IUI with Clomiphene- A first line treatment for infertility
This information is provided for couples who are trying to conceive by New York Fertility Services, providing low cost infertility services and specializing in all IVF treatment options in New York City.
If infertility is a problem despite the fact that the woman is ovulating and there is no tubal or male factor, this is are commonly classified as unexplained infertility. Some of the women have had endometriosis diagnosed and treated, thus are not truly unexplained, but do fit into this category in terms of an approach for treatments.
Clomiphene is inexpensive and acts in women who already ovulate to stimulate production of several eggs in the treatment cycle. It acts by causing the brain to misinterpret circulating estrogen levels. This induces the pituitary gland to produce a surge of the follicle stimulating hormone or FSH. Naturally the result is the production of more than usual numbers of follicles, each with one egg. Intrauterine insemination (IUI) places more sperm into the uterus and then the tubes than could ever reach through intercourse. Thus more bullets are shooting at more targets.
The combined use of clomiphene and IUI has been shown to nearly double the results compared to using clomiphene alone to improve pregnancy likelihood (Guzick, 1998). The master student of IUI, Dr Richard Dickey and colleagues in 2002 compiled a large series in New Orleans and reported almost 10% success per cycle, though some anovulatory patients were included. That group, the traditional use for clomiphene should have a somewhat higher rate of success.
The distinguished group in Boston published a study recently that confirmed a cycle success rate of 11.5% (Dovey, 2008) from over 4000 cycles of treatment. The patients were ovulatory and the series allowed mild male factor. The success of treatments cumulatively over up to four cycles, was successful in 24% of patients under age 35. Age specific pregnancy rates per cycle ranges from 12% under age 35 to 4% over age 40. Corresponding decreases in overall success were seen according to age. Only one patient was successful of the 55 women treated over 43 years of age.
The study verified findings by others who found that 90% of success is found in three or four cycles. Those who are not pregnant by then should move to gonadotropin and IUI or IVF therapy.
At an IVF pratice in Atlanta, the clinicians found that the addition of a chemical called PAF to the sperm wash dramatically improved success rates (Roudebush 2004) to nearly double those without it. This is a reasonable simple method which more clinicians might use.
All concerned with cost effective treatment for infertility continue to believe that clomiphene and IUI are a good treatment on younger patients who have are trying to conceive and fit the criteria outlined.
We should mention to those browsing the web for the latest new twist that the aromatase inhibitors, though promising, have not shown improved results. Studies of letrazole and anastrazole are continuing.
At New York Fertility Services in New York City, the use of clomiphene and gonadotropin with IUI are recommended as relatively low cost options for infertility treatment in selected patients. Be sure to ask about our multiple IUI cycle package that provides up to six IUI’s for one low cost.
For individual infertility advice by expert patient advocates, seewww.fertilitylifelines.com
Dovey S et al Fertil Steril 2008:90:2281-86
Guzick, DS et al Fertil Steril 1998;70:207-13
Dickey RP et al Fertil Steril 2002;78:1088-95
Roudebush WE et al Fertil Steril 2004;82:52-56