- 09-30-2003, 08:10 PM #1Registered User
- Join Date
- Sep 2003
- Hong Kong
I'm in my 30's and want to have a baby asap. Was wondering if anyone knows of intrauterine insemination of improving chances of getting pregnant faster without any actual fertilty prblems.
- 10-06-2003, 10:31 AM #2Registered User
- Join Date
- Jun 2003
- Hong Kong
You may want to try the Women's Clinic, Dr. Leong. Most Dr.'s deal with problem cases, but he will no doubt be able to help or point you in the right direction (The number at the clinic is 2523 3007)
- 10-09-2003, 12:11 PM #3Registered User
- Join Date
- May 2003
- happy valley
good website for fertility help
www.haveababy.com is a really good website and there's lots of other info if you do a search via yahoo. Here is a paste from their website. Assume that you would use IUI with some fertility drugs if you are keen to accelerate your pregnancy? By the way I did 3 goes with IUI and fertility drugs to no avail, so I'm doing ivf now (but I'm 38).
The birth rate per cycle of IUI with ovarian stimulation in women under 35 is about 15%. For women between 35-40, it is about 8-10%.
Over 40 the birth rate per cycle is <2%.
Thus after 35 when the biological clock starts to ramp up rapidly, it is wise to become more proactive and start thinking about IVF. After 40, in my opinion IVF is the only rational aproach given the dismal IUI birth rate of <2% per cycle at a time that eg quality is on a down hill slide,
The birth rate with IVF at any ade is at least double and after 35yrs probably 3-4 times as high per cycle.
If no pregnancy has occurred with IUI after 3 successive attempts with gonadotropin stimulation ( with one resting cycle between each stimulation cycle, then regardless of age, IVF is indicated.
See the article below and feel free to call 800-780-7437 if you wish to set up a free medical telephone consultation with me.
CONCEPTIONS, MISCONCEPTIONS, AND
WHAT PATIENTS SHOULD KNOW
Intrauterine insemination (IUI), the injection of sperm into the uterus by means of a catheter directed through the cervix, has been practiced for many years. The premise of this procedure is that sperm can reach and fertilize the egg more easily, if placed directly into the uterine cavity.
In the early ?0s, physicians were injecting small quantities of raw, untreated semen, (sperm plus the seminal plasma) directly into the uterus at the time of expected ovulation. However, when more than 0.2 ml of semen was injected in to the uterus, serious and sometimes life endangering shock-like reactions often occurred. It was subsequently identified that the reason for such reactions related to the presence of prostaglandins within the seminal plasma. This led to the practice of injecting small amounts (less than 0.2 ml) of raw semen. However, the pregnancy rates were dismal and side effects, such as severe cramping and infection were rampant.
Soon after establishing the Northern Nevada Fertility Center in Reno in 1982 (the Nation’s first private in vitro fertilization (IVF program), we began to recognize the potential advantage of washing and centrifuging raw semen, so as to separate sperm from the seminal fluid, and thereby remove prostaglandins that cause most of the problems. We subsequently introduced and, thereupon, became the first to publish on intrauterine insemination (IUI) in the prestigious Journal, Fertility and Sterility (April 1994).
Indications for Intrauterine Insemination (IUI)
?Artificial insemination with cryopreserved donor sperm: The recognition of HIV infection as a sexually transmitted disease, coupled with the fact that the virus is present in semen months before it can be detected in the blood, mandates that all donors have their semen cryopreserved (frozen) and stored for at least six months, whereupon, they be re-tested for HIV infection. Only upon confirmation of a negative test should the cryopreserved semen specimen be thawed and used for insemination. Since cryopreservation inevitably reduces sperm motility and function, it is not adequate to simply thaw the frozen specimen and then inseminate the raw semen into the vagina. Rather, the semen specimen should be processed for IUI. Provided that the recipient is ovulating normally, there is no need to administer fertility drugs, such as Clomiphene, Pergonal, etc.
?Artificial insemination with husband’s sperm: In cases of sexual dysfunction (impotence, retrograde ejaculation, etc.) or timing issues, husband’s sperm may need to be collected and processed in preparation of IUI.
?Cervical Mucus Hostility: Sometimes the cervical mucus acts as a barrier to the activation and passage of sperm as it passes through the cervical canal. Such hostility may be due to poor physical qualities of the mucus, cervical infection, or the presence of antisperm antibodies. In all but the latter case, IUI can readily be performed during natural cycles, unless the woman has ovulation dysfunction. However, when infertility results from the presence of antibodies in the cervical mucus, IUI will likely be ineffectual and should be replaced by in vitro fertilization (IV).
