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IUI (Intrauterine Insemination) Improves Clomid

Detailed studies have shown the chance of conception in healthy fertile couples is only about 20 % (one in five) per month. Thus, it often takes several months to conceive. In fact, we do not diagnose infertility unless a couple has tried to conceive for 12 months if < 35 years, or 6 months if >35 years. A couple trying for one year would have about a 5 % (1 in 20) chance to get pregnant each month. The following diagram illustrates the cumulative probability to conceive in normal fertile couples.

Months attempting

You can see that most couples will get pregnant within 12 months. Patience is a virtue. If it is longer than 12 months, the chance to conceive each month drops to about 5% each month. Thus, couples may need medical intervention. Many of our treatments will bring the couple back to this ‘fertile’ pregnancy rate.

Clomid is our 1st line fertility treatment. It is a medicine that acts, in part, by blocking estrogen receptors. When it acts at the level of the brain, the brain senses a lack of estrogen and tries to stimulate the ovaries. This results in increased egg production (10% twins) which improves the chances to get pregnant. Clomid does a negative thing at the level of the cervix. The cervical mucus, which help sperm get to the uterine cavity, is dependent upon estrogen. Therefore, clomid thickens the mucus and makes it difficult for the sperm to swim up. An IUI, which is performed like a PAP smear, involves inserting a small plastic catheter into the uterine cavity and injecting concentrated and mobile sperm. This is done at the time the eggs are released, so we know they will be present in the distal fallopian tube at the correct time. An IUI generally costs about $300, much less than most other fertility procedures. It is a very good way to maximize the results when using Clomid. This will help couples get pregnant sooner, an important goal. This is shown in the diagram below.

It is reasonable to assume that it may take more than one month of therapy to get pregnant, just like with fertile patients. We generally do not do more than 4-5 months of Clomid/IUI, as most conceptions occur by then.

When using Clomid, patient age is very important. Fertility rates decline with age, and clomid may not be the best option in the older group. We have more potent drugs to help patients produce even more eggs and thus improve the chances to conceive. Also, patients that have had a baby before and are parous, may get pregnant more easily than those who have never been pregnant. See the diagram below.

As you can see, age has a significant effect on the chance for pregnancy. We are often more aggressive in our patients >35 years of age. We encourage the use of IUI with Clomid, because it maximizes the chances to conceive each month.
 

 

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