Higher success rates in Embryolab with IUI

Higher success rates in Embryolab with IUI
14 Jul 2017

At Embryolab, we are keen to offer you the best way to your Fertility Journey! Our highly experienced fertility team in our state-of-the-art laboratories guarantees the most appropriate individualized solutions for every couple and woman who trusts Embryolab.

One of the most affordable and yet successful fertility treatment is the Intrauterine Insemination (IUI). Many recent studies have shown that when a low cost drug is used with IUI, it triples the chance of pregnancy! That’ s the fact at Embryolab, as well!

Unfortunately, this option is recently blocked by NHS.


IUI and Clomiphene

In women who do not respond to standard clomiphene citrate regimens, combination regimens have been proposed. Clomiphene citrate has been used in combination with IUI.

IUI combined with clomiphene citrate is thought to increase pregnancy rates in women with unexplained infertility and surgically corrected endometriosis, perhaps by correcting undetected defects in ovulatory or sperm transport mechanisms and increasing the density of motile sperm available to released eggs. The routine use of IUI to improve pregnancy rates in women receiving clomiphene citrate has not been completely studied. However, investigations suggest that the use of IUI may improve per-cycle pregnancy rates in patients even when semen parameters are normal.

Because Clomiphene blocks estrogen receptors, taking the fertility drug can have an adverse effect by thickening the cervical mucus and thinning the endometrial lining. With an IUI, the fertility doctor monitors the woman cycle. At the time of ovulation, the man produces semen specimens that are prepared in the laboratory utilizing specialized enhancing solutions. The IUI procedure is simple, much like a Pap smear. The prepared sperm are placed in the uterus using a thin flexible tube (catheter) that is passed through the cervix and into the uterus. IUI allows many more sperm than would usually make it into the uterus to get in there, which raises the odds of conception. From there, the sperm makes its way to the fallopian tubes, as it would after regular sexual intercourse.

The combined use of clomiphene and IUI has been shown to nearly double or even triple the results compared to using clomiphene alone to improve pregnancy likelihood.


What is Clomiphene?

Clomiphene is a non-steroidal fertility medicine, which causes the pituitary gland to release hormones needed to stimulate ovulation in women with certain medical conditions (such as polycystic ovary syndrome) that prevent naturally occurring ovulation.

Clomiphene should be used exactly as directed by a fertility specialist, who will perform medical tests to make sure there are no conditions that would prevent the safe clomiphene use.


How does Clomiphne work?

During a normal menstrual cycle only one egg is ovulated. The use of clomiphene often causes the ovaries to produce two or three eggs per cycle. Clomiphene is taken orally for 5 days and is active only during the month it is taken.

Of women who are anovulatory (unable to produce an egg each month), approximately 70% will ovulate when treated with clomiphene. Women less than 35 can achieve pregnancy rates of 20-25% per month as long as there are no other significant factors present. Older patients may not achieve these rates as their declining egg quality will become a factor. Success rates are highly individual and depend on a number of factors.

Clomiphene is considered a first-line treatment because of its low cost, relative ease of use, and minimal side effects. It has been 50 years since the first clinical trial demonstrated that administration of clomiphene citrate induces ovulation in more than 75% of amenorrheic women.

In a recent meta-analysis study that included 15 randomized controlled trials, clomiphene citrate was shown to be more effective than placebo in increasing the pregnancy rate in anovulatory patients with possible PCOS. Further, in another study that included 626 patients with PCOS, clomiphene citrate use resulted in a live-birth rate of 22.5% versus 7.2% with the use of metformin, although an increased rate of multiple pregnancy was observed in the clomiphene citrate group.


What are typical ovulation and conception rates with clomiphene citrate?

Ovulatory response to clomiphene citrate is dependent on body mass index, free androgen index, and type of ovulatory dysfunction. A meta-analysis using dose-response relationships from 13 published reports showed a cumulative ovulation rate of 46% with a 50-mg daily dose of clomiphene citrate; ovulation was achieved in another 21% with a 100-mg daily dosage, and an additional 8% with 150-mg daily dosage.

The estimated mean rate of conception per ovulatory cycle after clomiphene citrate is approximately 15% in anovulatory women who respond to treatment and can be as high as 22% in the absence of any other infertility factors. This fecundability rate of 15% to 22% with clomiphene citrate use is comparable to the 13% to 30% monthly fecundability rate seen in fertile couples not using birth control and in women discontinuing use of diaphragm or oral contraception.

The discrepancy between ovulation and pregnancy rates may be partly explained by the peripheral antiestrogenic effects of clomiphene citrate on quality of cervical mucus and the endometrium, which may inhibit sperm penetration and affect implantation. Specifically, when compared with spontaneous cycles, the endometrium may be thinner and the quality of cervical mucus poorer during use of clomiphene citrate.

This increase in conception rate after clomiphene citrate was more apparent in women with infertility lasting more than 3 years.


What are the risks and complications of clomiphene citrate use?

There is a modest increase in the risk of multiple gestation with clomiphene citrate use, most of which are twins (6% to 9%) and, very rarely, triplets (0.3% to 0.5%). No evidence has been found of increased risk of spontaneous abortion in pregnancies resulting from clomiphene citrate treatment. Ovarian hyperstimulation syndrome is a known complication of clomiphene citrate usage; however, most cases are usually mild and patients rarely develop severe manifestations, which include abdominal pain, hypovolemia, nausea, vomiting, and oliguria.


In conclusion…

Clomiphene, when administered under strict medical surveillance, is a safe low cost drug which in combination with IUI significantly raises both the pregnancy and the take home baby rates. Embryolab, as a leading Fertility Clinic, takes the time and effort to create tailor-made solutions, for your Fertility Journey.


Βασίλης Κατσαρές

Βιολόγος - Μοριακός Γενετιστής, B.Sc., Ph.D. View more