?Abnormal Ovulation: In some cases where the woman requires the use of fertility drugs to induce normal ovulation, the concomitant performance of IUI can optimize pregnancy rates.
Selecting the Fertility Drug of Choice for Intrauterine Insemination (IUI)
Clomiphene citrate (Serophene): A recent study confirmed that normally ovulating women taking Clomiphene citrate experience a reduced chance of achieving pregnancy when compared with fertile women who are not taking Clomiphene. Furthermore, additional studies have reported very few viable Clomiphene-induced pregnancies in women over the age of 40. The reason is Clomiphene’s anti-estrogen effect on the lining of the uterus and on the production of cervical mucus. To give a normally ovulating woman Clomiphene in the knowledge that she will, in any case, only release one egg at a time defies all logic. The only advantage to Clomiphene therapy lies in its simplicity of administration, low incidence of side effects, and it’s relatively low cost. It should also be recognized that Clomiphene should not be used for more than three consecutive months in a row without taking a full month’s break before starting a fourth cycle of treatment. The reason is that after the third consecutive month of Clomiphene therapy, there is a progressive decline in fertility, to the point that following six or more back-to-back cycles of treatment, the drug exerts a strong contraceptive influence. The latter results from a build up of the antiestrogenic properties of Clomiphene. The good news is that upon discontinuation of Clomiphene for six weeks, all of these adverse effects disappear, leaving the slate clean.
Gonadotropins: Women with absent or abnormal ovulation who require fertility drugs in preparation for IUI, should receive gonadotropins (e.g., Pergonal, Fertinex, Humegon, Repronex, Gonal-f, Follistim). Granted, these agents are relatively expensive, but they have no antiestrogenic properties and in the hands of the experienced physician, the pregnancy rate is nearly double that which can be achieved with Clomiphene, and side effects can be either prevented or readily managed.
Success Rates with Intrauterine Insemination (IUI)
Success rates with IUI are contingent upon the procedure being performed (1) for the correct indications, (2) avoiding the performance of IUI when contraindications exist (see below), (3) whether the woman is ovulating normally on her own and for the age of the woman. By and large, birth rates per cycle of IUI performed for the correct indications are reported to be about 15% for women less than 30 years of age, 12% for women 30-35 years, 7-8% for women 35-39 years, and less than 2% for women over 40 years.
Contraindications to Intrauterine Insemination (IUI)
Refractory male infertility: Contrary to popular belief, the performance of IUI in cases of male infertility does not improve success rates over regular and well-timed intercourse alone. In vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI) is the only method to optimize pregnancy rates in association with male refractory infertility.
Tubal Disease: Since pelvic inflammatory disease (PID) inevitably damages the intricate and sophisticated inner lining of the fallopian tubes, no surgery to the outside of the tube(s) will remedy damage done to the inner lining. As such, the pregnancy rate can be expected to be at least 10 times lower than average when fertility drugs and/or IUI are used in such cases. Moreover, the incidence of ectopic pregnancy is about 1 in 6. Bypassing the “damaged plumbing?with IVF is the only rational treatment is such cases.
Mild to moderate pelvic endometriosis: While the exact cause of endometriosis remains an enigma, it is now apparent that immunologic dysfunction is a significant feature of this disease, and that a toxic environment exists in the pelvis (surrounding the tubes and ovaries) in patient with this condition. As a consequence, ovulation, whether spontaneous or induced by fertility drugs commits the egg to pass through a toxic pelvic environment in order to reach the sperm waiting in the fallopian tube. This significantly reduces the egg’s fertilization potential. Furthermore, once the fertilized egg reaches the uterus, immunologic factors associated with endometriosis increase the risk of the embryo being rejected before pregnancy can be diagnosed. Such women may experience repeated “mini-miscarriages? In spite of these antifertility influences, many women with mild endometriosis in fact do conceive on their own, or following ovarian stimulation with fertility drugs. However, for reasons already referred to, the chances of conception are significantly reduced, and if they are ovulating normally on their own, the addition of fertility drugs will afford no additional benefit. Simply put, women in their late 20’s to early 30’s, who have the time to wait, can anticipate about a 40% chance of conceiving on their own within two or three years, contingent upon their ovulating normally and having fertile male partners. The occurrence of pregnancy in the latter cases occurs in spite of, rather than due to, such treatment. Such women should consider deferring all and any invasive treatments in favor of a “wait-and-see?approach. Conversely, women over the age of 35 whose egg quality is inevitably on the decline, IVF offers the only rational approach.
