Dr. Walid Saleh from CRE (previously SIRM-Dallas) on IUI with Injectables Success Rates
Unfortunately, despite the lack of evidence to support it, many couples are prescribed gonadotropin injections and artificial insemination (COH/IUI) as a first line of treatment on the basis that “injections are better than tablets.” In reality, most studies agree that pregnancy rates are similar for both options. It makes perfect sense. If someone already ovulates on her own, why would the “boost” provided by exogenous FSH injections be any superior to the endogenous one achieved with a $4 tablet like clomiphene. Nothing in those injections addresses or bypasses the “unexplained” factor causing infertility in the first place. Furthermore, unlike clomiphene and IVF, COH/IUI treatments are associated with a 30% risk of unpreventable high-order multiple births.
While unexplained infertility is a frustrating condition, it usually has a good outcome. For these couples, 3-6 cycles of superovulation with oral clomiphene citrate combined with intrauterine insemination (CC/IUI) have provided a less invasive option before proceeding to low cost or micro-IVF.
IUI with Injectables provides a 7% monthly chance of pregnancy, with a 6 month cumulative pregnancy rate of 35%. This treatment probably works by improving timing of conception, by-passing potential cervical factors or increasing the number of eggs ovulated. It is very important to keep in mind that the chance of pregnancy is NOT affected by the frequency of your office visits, serial blood tests and ultrasounds or hCG administration. All these procedures only increase your cost and anxiety, not your chances of conception.
While it is true that prolonged use of clomiphene occasionally causes thinning of the uterine lining, this ultimately does not affect chances of pregnancy and resolves spontaneously after taking a month off. Adding estrogen orally is another cost-effective way of resolving this non- issue.
Besides the high cost of medication, injectibles also require serial office visits, ultrasound monitoring, and blood tests ranking up the cost of conception in the thousand of dollars. By the time a couple completes the 6 cycles of COH/IUI they did not need in the first place, chances are they can no longer afford the IVF they now need.
In conclusion, while injectibles are useful in an anovulatory patient that is resistant to clomiphene, their use in the treatment of unexplained infertility is unjustified.