Friday, June 1, 2012

WHY CAN AN IUI FAIL?


Due to our recent IUI failure I've been hearing this question alot the past few weeks.  I thought it might be  a good opportunity to discuss reasons why some IUI's fail.  From the articles I've read, success rates vary between 5% to 25%.  


AGE:
Like most fertility treatments, increasing age of a woman (35 and older) decreases success rates. Unfortunately egg quality tends to decline with age.  At age 18, a woman has a 25% chance of conceiving, however by age 40 her chances decline to about 4 to 6%. A woman also has less eggs or ovarian reserve as she ages since many have already been used with previous cycles (number of eggs left  = ovarian reserve).  


EGG QUALITY:
Just because a woman is ovulating doesn't mean that she has quality eggs. Low quality eggs have internal defects such as chromosomal problems or problems with energy production (eggs need to be able to divide after fertilization).  A woman is born with about 1 million eggs that like dormant in the ovaries until they are "activated" by hormones at the time of ovulation. Unfortunately as far as I know of there is nothing that can "boost" egg quality.  Often times, couples with "bad eggs" need to rely on donor eggs.  From my understanding the only way to truly test egg quality is with egg retrieval prior to completing an IVF cycle.  The bad news is that this is very costly financially and invasive (requires a surgical procedure).  Also, after the eggs are retrieved there is no accurate test to assess quality.  Often times it is subjective and based on someone looking at them under a microscope.  Since egg morphology has not been adequately studied, many women go through several cycles of failed IUIs or IVF cycles without even knowing she has poor egg quality.

Last, eggs that are released may be immature and therefore incapable of being fertilized.  During a normal cycle, certain hormones prepare the egg to have the capability of becoming fertilized.  


BLOCKED FALLOPIAN TUBES:
Blocked fallopian tubes can occur from many factors such as STDs, a uterine infection caused by abortion or miscarriage, a ruptured appendix (causes scar tissue), any previous abdominal surgery (causes scar tissue), ectopic pregnancy or endometriosis.  If the tube is blocked, there is a physical barrier preventing the egg and sperm from coming into contact.  Luckily an HSG test, although invasive and painful, can detect this.  Many times the solution they inject into the uterus during the procedure can unblock the tube. If that fails, sometimes laparoscopic surgery is required to remove scar tissue.


POOR TIMING
Timing is critical.  After the egg is released from an ovary it only has about 12 hours to become fertilized.  If fertilization fails the egg disintegrates.  It's amazing anyone becomes pregnant with such a short time frame allowed for fertilization. The good news is that sperm can survive for a few days in the woman's uterus.  If intercourse occurs a few days before fertilization, the sperm can already be there to wait for the egg.  Also, with intercourse sperm can travel up the wrong fallopian tube or can become trapped.  Sperm can also swim poorly for various reasons, not allowing them enough time to reach the egg. 


 The IUI must be done in roughly that 12 hour window.  If the IUI is done too early or worse too late (after ovulation has occurred), the chance of the sperm contacting the egg is slim.  IUI has the advantage of helping the sperm get to it's target quicker, however if the egg has not yet matured or has already died the procedure will fail.  To ensure this doesn't happen, it is essential that the woman has several bloodtests to check hormone levels that indicate she is ovulating.  Ultrasounds are also essential to determine the exact time of ovulation.  Nowadays many doctors help mother nature by giving an injection of HCG - a hormone that triggers ovulation. This takes much of the guess work out of the equation....but remember if the shot is given too early the egg will be immature.  If the shot is given too late, natural ovulation may have already occurred.  


NOT OVULATING
If a woman isn't ovulating there is no egg to be fertilized.  No doctor in the right mind will complete an IUI unless ovulation has been triggered with hormones.


POOR SPERM QUALITY
This is our problem.  Even though there may be ample sperm, if they are malformed they may not have the physical capability of penetrating the egg to fertilize it.  This is usually caused by deformities in the head of the sperm.  It's like having a million spoons when all you need is a knife.  The spoon just won't do the trick. Many studies have shown poor success rates for IUIs with poor sperm quality.  Sadly there is no known medical treatment to improve sperm quality.  


WHEN IS AN IUI SUCCESSFUL


LOW SPERM COUNT OR MOTILITY:
Sperm can also swim slowly, may not be able to swim at all, swim in circles going no where, or may have 2 tails causing them to swim poorly.  If they can't reach the egg in time, it'll be too late.  Luckily for this particular problem the IUI does the work for the sperm.   Since the sperm are injected directly into the uterus they need not swim far.  Also, if the sperm are normal but there just isn't an abundance of them, IUIs are more successful as it gets the few sperm closer to the egg.  





