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Archive for the ‘intrauterine insemination’ tag

Infertility Podcast Series: Journey to the Crib: Chapter 15 Intrauterine Insemination

By David Kreiner MD

June 3rd, 2013 at 8:52 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Fifteen: Intrauterine Insemination. You, the listener, are invited to ask questions and make comments and Dr. Kreiner will respond.  You can access the podcast here: http://podcast.longislandivf.com/?p=98

 Intrauterine Insemination

Intrauterine Insemination, or IUI, involves preparing the sperm usually by a washing procedure removing prostaglandins and debris that would otherwise cause severe cramping when the sperm is introduced into the uterine cavity.  Since clomid, an anti-estrogen, can thicken the cervical mucus and create a cervical barrier to the sperm, IUI is a valuable adjuvant to clomid therapy.

The disadvantage of IUI is that as many eggs as you ovulate can fertilize and implant.  In cases where multiple eggs are developed in ovarian hyperstimulation therapy like clomid and FSH (bravelle, menopur, gonal F, Follistim) the risk of multiple pregnancy occurring is enhanced.  The increase in pregnancy rate from this therapy as well as the increased risks associated with IUIs needs to be compared with the relatively superior success rate from In Vitro Fertilization where a single embryo transfer may be performed and excess embryos cryopreserved for a subsequent cycle.  If costs of the treatments are a consideration, such reduced-cost procedures like Minimal Stimulation IVF or Micro-IVF may prove to be a cost effective alternative to IUI when insurance does not cover the IUIs.

Interestingly, not all insurance companies have caught on to this issue of a higher risk of multiple pregnancy with IUI associated with clomid or FSH.  Some require patients to go through a minimum number of IUIs prior to covering the more effective and safer IVF.

Ironically, a multiple pregnancy will cost the insurance company far more than if they had covered IVF.

Worth repeating from the last podcast on clomid therapy: For those patients without insurance coverage, Micro-IVF, minimal stimulation IVF (utilizing Clomid), costs approximately the same as three Clomid/IUI cycles but offers women under 35 years of age a better than 40% pregnancy rate and as such may be a more cost effective alternative.

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Was this helpful in answering your questions about Intrauterine Insemination?

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Stuck at the Fork of IUI Road and IVF Blvd.?

By Tracey Minella and David Kreiner MD

October 21st, 2011 at 12:00 am


You may not know where you went wrong, but most infertile couples feel lost at some point along their infertility journey. And the longer the trail of treatment gets, the more it can feel like you’re on a road trip from hell without a map…and with a partner who won’t stop for directions.

If your own journey has got you stuck at the corner of IUI Rd. and IVF Blvd… wondering whether to continue with more IUIs or to move in a different direction like IVF or micro-IVF…East Coast Fertility’s Dr. David Kreiner may be the infertility GPS system you’re looking for.

Dr. Kreiner gives valuable insight on how to handle this tough question if you find yourself at that particular crossroads:

Wantababy asked: iui versus micro ivf versus IVF:

I had three negative IUI cycles. I was on clomid and ovidril which produced ample follicles. IVF is not covered under our insurance and 12,000.00 with no guarantee is very expensive. Is micro-ivf advisable? Is it advisable to do a fourth IUI which is covered under insurance? i had been going for acupuncture which I didn’t do for the first three IUI cycles.

Dr. Kreiner (The FertilityDoc) replied:

I prefer to have entire history which would influence my decision. Issues such as your age, duration of infertility, cause of infertility, your antral follicles count, AMH, day 3 E2, FSH all play a role. Personally, I weigh heavily a covered cycle vs. having to pay for uncovered cycle but at some point it does make sense to move to more aggressive treatment.

MicroIVF in general has about 3 times the success of an IUI and costs $3,900. Some groups, age, diagnosis do better with MicroIVF than others.

In addition, we do have income based grants and often studies which will significantly lessen the cost of a full stimulation IVF. If you prefer to discuss your personal situation directly email me at dkreiner@eastcoastfertility.com or call 516-939-2229 for a consultation. Free consultations are available if you are not covered by insurance.

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How many IUIs did you have before moving on to IVF? What factors went into your decision to do more IUIs or to move on to IVF?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=1666&picture=signpost

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