Why Isn’t Your IUI Working?

Hi there — thanks for joining. I’m Dr. Aimee a fertility expert. Some patients have endearingly called me, “the ultimate turkey baster” — I’ll take it! As you can probably guess, this post is not at all about Thanksgiving and instead covers everything you want to know about IUI and why it may not be working for you.

One of the most common questions I get asked from patients is, Why didn’t my IUI work?

I think it’s really important to understand the reasons IUI may not work — for you, or for anyone. What you learn may direct you to a different course of treatment, or it may mean switching things up for your next IUI attempt.

Let’s walk through what would happen if you’re my patient and considering IUI:

First, we’d sit down and talk through some key questions BEFORE taking any action — IUI or otherwise. We discuss things like your diagnosis, how many kids you want, how old you are, and if and how IUI fits into your family planning.

For example, if you’re 37 years old and you want three kids then perhaps starting with IUI isn’t the right thing to do. Preserving your fertility by freezing embryos (or eggs), and then doing IVF — that might make more sense.

In other words, it is important to think about your diagnosis and goals before confirming if IUI is the best way to achieve those objectives.

Are you having this same type of doing the same with your doctor?

Once it’s confirmed that IUI is the best route for you, we then take the following steps to give us the best chance at a successful outcome:

1. Check to see if your fallopian tubes are open.
2. Do an ultrasound. We do this to ensure there’s not a polyp or fibroid inside the uterus which would create a barrier to implantation
3. Conduct a semen analysis. We do this to find out the health of the sperm before continuing with an IUI. Imagine the disappointment if you find out on the day of your IUI that the sperm quality is very low for the first time.

If it’s determined that the sperm quality is low then there is another series of steps that can be taken to improve the quality before IUI.

What’s the bottom line? Do a TUSHY check first. You may learn that your tubes are blocked in which case doing IUI is not a worthwhile spend of time or money.

So what happens if you do a TUSHY check and your tubes aren’t blocked and IUI still doesn’t work? What does that mean?

Well, it means that you are HUMAN.

Unfortunately, or fortunately — it’s that simple.

Why don’t IUIs always work for people?

Well, many things have to go right. Here’s what is required for IUI to work:

1. The egg that’s ovulated needs to be a good egg and get picked up by the fallopian tube
2. The sperm and egg have to meet in the tube
3. The sperm has to fertilize the egg
4. The embryo has to travel down the fallopian tube for almost a week
5. The embryo has to implant in the uterus

If any of these steps aren’t perfect then your IUI won’t work. It seems like a miracle that people ever get pregnant with all of the little things that have to go right!

But, it’s important to understand all of these micro-steps so that you’re clear on why it may not work. If you don’t succeed it doesn’t necessarily mean that something is wrong with you.

I tell my patients that 90% of the time IUI doesn’t work.

You’re normal by having a 10% chance at a successful IUI.

Obviously there are things we can to do improve your IUI chances. But I want to be real with patients.

I surveyed several patients prior to IUI and asked them what they thought the success rate is for the procedure. Most people thought there was a 50% chance it would work.

50%.

When in reality it is 10%.

That’s a big gap. It’s part of why I’m doing this show. It’s important to know the truth and to set expectations accordingly.

I don’t want you to be the 41-year-old who decided to start with IUI instead of another fertility treatment because you thought the odds of getting pregnant that way were much higher than they are.

You may think there is a 50% chance IUI works when you’re 41, but in reality, it’s more likely to be a 5% chance that it works at that age.

I don’t want you to be frustrated, rather it’s best to be informed. And that’s what this post is all about.

Now you may be wondering, can we determine which of the five steps above goes right and which goes wrong? No, unfortunately, we are not yet able to pinpoint what specifically went wrong. This is why getting your TUSHY checked is so important — it’s something you can control, and sometimes information is calming in a process that can otherwise leave you feeling powerless.

Here’s the crazy part. Are you ready?

During IUI roughly 50 million sperm cells are directed towards the egg. One would think that at just 3cm away (from the egg) it’d be quite simple for at least one sperm to fertilize an egg.

While I am the ultimate turkey baster, I am not a medical deity. The fact remains that human biology has its limitations.

Steps you can take to improve your IUI rates

1. Consider taking fertility pills (also known as ovulation induction) to increase the number of eggs you ovulate. This is to increase your chances via the number of eggs ovulated (not because you have an ovulation problem).
2. Make sure you’re getting monitored in your cycle so you are timing the procedure as accurately as possible. How will you know the timing is right for your IUI if you haven’t taken a look at the follicle to make sure it’s the right size? Take a trigger shot to time the IUI right so that the egg and sperm meet. Don’t go into things blindly. I recommend asking your doctor to monitor you if they aren’t already.
3. Consider a double IUI. This doesn’t mean two IUIs at the same time. It means staggering the IUI — two days in a row.
4. Think about taking supplements that are friendly and may bolster egg AND sperm health — it isn’t just a woman’s role to prep for IUI! High dose antioxidants can help guys, depending on the sperm situation, and for women CoQ10 in addition to prenatal vitamins is something to consider.