41 comments:

  1. Thank you for taking the time to answer my question and anyone else who was asking the same thing. This is very informative and gives me a much better understanding and I think I'm going to definitely need as much information as possible. It seems more complications are on the horizon for me as we're getting results of preliminary tests from the repro endocrinologist I'm seeing. Two more appointments are this week.

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  2. Unfortunately, I just learned my left fallopian tube is blocked. Today I visit the hospital for a HSG to get further details. I'm hoping it's a simple fix. This is complication #2 for me.

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  3. I just had my first IUI today. It wasn't part of the plan but being I was about to ovulate on my own, without drugs, this month - they wanted to take a shot at it. They said the timing was really good. I'm feeling very confident but with confidence also comes great dissapointment. They were able to successfuly get the blockage out of my left fallopian tube last week as well (which is where I am ovulating from today). I just started going to Main Line Fertilty on 5/23 and have been there 7 times already. I'm really hoping this works!

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  4. Excuse me everything is fine with the couple, there are no problems, we are well below the age limit, even after years of married life, why is this not working, none of the above apply to us, The truth and honest answer Doctors are not Gods and they are unable to predict success. This is also another trial and error method.

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  5. I have failed 6 cycles of IUI and I am not having any problems with egg quality or egg production then what could be reason for IUI failure, is it doctors fault or it is my fate

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  6. If the above problems don't apply to you then likely, after several failed IUIs, something is being missed. But do remember that even in "normal" couples without reproductive issues it can take a few months to get pregnant so even though 6 times seems like alot, it MAY be normal. Likely though there is a problem that one of you have that ISN'T the above and is undiagnosed. We didn't have any of the above reasons why the IUI should fail either....I ovulate, my tubes are normal, etc.... Because our problem was more complicated (my husband's sperm were "deformed" and nearly incapable of fertilizing my "normal"l eggs) we could have probably done several dozen IUIs and they STILL would've failed. I hope that makes sense. I guess if your IUIs are failing, you BOTH need a more extensive work up to decipher the problem. It could be SO many things from a sperm issue to an implantation issue (there are multiple problems women can have with implantation). Good luck and keep preserving.

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  7. I had done my third iui. This time i must be more careful by resting at home and do light house work. Doctor said this would be my final attempts for iui. Next i will referred for ivf. As ivf is so costly, i have to plan for saving...i dont give hope on any as will dissappointed later.

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  8. I am so glad you created this blog. My wife and I have been TTC for about 1 year now and are still unsuccessful :(. We already did all the fertility check ups and even did 3 IUIs and nothing. We are only 28. I think it is really setting in and I am so devastated, sad, jealous, all of the negative emotions in the book I am suffering from it.

    I have been holding it in for so long now that this blog just helps me be heard. It is just so dam hard. We just got 2 more baby announcements today. Geez. We were the first to get married with the intent to start a family. I worked my butt off building my career and after we have everything we need...nothing.

    Just sucks. I just feel alone in this situation because none of our friends or family seem to have an issue. I totally understand what you are going through and I pray and hope that everything works out for every single person in this blog. I hate being so negative as it really is not me. I feel as if I am a different person. It's hard being the girl, but it is equally hard for the male. Just feel like crap and we just want to "man up" and don't discuss this matter with anyone. Anyways...my first post ever about this and I honestly feel good. To anyone reading, thank you for hearing me out and I wish you the best of luck on everything.

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    1. We heard yesterday that our second attempt of IUI failed, we have been trying since 2009 and were only referred to infertility specialist end on 2013. Hubby has low sperm count but otherwise working in Iraq so timing is also a huge problem. Seeing specialist tomorrow again for last round of IUI, emotionally and financially we cannot afford to do more. It is really so frustrating and heart breaking. We are both in our late 30's so time is not on our side. As you said everybody else falls pregnant at the drop of a hat and we don't. I don't drink, smoke and haven't had caffeine for the last year. I have been drinking folic acid for years now and must say getting fed up. What gets me the most is everybodies opinion on why we are not getting pregnant, and how it's not so bad because I don't know what I am missing because I have never had a child. Somedays you just want to curl up in a little ball and cry your heart out and other days you manage to stay strong and be positive. It is so difficult to stay positive and then feel guilty because you 're trying not to be excited because this month might be the month just to be thrown in to the deepest coldest and loneliest pit of dissapointment. I am a believer and I know God see's my pain and understands what I am feeling, I just wish I could hear from Him why I am not suiteable to be a parent. In short, it does feel as if you just need to get your feelings out to a group of people who know first hand what is like. Good luck, and may you be blessed with a little angel soon.

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    2. I know exactly how you are feeling. Especially when people tell you whats right and whats wrong it gets to you. People do not and will not understand your pain. You both will have to support each other as that's the only thing which will matter in the long run. I also have many conversations with God, but I feel some people like us cannot get what we want no matter how much we pray to him. I hope you were lucky in your third cycle..God bless you.