Fertility Drugs and Multiple Births
Normally ovulating women usually develop a number of follicles (fluid filled spaces within the ovary(ies) that contain eggs and produce estrogen) during the first week of the menstrual cycle. All but one (and sometimes two) of the follicles fair to develop to the point of being eligible for ovulation. The process in known as Selection. It is important to recognize that in all normally ovulating women, the one of two follicles selected to ovulate will inevitably be larger than the remaining follicles, regardless of whether the woman is receiving fertility agents, such as Clomiphene or Pergonal, etc. Simply put, one or two follicles will always show enhanced development over the others, and as soon as these selected follicles ovulate, all the remaining follicles are rendered incapable of following suit. As a result, normally ovulating women no not have a greater incidence of high order multiple pregnancies. In contrast, women who do not ovulate at all, and those who ovulate irregularly or dysfunctionally do not have the ability to select one or two dominant follicles for ovulation. As such, following the administration of fertility drugs for ovarian stimulation, numerous follicles may develop at the same rate and several eggs can be ovulated simultaneously. This translates into a greater chance of pregnancy, but also a greater chance of multiple pregnancies. It is interesting that almost all reported cases of high order multiple pregnancies (greater than twins) following the use of fertility drugs have occurred in women who do not ovulate normally on their own.
It follows that only those women with absent or abnormal ovulation are at-risk for high order multiple pregnancies. They, therefore, need to be counseled regarding the consequences of premature birth and the availability of selective pregnancy reduction towards the end of the third month of pregnancy. Another alternative is to avoid the issue completely by choosing in vitro fertilization (IVF), where the number of potential babies can be limited by the number of embryos transferred to the uterus.
It is indeed unfortunate that fertility treatment has become so regimented that most patients find themselves being ushered through a scripted treatment process, one that almost mandates surgery if the fallopian tubes are damaged or blocked, and Clomiphene/IUI for all other cases, even including male infertility. For the majority of couples who require an individualized strategic plan of action at an early stage, such an approach is emotionally, physically, and financially draining, leaving them both suspicious and critical of the intent of the medical profession.
Intrauterine Insemination (IOI), like any other form of fertility treatment, can be of great value if used appropriately and selectively for the correct indication. The use of fertility drugs should not be regarded as a necessary adjunct in all cases of IUI, which in turn should not be considered as a required preliminary to in vitro fertilization (IVF). Some women are better off with fertility drugs alone, some women require IUI alone, and some require IUI with fertility drugs, while others should go directly to IVF.
2.OVARIAN STIMULATION WITH GONADOTROPINS IN NORMAL VERSUS ABNORMAL/NON OVULATING WOMEN
Normally ovulating women undergoing gonadotropin stimulation (with or without IUI) tend to be “normal responders?and have virtually incidence of multiple pregnancies as compared to untreated fertile controls. In comparison, women with absent or dysfunctional ovulation who undergo ovarian stimulation experience double the per-cycle pregnancy rate and about15 times the multiple pregnancy rate and tend to be “high responders?who are highly susceptible to the development of ovarian hyperstimulation syndrome (OHS).
Serial ultrasound examinations performed around the time of ovulation on women undergoing gonadotropin-IUI, reveal that normally ovulating women tend to present with one (and sometimes two) dominant follicles, while absent/abnormal ovulators usually have numerous large follicles. Follow-up ultrasound examinations, performed 48 hours after HCG administration will reveal that in the case of normal ovulators, only the one (or two) dominant follicles actually ovulate, with other follicles remaining unaltered. In contrast, absent/abnormal ovulators tend to ovulate from multiple follicles. Perhaps this is due to a mechanism inherent in normally ovulating women which confines ovulation to an ability to those follicles that would otherwise have been targeted for natural “selection?to dominance.
If the premise upon which the performing ovarian stimulation (with or without IUI), is cause multiple eggs to be released and thereby increase the chance of pregnancy, then (with a few notable exceptions), the value of such treatment in normally ovulating women is questionable. This would especially hold for “poor responders?and older women for whom time is often running out. In such cases only IVF, by allowing access to more eggs/embryos, is capable of improving the birth rates per cycle, significantly.
- 10-09-2003, 10:59 PM #4Registered User
- Join Date
- Sep 2003
- Hong Kong
thank you so much for your responses....they were both informative and useful. i've scheduled a doc's appointment to discuss this topic but more importantly the preconception check up..make sure everythings ok first!!!
- 10-29-2003, 09:25 AM #5Registered User
- Join Date
- Oct 2003
- hong kong
Plenty of information there.
Avi-hope your checks went well. There are quite a few reproductive fertility doctors here. If you need anymore info on them let me know.
- 11-24-2004, 11:04 PM #6Registered User
- Join Date
- Nov 2004
- hong kong
I came across your thread from last year on this topic. I too am in my 30s and looking to get pregnant for the first time asap. Did you end up finding a good IUI clinic in HK?
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