Replay: Why IUIs Fail — Even When Everything Looks Normal

In this replay episode of Taco Bout Fertility Tuesday, Dr. Mark Amols breaks down one of the most frustrating questions in fertility treatment: why IUIs sometimes fail even when everything seems like it should work. He explains the real success rates of IUI, why unexplained infertility is not the same as no problem, how sperm and tubes can look normal on paper but still not function normally, and why a failed IUI does not mean IVF will fail too. This is a helpful episode for anyone trying to understand realistic expectations for IUI and when it may be time to move on to IVF. Originally released in 2021. 

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Transcript

0:01

Today we talk about why do iuis fail. I'm m. Dr. Marc amals and this is taco about fertility Tuesday. When you think about actually doesn't make any sense why an IUI wouldn't work. I mean, you're making extra eggs, you're taking sperm and you're injecting it right into the uterus. I mean, in your mind it should work. And, it really should when you think about it. But what's surprising Is that, IUIs actually are not very high chances. Each IUI is going to be somewhere between about 10 to 22%. Now, if you're doing something more aggressive, you're going to be in the higher 15 to 22% range. But if you're doing something a little milder, like just Femara, Clomid, you might only be between about 12 and 15%. And so although it does seem like they should work, it's important to understand that they don't all the time. I don't tell you this because I want you to feel there's no chance of them working. They do work. I more want you to understand that you should set expectations that it's going to be lower chances that could take a few cycles to work. However, even when I tell patients this and I prepare them ahead of time, that the chances are better that they won't work than will work on the first try. They're devastated when it doesn't work. And so today I want to talk about why does it not work? Why does something seem like it should absolutely work, not work? In the last episode we talked about reason why IUIs are done, and that does play a little bit of a part into things, working or not. So clearly, if you're doing an IUI for the wrong reason, then it's not likely going to work. So, for example, if your tubes are blocked and you're doing IUIs, you are not going to get pregnant because your tubes are blocked. Sperm can't get to the egg. If your sperm is too low, if it's less than 10 million sperm total, then there's a good chance IUIs won't work and that your doctor is probably doing them, hoping it will work, but in reality it's probably not going to. What I want to talk about is when it is the right time to do IUIs and then it still doesn't work. And the most common times that we do IUIs are, ah, going to be with unexplained infertility, and then we're also going to do it with Male factor problems. Now, there are other reasons to do IUIs that people may choose, such as, not able to have intercourse or painful, intercourse requires them to do IUIs. But in the end this still applies to them. So as we discussed in the last episode, the purpose of IUIs is to bypass the cervix, where there could be a hostile environment. Plus, you're helping improve the sperm parameters by now putting millions into the uterus versus only hundreds of thousands. Naturally, when you have intercourse, only hundreds of thousands of sperm get into the uterus, whereas now millions get in. So by improving the sperm, by increasing the quantity and by bypassing the cervix, you're able to, to have success. So let's talk about unexplained. Unexplained infertility does not mean there's not a problem. It just means we don't know exactly what the problem is. And so there's the potential that there could be a problem that's unrecognized, not because the doctor's bad their job, but because the testing we have doesn't cover everything. And for example, your tubes, just because the tubal test says the tubes are open, doesn't mean that the tubes are functional. You could have open tubes, but the little fingers that pull the egg towards the tubes may not be working. And so in that situation, everything looks good, but you really cannot get pregnant with IUIs, the same thing with sperm. Sperm may look good, but we have to keep in mind that the. These are just statistics. We're just saying if sperm is in this parameter, there is lower chance there will be problems. It doesn't mean there can't be problems. I always make the comparison of sperm to NBA draft picks. Years ago, when they used to pick NBA players from the draft, they looked at the history of the player. They would say, how well did they do? Did they do really well in college? And that was kind of the way we did it all the time. And then when metrics start coming out and they start realizing, you know, if we just look at the height of the player, if we look at the wingspan, how high they can jump, even if they're not a great player, we can determine that they're going to be pretty good in the NBA. And so when they started doing that, they started having more players make it on successfully than just using the old technique of looking at their past. But what's important to understand about this is, is sometimes there's been some really big flops where when you look on the paper, looks Amazing. It's gonna be the next Michael Jordan. But then in real life, they don't do that well. Well, the same thing goes for sperm. Sperm can look really good on paper. And we're like, wow, that's the Brad Pitt of sperm right there. But in reality, the sperm may not be well on game day. On game day, it may be falling short, going a step further than that. There can also be issues with the sperm being able to fertilize the egg. So the sperm has to interact with the egg to fertilize it. There's a thing called an acrosome on the top of the sperm. In some sperm, it's not as good, or there could be problems. Now, the issue is, again, with unexplained infertility, there really isn't a good test to check the sperm ability to fertilize the egg. Because even if you use the mouse egg fertilizer, that doesn't matter. That's not your egg. If you use another woman's eggs to test, it doesn't help because it's not your eggs. So the only way we could ever know the sperm can fertilize the egg is by doing ivf, putting the sperm with the eggs and seeing if they work. And if they don't, then we could take a step back and say, okay, here's a problem. His sperm can't fertilize the eggs. Well, so as you can see, there are situations where. Where IUIs will not work, but there's really no way to know they won't work. You can never know if the sperm's going to fertilize. You can never truly know if the tubes are functional or not. And that's where IVF comes in. It's not that IVF is this amazing treatment that is so much better than IUIs. It bypasses everything. So even if you're wrong, what's going on, IVF is going to bypass it. So if it's a tubal problem, the IUIs didn't work. Guess what? IVF works. Now, if it's a sperm issue, not being able to get into the egg, IVF now can work by doing icsi, where we inject the sperm in. If it's an issue where the sperm just isn't working well, but looks good again, IVF will fix it. What's important to remember is, is that IUIs can't fix everything. Matter of fact, they only fix a few problems. And so the people who should do them, about 50% of people will get pregnant with them. But people who should not do IUIs obviously will have a lower pregnancy chance. The most important thing for you to keep in mind is that don't think of IUI as this treatment. That if it doesn't work, then that means IVF won't work, because they're completely different treatments. I always make the joke that IUI is not like a Junior Whopper Burger at Burger King, and IVF is a Whopper, just a bigger version, better version of it. But instead, if IUI is the Junior Whopper, then IVF is going to be like the best taco or filet mignon you've ever had. It's a completely different treatment that has different success rates, not because it's better, but because it, bypasses everything and then allows us to get more A. IUIs are a very useful treatment, and they work a lot. The important thing to remember is, is when they don't work, don't blame yourself. You didn't do anything wrong. They can't fix everything, and they really only fix a few things. And sometimes we do IUIs thinking they're the right treatment and later find out they weren't. But the reason we try them is because they're easy, they're a lot simpler, they're less stressful, and they work most of the time. And so when you go into an iui, remember it may not work on the first try, but we recommend doing about three to four tries. If, it hasn't worked by then, then that's when you move on to either more testing or going on the ivf. Just remember, it didn't work, not because of something you did, but because IUIs can't fix everything. Well, I hope you guys enjoyed this episode. As always, if you like what you Hear, please review us. Give us 5 stars on your favorite podcast media that you listen to. I look forward to talking to you again next week with more subjects. And again, if you ever have any that you would suggest, please send a message to me either through our Facebook page or by sending it to tbftewdirectionfertility.com I'm more than happy to address it. Until next week, this is Taco Belt Fertility Tuesday.