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    3. Reply to December 29 posting. I am currently going through the same thing that you are going through. I have the exact same thoughts and feelings as you. I am going to try one more IUI. After that I will have to stop due to costs and going back to work/not being able to go to the clinic on call. There are so many couples out there who would make great parents and yet they are unable to have children of their own. This is one thing about life that is most upsetting to me. Sending lots of love and wishes to those trying to conceive.

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  9. I recently went through our 2nd cycle iui. I have chronic severe endometriosis which doesn't help. I am 37 and have recently found out my daughter who is adopted had and abortion. I am seriously depressed and so confused. Have delayed 3rd treatment due to stress levels. I am guessing a lot of you are wondering why I want a child when I have one. I feel incomplete as a women and although I love my two daughters I have a new partner and want to add to my family

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  10. This infertility issue is making me feel very much less of a woman. Being flat chested never did help and now this. I am 37 years old and divorced. Was too busy with work and thought now would be the time or it'd be too late. That's when I was diagnosed with "diminished ovarian reserve". Then my first IUI (done 3/1/2014) was a failure. Wish I was dead. What's the point of this meaningless life of existence?

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  11. To anonymous,
    While every person who gets infertility thrown in their face has different circumstances I think the majority have felt like complete crap alot of times. I know this has caused me to feel my lowest of my lows. Other life circumstances don't help. While being 37 is a big deal because we are "advanced" for our fertility years, please remember it CAN still happen. But also remember and be prepared if it doesn't. Have hope but also remain realistic and grounded. I beg you that if you haven't already please get help to help you manage your feelings. I did and am still seeing someone which really has helped me greatly. Feeling like you want to die ISN'T good and I've been there, mainly because of the issues I've dealt with with infertility. Also, please remember that just like getting pregnant naturally, it MAY take several IUIs to work and this is NORMAL. While it sucks that first didn't work, if you have resources for more, keep going until you financially, physically or emotionally can't. Also, I have struggled with the above comment you made about having a meaningless existence. It sure does feel that way especially if your hearts desire is to have children. NOTHING can fill that void but with help and time it does lessen and while we have been lucky, at one point in time I was starting to see the positives and meaning in my life if we didn't have children. While it's hard to see, your life CAN have meaning with our without children....it just takes creativity and work to see that. I wish you the best.

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  12. I've never written on any online board, but I've reading a lot of them. I'm 37, my husband is 44. We have been trying for years. We have done 3 IUI, and today I got my period. So sad. I want to cry. Our insurance does not pay for IVF and IUI. We have been paying out of pocket for IUIs, letrozole medication and trigger shot. I have done HSG and blood test, and numbers are ok. But my husband's sperm has very low morphology. The count and speed are ok. I am so fed up. Why some women can have multiple babies? Due to this problem, I became an envious person. I used to be cheerful and fun. Now I don't feel hanging out with friends. I should not, but I started blaming GOD too. What have I done? What did I do wrong? Am I a bad person? I know I should be thankful of what I have....but it is getting harder and harder to stay positive. Life is so unfair. I don't smoke and drink caffeinated drinks. I've been married to the same man for 12 years. We both have no child. I am sad.......want to cry. I am driving myself crazy. I wish at least our insurance covers these expenses.....I am sorry for venting everyone who reads this.

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    1. My reply is a little late coming, but I am so happy that you were brave enough to vent. There's something about putting it in writing and sharing it that's cathartic. Please feel free to keep writing and venting and good luck. I am here for you!

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  13. Children are gifts from God lets just hang in there The good Lord will reward us in fue time

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  14. i had my first IUI last week iam 30 and my hubby too,
    i feel depressed all reports are fine but iam fat and my husband has low sperm count
    what are chances of IUI sucess

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    1. I am not an expert but have done alot of research on chances of an IUI working. From what I've read it's about 25%...same as chances of getting pregnant "naturally". I hope that helps. Good luck, try to stay positive and keep persevering.

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  15. Took time off the stress of infertility has really gotten to us. 2 failed IUIs......and thousands of dollars spent and if one more friend tells us they ate pregnant.....ahhhhhh.

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  16. Hello
    We got the failure report of iui today.... I'm feeling so devastated.

