Ovulation induction & IUI

What is ovulation induction?

Ovulation induction is the controlled stimulation of the ovaries leading to the development and eventual ovulation of usually one but sometimes up to three eggs.

Who needs it?

Women with ‘anovulation’ (absence of ovulation) who want to conceive need ovulation induction. The most common cause of anovulation is ‘polycystic ovary syndrome’. Another cause is excessive blood levels of a hormone called prolactin that prevents ovulation. Other causes include stress, anxiety, extreme physical exertion (as with long-distance athletes), profound weight loss (greater than 15% of body weight), anorexia and serious illnesses. We also use ovulation induction to improve their natural hormone levels in some women or along with certain procedures like intrauterine insemination of sperm (see below).

How is it performed?

Couples are assessed carefully before this treatment is started. We obtain detailed histories and examine women and perform blood tests assessing ovarian function, pelvic ultrasound scans, dye tests to confirm the tubes are open and sperm tests. The way we choose to induce ovulation will depend on the individual circumstances but will be discussed and agreed beforehand.

What else needs to be done?

Most couples will be advised to increase how often they have sex during ovulation induction treatment. Although there is no ideal pattern for this, intercourse on alternate days around the time of ovulation is generally considered sufficient. Women on tablets will generally ovulate around the middle of their cycles and ultrasound monitoring may help to pinpoint the day more accurately. Those having injections will usually be aware of the day they ovulate because of ultrasound monitoring and the hormone injection that is given to help release the egg. Following surgery, the day of ovulation will need to be worked out by the doctors using ultrasound and hormone tests.

What problems can arise?

Problems can arise from any form of ovulation induction treatment and couples need to be aware of common ones:

Intrauterine insemination (IUI)

IUI especially when combined with ovulation induction can improve the chances of conceiving in couples with certain types of infertility including unexplained infertility and mild sperm abnormalities. It is also useful with donated sperm in treating men with no sperm at all. It is much cheaper and less complicated than IVF treatment. We offer the choice of 4-6 cycles of IUI in suitable couples before considering IVF.

Intrauterine insemination (IUI) with partner sperm

Some couples may be treated by injection of washed husband sperm directly into the womb around the time of ovulation (intrauterine insemination). This is useful for couples with mild sperm problems as well as those in whom no problems have been found in either partner. The sperm is obtained from the man by masturbation, washed in a special medium and placed into a syringe that is attached to a small tube. With the woman lying on her back, the tube is passed into the womb through the cervix and the sperm injected into the womb. The woman continues to lie down for about half an hour after the insemination.

Intrauterine insemination (IUI) with donor sperm

This is also known as donor insemination (DI) and is the injection of donated sperm into the womb of women whose partners are unable to produce sperm of their own. Approximately 10,000 cycles of DI are performed in the UK every year. The treatment is regulated by the Human Fertilisation and Embryology Authority (HFEA) in the UK and is strictly monitored. In a small proportion of couples, the man may not be producing sperm at all. This may be due to problems the man is born with or it may develop for no reason, or following infection, medical treatment or surgery. Some men may have a genetic abnormality that makes them infertile or that they do not wish to pass on to their children. IUI with donor sperm is performed in exactly the same way as IUI with husband sperm (detailed above) and can be performed with or without ovulation induction. The maximum number of children that any particular sperm donor is allowed to father varies around the world and is currently 10 in the UK.
Ethical issues

There are implications of using donated gametes that all involved parties need to be aware of:

How effective are ovulation induction and IUI?

Induction of ovulation treatment is very successful in causing release of the egg from the ovaries but is much less successful in achieving pregnancy. The chances of success appear to be similar whether treatment is with tablets, injections or surgery. About 3 out of 4 women treated will ovulate successfully but only 1 in 3 of these will conceive. Combining ovulation induction with intrauterine insemination further improves the chances of conceiving in certain couples, such as those with sperm problems or with no problems in either partner.

Treatment success is measured professionally by pregnancy and life birth rates and current average rates in the UK are detailed in the table below.

Age groups Fresh IVF/ICSI cycles Frozen embryo cycles IUI cycles without drugs IUI cycles with drugs DI cycles without drugs DI cycles with drugs
< 35 years 32% 22% 11% 13% 0% 16%
35 – 37 years 27% 17% 11% 13% 1% 14%
38 – 39 years 19% 18% 9% 10% 5% 10%
40 – 42 years 12% 12% 6% 9% 10% 6%
43 – 44 years 4% 8% 5% 4% 12% 0%
> 44 years 3% 12% 12% 0% 12% 0%

 

Table 1. Live birth rates for assisted conception cycles in the UK; HFEA published results for – 2008.

Useful contacts:

Donor Network

P.O. Box 265, Sheffield, S3 7XY
Tel. 0208 245 4369

British Infertility Counsellors Association (BICA)

69 Division Street, Sheffield, South Yorkshire
Tel. 01342 843 880

Human Fertilisation and Embryology Authority (HFEA)

30 Artillery Lane, London, E1 7LS
Tel. 0207 377 5077; www.hfea.gov.uk