Have you had a difficult IUI? If so, these are the questions I’d ask you:

• Was your bladder full?
• Were you given a valium before the procedure?
• Was your IUI done under ultrasound guidance?

If, for example, you’re getting an IUI and look down to see your doctor sweating and flustered because they can’t find your cervix, then it’s time to suggest a brief pause. Consider doing the following:

• Recommend another speculum size.
• Wait for the bladder to fill. The uterus is like a lawn chair in shape. As the bladder fills the uterus straightens and makes it easy to get a catheter in.
• Use an ultrasound. If you’re in a clinical setting then there should be abdominal ultrasounds readily available. You’ll want to ask your doctor to use an abdominal ultrasound probe to see exactly where they need to go.

Ask these questions too.

• Can you write me a prescription for valium?
• Should my bladder be full before I come in?
• Will you do this under ultrasound guidance?

Another thing I offer my patients is the option to take progesterone after IUI. Progesterone stands for “promote pregnancy”. Progesterone to me is like water to a marathon runner. We want to give progesterone throughout the fertility journey just as a runner hydrates throughout a race.

Watch my show on How to Prepare for IUI.

I want to now talk about the things I hear about IUI that are simply not true.

IUI Myths:

1. “I only get three tries to do IUI.” That’s not true. However, if something doesn’t work after three times it’s definitely worth taking a step back and reevaluating if it makes sense to continue. Is there anything within your control that you can change to improve your chances?
2. IUI takes only the good sperm and puts it at the top of the uterus. Ahh, I wish this was true! What we do is process the sperm and separate the semen from the sperm cells and deliver as many of the motile sperm cells as possible. You’ve probably heard the term morphology. Sperm morphology has to do with the shape of the sperm. We can’t separate out the badly shaped sperm from the good shape sperm. If the sperm is moving and alive it makes the cut. During IUI we’re taking all the moving sperm and delivering it at the top of the uterus.
3. Sperm quality doesn’t matter when doing IUI. That’s false. Sperm quality does matter — certain % motility, amount moving in the right direction, and a certain count to make IUI worth your while. Talk to your doctor about what their personal cut-offs are and see if IUI is still right for you. If the sample is low then consider seeing a urologist or take a sperm DNA fragmentation test to ensure IUI is the best option. Especially if your doctor’s parameters are slightly lower. You may consider an anti-sperm antibody test. This will help you to see if maybe one of the reasons good sperm isn’t getting into the egg is because the sperm have antibodies bound to their heads which might make fertilization more difficult.
4. The sperm will fall out. Here’s the thing — I can’t put a cork in the cervix after the IUI, and certainly there’s some level of gravity with sperm falling out. I have my patients lie down for 10 minutes or more. But that’s not a reason to avoid IUI.
5. I can ask to have sperm directed to the side where ovulation is occurring. No. Unfortunately, this is not something we can do. At the tip of the catheter, there are two holes on either side. When you push the end of the syringe sperm comes out. The cavity is so small we don’t have the ability to push into one side or the other.
6. You can spin sperm for gender. No — you can’t! There’s a company that claims they can, but no — that is not possible. Spinning sperm for gender is actually not a thing unless you go to another country.
7. Abstain leading up to the IUI and then after the IUI. Having sex is not dangerous — it will not harm your IUI. People confuse the instructions they’ve gotten for the semen analysis with the instructions for the IUI. Again, talk to your doctor as they know the sperm’s health better than anyone else. Most people are fine to have sex every other day before and after the IUI.

Lastly, this is a photo of the crotchless Egg Whisperer Fertility Pants that I’ve designed with my patients’ comfort in mind.

These are pants my patients get in my office when they want to do IUI. Who wants to be exposed with their legs hanging out, doing IUI, when you could be all warm and snuggly in these pants?!

If you’re interested in getting a pair for your IUI treatment, or otherwise, then please send me an email: [email protected].

SUMMARY:

I hope this was helpful and has given a dose of reality regarding the effectiveness and setting expectations when undergoing IUI.

Over my 12 years of treating thousands of patients, I have had hundreds get pregnant through IUI, however I’ve also had many who did not find success through IUI.

My goal is to be transparent and honest with you so you can go into your fertility journey fully informed and able to make the right decisions for you, in conjunction with your doctor.

As always, please comment below or send me a note if you have any questions about this show or if you have a suggested topic for a future show.

You can also catch more of me and topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!