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  17. My heart breaks as I read through these posts. It was not long ago I was exactly where all of you are. I was angry with God, jealous of every mom with a child I saw and depressed to the point I couldn't get out of bed. I was in my 30s, have endometriosis and we discovered my husband had a zero sperm count. After much praying, crying and talking for months we decided to pursue donor sperm. It was actually my husband's idea as I was against it at first. However, we ultimately did it and I am so happy we did. We were blessed with a beautiful baby girl and then a year and a half later a set of two little boy twins. I read all about what to do to get ready for an IUI if you have fertility issues and followed all of the protocol (I took DHEA, folic acid, magnesium, flaxseed, coq10, and cut out caffeine, all sugar and lost 10 lbs). Donor sperm is selected to have speed, quantity and prime morphology which tips the odds in the favor to conceive. These three little ones are the apple of their dads eye and he has said he is so glad he doesn't have sperm because then he wouldn't have these great kids. Please keep pushing through everybody. It can happen. We had all of the cards stacked against us and our persistence and willingness to be open to something else did pay off. We are currently in the process to adopt from Ethiopia as we want one more child. Before we had these children I never would have adopted but my heart has been changed watching my husband love our children as if they were his blood. I pray all of you get the children you desire!

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  19. Hi all im reading all your comments some so sad we had one cancelled iui and yesterday we started a new course hoping I will react this time.

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  22. i did my first IUI last month & it failed.. I m depressed.. my husband didn't support me & now he don't want to live with me.. i m just 1 year married.. its my fate.. going to do laprascopy next month..

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  23. Reading all these comments raises emotions and i can connect very well. I have been married 10 years. Had 4 miscarriages and tried iui this month. Just when i was being positive that i could be pregnant after 4 days of missed period alas my period showed shattering all my hopes. My Dr thinks i should try iui again after a month rest but honestly it's a depressing situation

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  24. Nice!
    http://prolargentsizecapsule.blogspot.com/

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  25. we go to try my second IUI,i hope this time it works

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  26. I am so glad to have found this.

    My husband and I tried for 18 months without success. We went to see the specialist and it was determined we had Male factor infertility. We had success on our 3rd IUI, natural cycle.

    Good luck everyone!

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  27. This comment has been removed by a blog administrator.

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  28. great post. Now in this video you will get all the details about the IVF centre in India.

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  31. hi , i have been trying to conceive for more than 14years but no success,i have done 3 failed ivf and it was heart broken , doctors think my eggs are not good enough, i was on google and i saw on a forum how ashra helped one miss kristine with almost same issue as mine , i contacted ashra with this contact details email : ashraspelltemple@gmail.com and cell phone /whatapps number +2348058176311 and a special pregnancy cleanse and pregnancy spell was done for me , few weeks later i felt ill and went to the doctor and my doctor confirmed it that am pregnant,just as ashra has promised me that within 8 weeks i will be pregnant, now am taking my time to put the contact details of ashra (ashraspelltemple@gmail.com or cell phone/whatapps number +2348058176311) for anyone out there going through the pain of trying to conceive to contact ashra for help today

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  32. Don’t think of anything else just contact Dr Abalaka and purchase some of his herbal medication and your depression will go away. This was my state of mind when my doctor told me that i will not be able to conceive due to the Fibroid that was rolling in my family life and when i decide to reach out to the priest, and the Priest told me what to do in other to get the medication. Eventually I receive all the Herbal medications that cure my Fibroid and give me the chance to become a proud mother: Dr Abalaka is a great spiritualist, He did it for me, you can contact Dr on (dr.abalaka@outlook.com). If you are suffering from the following gynecology disease::
    1. Fibroid
    2. High Blood Pressure (herbs to reduce your BP within 7days)
    3. Infection, regular body pains
    4. Blockage from the fallopian Tube
    5. Cyst from the ovaries
    6. Unpleasant smell from the virginal
    7. Irregular menstruation
    8. Weakness of the penis (not able to have sex with your partner or inability to satisfy your partner sexually)
    9. Watering sperm (low sperm count) not able to get woman pregnant.
    10. Infertility for easy Conception.......
    11. Skin diseases, Toilet infection and bad body odor…….Etc..
    Simply contact the spiritualist Dr Abalaka on (dr.abalaka@outlook.com) to get his Herbal Medication to cure your disease and put yourself on a motherhood side of life..

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  33. hi , i have been trying to conceive for more than 14years but no success,i have done 3 failed ivf and it was heart broken , doctors think my eggs are not good enough, i was on google and i saw on a forum how ashra helped one miss kristine with almost same issue as mine , i contacted ashra with this contact details email : ashraspelltemple@gmail.com and cell phone /whatapps number +2348058176311 and a special pregnancy cleanse and pregnancy spell was done for me , few weeks later i felt ill and went to the doctor and my doctor confirmed it that am pregnant,just as ashra has promised me that within 8 weeks i will be pregnant, now am taking my time to put the contact details of ashra (ashraspelltemple@gmail.com or cell phone/whatapps number +2348058176311) for anyone out there going through the pain of trying to conceive to contact ashra for help today

    ReplyDelete