Why Isn’t Your IUI Working?

Let’s walk through what would happen if you’re my patient and considering IUI:

Once it’s confirmed that IUI is the best route for you, we then take the following steps to give us the best chance at a successful outcome:

  1. Check to see if your fallopian tubes are open.
  2. Do an ultrasound. We do this to ensure there’s not a polyp or fibroid inside the uterus which would create a barrier to implantation
  3. Conduct a semen analysis. We do this to find out the health of the sperm before continuing with an IUI. Imagine the disappointment if you find out on the day of your IUI that the sperm quality is very low for the first time.

So what happens if you do a TUSHY check and your tubes aren’t blocked and IUI still doesn’t work? What does that mean?

Why don’t IUIs always work for people?

  1. The egg that’s ovulated needs to be a good egg and get picked up by the fallopian tube
  2. The sperm and egg have to meet in the tube
  3. The sperm has to fertilize the egg
  4. The embryo has to travel down the fallopian tube for almost a week
  5. The embryo has to implant in the uterus

I tell my patients that 90% of the time IUI doesn’t work.

Here’s the crazy part. Are you ready?

Steps you can take to improve your IUI rates

  1. Consider taking fertility pills (also known as ovulation induction) to increase the number of eggs you ovulate. This is to increase your chances via the number of eggs ovulated (not because you have an ovulation problem).
  2. Make sure you’re getting monitored in your cycle so you are timing the procedure as accurately as possible. How will you know the timing is right for your IUI if you haven’t taken a look at the follicle to make sure it’s the right size? Take a trigger shot to time the IUI right so that the egg and sperm meet. Don’t go into things blindly. I recommend asking your doctor to monitor you if they aren’t already.
  3. Consider a double IUI. This doesn’t mean two IUIs at the same time. It means staggering the IUI — two days in a row.
  4. Think about taking supplements that are friendly and may bolster egg AND sperm health — it isn’t just a woman’s role to prep for IUI! High dose antioxidants can help guys, depending on the sperm situation, and for women CoQ10 in addition to prenatal vitamins is something to consider.

Have you had a difficult IUI? If so, these are the questions I’d ask you:

  • Was your bladder full?
  • Were you given a valium before the procedure?
  • Was your IUI done under ultrasound guidance?
  • Recommend another speculum size.
  • Wait for the bladder to fill. The uterus is like a lawn chair in shape. As the bladder fills the uterus straightens and makes it easy to get a catheter in.
  • Use an ultrasound. If you’re in a clinical setting then there should be abdominal ultrasounds readily available. You’ll want to ask your doctor to use an abdominal ultrasound probe to see exactly where they need to go.
  • Can you write me a prescription for valium?
  • Should my bladder be full before I come in?
  • Will you do this under ultrasound guidance?

IUI Myths:

  1. “I only get three tries to do IUI.” That’s not true. However, if something doesn’t work after three times it’s definitely worth taking a step back and reevaluating if it makes sense to continue. Is there anything within your control that you can change to improve your chances?
  2. IUI takes only the good sperm and puts it at the top of the uterus. Ahh, I wish this was true! What we do is process the sperm and separate the semen from the sperm cells and deliver as many of the motile sperm cells as possible. You’ve probably heard the term morphology. Sperm morphology has to do with the shape of the sperm. We can’t separate out the badly shaped sperm from the good shape sperm. If the sperm is moving and alive it makes the cut. During IUI we’re taking all the moving sperm and delivering it at the top of the uterus.
  3. Sperm quality doesn’t matter when doing IUI. That’s false. Sperm quality does matter — certain % motility, amount moving in the right direction, and a certain count to make IUI worth your while. Talk to your doctor about what their personal cut-offs are and see if IUI is still right for you. If the sample is low then consider seeing a urologist or take a sperm DNA fragmentation test to ensure IUI is the best option. Especially if your doctor’s parameters are slightly lower. You may consider an anti-sperm antibody test. This will help you to see if maybe one of the reasons good sperm isn’t getting into the egg is because the sperm have antibodies bound to their heads which might make fertilization more difficult.
  4. The sperm will fall out. Here’s the thing — I can’t put a cork in the cervix after the IUI, and certainly there’s some level of gravity with sperm falling out. I have my patients lie down for 10 minutes or more. But that’s not a reason to avoid IUI.
  5. I can ask to have sperm directed to the side where ovulation is occurring. No. Unfortunately, this is not something we can do. At the tip of the catheter, there are two holes on either side. When you push the end of the syringe sperm comes out. The cavity is so small we don’t have the ability to push into one side or the other.
  6. You can spin sperm for gender. No — you can’t! There’s a company that claims they can, but no — that is not possible. Spinning sperm for gender is actually not a thing unless you go to another country.
  7. Abstain leading up to the IUI and then after the IUI. Having sex is not dangerous — it will not harm your IUI. People confuse the instructions they’ve gotten for the semen analysis with the instructions for the IUI. Again, talk to your doctor as they know the sperm’s health better than anyone else. Most people are fine to have sex every other day before and after the IUI.




Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store
Dr.Aimee Eyvazzadeh

Dr.Aimee Eyvazzadeh

Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer: www.eggwhisperer.com