The success of IUI depends on 2 factors:

• The indication for IUI (the reason it is being performed)
• Whether performed in a drug stimulated or natural (drug free) cycle

In general IUI is a good treatment if it is performed to overcome a problem of lack of sperm . It is also successful if intercourse is not occurring normally such as in cases of ejaculation dysfunction (ED). It is moderately successful when used for cervical mucus hostility when sperm are killed within the cervix. It tends to be less useful if the indication is male factor subfertility. The success rates are higher in a drug stimulated cycle (super-ovulation intrauterine insemination).

Intrauterine insemination is a successful treatment if used in appropriate couples. The chance of pregnancy is reduced in women over the age of 40 years and it is probably not an appropriate treatment for male factor subfertility if less than five million motile sperm are obtained at the end of the sperm preparation technique.

For most couples, up to three cycles of intrauterine insemination may be attempted assuming a good response is being maintained. After that time we would review treatment with you and either consider further IUI treatment or it may be appropriate to move onto other forms of fertility treatment at that stage.

What are the risks of intrauterine insemination treatment?

1. Multiple pregnancy
   The most important risk of treatment with intrauterine insemination in a stimulated cycle is the risk of multiple pregnancy. Approximately 1 in 4 women who become pregnant following this treatment will have a multiple pregnancy. Usually this is a twin pregnancy, although triplet pregnancies are possible and occur in approximately 1 in 20 of all pregnancies conceived as a result of this technique. We will know how many eggs are being produced by the ultrasound monitoring discussed above, and therefore this should avoid situations which you may have read about where women have four or more babies as a result of fertility treatment. If, during your ultrasound monitoring, it is shown that you have many follicles developing, then it is preferable to cancel treatment in that month rather than risk several babies being produced! It is always preferable to err on the side of caution.


2. Ovarian hyperstimulation (OHSS)
   The second risk of treatment is ovarian hyperstimulation syndrome. As the ovaries are stimulated more than they would be in a natural cycle, they become larger and contain fluid filled structures (follicles) that hold the eggs. Rarely the ovaries can become very swollen leading to a condition called 'ovarian hyperstimulation syndrome'.
   
   The symptoms of severe ovarian hyperstimulation syndrome include abdominal pain and swelling, shortness of breath, nausea, and possibly vomiting, and a reduction in urine output. In the presence of severe symptoms, hospitalisation may be necessary. This enables fluid, minerals and protein to be replaced and corrective measures taken to prevent further complications. The chances of OHSS developing are < 1 in 100 for patients having intrauterine insemination treatment. Although it is not possible to be certain which patients will develop ovarian hyperstimulation syndrome, those with the ovarian hormone abnormality called 'polycystic ovaries' are known to be more at risk. This condition will be assessed at the time of the preliminary consultation prior to starting treatment. However, this condition is very seldom.

IVF is probably the most well known of the "Assisted Reproductive Technologies". It is otherwise known as "test tube baby", and has helped infertile couples conceive and bear children for over two decades. These days, fertilization actually occurs in a dish, and not a test tube. It was originally developed to help couples overcome tubal factor infertility, but has become useful in treating other factors, such as immunological problems, unexplained infertility and male factor infertility.

IVF is basically a four step process.

• First, you take medications to make multiple follicles begin to develop on your ovaries. This step is referred to as ovarian stimulation, or superovulation.
• Step two involves monitoring follicular growth by ultrasound, to determine egg growth and uterine lining development. When it is determined that the follicles and the uterine lining are appropriately mature, a trigger shot of Human Chorionic Gonadotropin is then administered.
• 36 hours after the trigger shot, the third step begins with retrieval of the eggs by ultrasound-guided-needle aspiration, this process is best done under light anaesthesia. A sperm specimen is then washed and prepared for insemination. The washed sperm is then placed in a dish with the eggs, and they are placed in an incubator for 18 hours. After 18 hours, the embryos are observed for normal fertilization, under a microscope, where the pronucleus of egg and sperm can be seen. The embryos are then incubated for further development into multi-cell embryos.
• The fourth and final step involves transferring the embryos into the uterine cavity via a catheter inserted through the cervix. The number returned varies with the desires of the patient, under the guidelines of age categories; under 40 years old, up to two embryos; 40 years and older, up to a maximum of three embryos. Additional embryos may be frozen and stored for future use.