IUI - Problems and solutions
There aren’t any tests to predict the right dose of clomiphene for a particular woman having IUIS, so common problems are:
- The initial dose of clomiphene isn’t high enough to produce more than one follicle. If this happens, we will give you the choice of continuing treatment or stopping and trying again at a higher dose of medications.
- The initial dose of medications causes too many follicles to grow, increasing the risk of multiple pregnancy such as twins or triplets. If this happens we will stop treatment and ask you not to have sex or to use barrier contraception such as a condom or diaphragm. A lower dose of medications will be used in the next cycle. Although we can count the number of sperm we place in the uterus, we can’t be sure they actually reach the egg(s) and lead to fertilisation. Because of this, we usually recommend that you consider moving to IVF if you do not become pregnant after 4 cycles of IUI using partner’s sperm, or after 6 or more cycles if you are using donor sperm.
Risks and side effects
- Multiple pregnancy, Blood tests and ultrasound scans give a good idea about how many follicles are growing in the ovary in a particular month of treatment but they are not perfect. About, 10-15% of pregnancies from IUIS treatment are twins and about 1% are triplets. Quadruplets or more are possible but very rare. Twins are associated with 2-3 times more risk for both the mother and children for a wide range of adverse outcomes, from maternal death to cerebral palsy. See our Fertility Facts on the risk of twins.
- Ectopic pregnancy, When an embryo implants in the Fallopian tube, the cervix or the abdomen it is called an ectopic pregnancy. Ectopic pregnancies can be dangerous because the placenta can burrow into a blood vessel and cause major internal bleeding. IUI probably doesn’t increase the risk of ectopic pregnancy, but all women having fertility treatment need to be aware of the possibility of ectopic pregnancy. We can usually detect an ectopic pregnancy by the level of hCG in the pregnancy test and an early ultrasound scan, but not always. Symptoms include severe, localised abdominal pain.
- Ovarian Hyper-Stimulation Syndrome (OHSS) The low dose of medications used means that OHSS is very rare in IUIS. The IVF section covers OHSS in detail.
- Vaso-vagal reaction There is a small chance of a vaso-vagal reaction at the time of insemination when the catheter is placed in the uterus. The vaso-vagal reaction is a reflex that causes the heart to slow, blood pressure to drop, and fainting. If this happens the insemination would be stopped and done at a later time.
- Infection after insemination Infection can occur when bacteria that are present in the vagina are transferred into the uterus during the insemination procedure. It probably happens in about 0.3% of cycles. Infection nearly always settles with antibiotics, but there have been rare cases of damage to the uterus or Fallopian tubes. Call the clinic if you feel sore, feverish or unwell within a few days of insemination.
- Bleeding after insemination Occasionally there is a little bleeding from the cervix the day of insemination or the day after. It is unlikely to affect the chance of pregnancy.
Pain
Pain is your body’s way of saying that something may be wrong. We need to know about any symptoms that might be concerning you. It is important to contact the clinic the same day if you have any of the following symptoms:
- Abdominal pain or discomfort;
- Abdominal bloating or swelling;
- Nausea or vomiting;
- Decreased urine output;
- Shortness of breath or difficulty breathing;
- Severe headache;
- Pain, bleeding or cramping after the insemination.
Good to know:
The medications used in IUI have been used over 40 years without any evidence of an increased risk of birth defects. Long-term follow up studies have failed to show any association between fertility treatment and ovarian or breast cancer. Pregnancy provides some degree of protection against ovarian cancer.