 hours. If no sperm are present at that time to fertilise the egg, it will disintegrate. So, the timing should be perfect.
Endometrial lining: Another possible reasons IUI fails might be if the endometrial lining is not proper, and the fertilised egg cannot get embedded in the cavity.
Ovulation: Irregular or absent ovulation may mean no egg is available for fertilization.
Progesterone Deficiency: Progesterone may also be one of the failed IUI reasons, as it is initially necessary to support a pregnancy.
Hormonal Imbalances: Conditions like PCOS or thyroid disorders can affect ovulation and implantation.

IUI Failure Symptoms

The possible signs of IUI failure helps manage expectations and identify when to seek medical advice for further evaluation and treatment options.

No specific symptoms indicate IUI failure.
If the treatment hasn't worked, period will arrive on schedule.
Negative pregnancy test about 14 days after IUI indicates an unsuccessful cycle.
Premenstrual signs such as bloating, mood swings, or mild cramps may still occur.
Poor egg and sperm quality can cause chromosomal abnormalities, leading to spontaneous abortion.
Chromosomal abnormalities account for 85% of early pregnancy losses.
Watch for unusual vaginal discharge or changes in menstrual flow.
Severe cramping, pelvic pain, or heavy bleeding should be reported to a doctor immediately.

How is IUI Performed? (Step-by-Step Procedure)

IUI is a simple and quick procedure that usually takes about 10–15 minutes:

Ovulation Tracking: Your doctor monitors your cycle using scans and blood tests to find the best time for insemination.
Semen Preparation: The semen sample is washed to separate healthy, motile sperm.
Insemination: Using a thin, flexible catheter, the prepared sperm is gently placed into the uterus.
Rest and Recovery: You may rest for a few minutes after the procedure and then continue your normal routine.

What To DO After IUI Failure?

Understanding your options after IUI failure is important to improve your chances of conception and choose the right fertility treatment for your situation.

If there are 3-4 failed IUI cycles, low ovarian reserve, and age above 35, consider IVF as the next step.
IVF and ICSI can significantly increase the chances of conception, especially in cases of severe male infertility.
While IUI is less expensive than IVF, the cost of multiple tries and medications adds up.
IUI failure impacts infertility, and the success rate is lower compared to other ART procedures.
After 3-4 failed IUI attempts, consult an IVF specialist rather than continuing with natural attempts.

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IUI Success Rate and Factors Affecting It

The success rate of IUI is not that great, though success would depend on the cause of Infertility, the age of the woman, and the time since the couple is 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 why IUI fails depend on person to person, their age, egg quality and a number of other factors.

Frequently Asked Questions

There are several reasons behind the failure of IUI. Some of the common reasons for failed IUI are endometriosis, poor sperm quality, decreased ovarian reserve, poor egg quality, etc.

Your decision to try IVF depends on the reason behind your inability and the number of times you have undergone failed IUI attempts. If you have more than 2-3 failed IUI attempts, or with unexplained causes of infertility, it is the time for you to reconsider your option and try IVF.

Causes can include poor sperm quality, issues with the woman’s eggs, blocked fallopian tubes, or uterine problems.

If pregnancy tests are negative two weeks after the procedure, it suggests the IUI has failed.

Symptoms can include menstrual bleeding, cramping similar to a regular period, and negative pregnancy tests.

Tests can include sperm analysis, ovulation tracking, ultrasound scans, and blood tests to check hormone levels.

Your period usually arrives within 2 weeks after a failed IUI. If it’s delayed, take a pregnancy test or consult your doctor at Medicover Hospitals.

Yes, many women conceive naturally even after failed IUI cycles. Success depends on age, fertility health, and underlying conditions.

If you’ve had multiple failed IUI cycles or are over 35, consult a fertility specialist at Medicover Hospitals to explore further treatment options.