Case Studies
& FAQ’S
Case Study IUI
Kate and Mark had been trying to conceive for three years before they came to SEFC. Kate was 31 years old and an office administrator and Mark, 38 years, a telephone engineer. The couple were both in good health and Mark had a 5 year old son from a previous relationship. Mark drank approximately 30 units of alcohol per week and was advised to reduce his intake.
Basic investigations had been carried out at their local hospital and by their Family Doctor. A blood test confirmed that Kate was immune to rubella (German measles) and a urine test was negative for Chlamydia (a common sexually transmitted disease). Kate had used ovulation predictor kits from the chemist which suggested that she was ovulating. She was reassured that a progesterone test in the third week of her cycle was consistent with ovulation. A Laparoscopy under general anaesthetic allowed her gynaecologist to assess the pelvis. This showed a normal uterus and ovaries. A few spots of endometriosis of doubtful significance were noted but not considered worth treating. Both fallopian tubes appeared healthy and were confirmed to be open by injecting some dye. Mark produced a semen sample for analysis after three days of abstinence which was reported as normal.
As all investigations were normal, the couple were told they had ‘Unexplained Subfertility. This diagnosis does not necessarily rule out infertility problems, but current technology does not allow the cause to be identified. The couple were advised to consider treatment by IVF (test tube baby) or Intrauterine Insemination (IUI). As Mark already had a child, the couple were not eligible for treatment at an NHS unit. They therefore contacted SEFC directly and booked a consultation with the Consultant. An appointment was available within the next two weeks.
The Consultant took a detailed history from the couple to confirm the diagnosis and discussed IVF and IUI with the couple. Overall, treatment was recommended by IUI as this is medically safer, less invasive and less expensive than IVF. It involves a course of ovarian stimulation using injected medication. Usually about three ultrasound scans are carried out to assess the number and size of the developing follicles. When 2-3 follicles are mature, ovulation is induced. A washed semen sample is then inseminated into the uterus using a fine catheter at the time ovulation is about to occur. The couple were recommended to plan for up to three attempts at IUI. Over a course of three attempts, this would produce a higher pregnancy rate than a single IVF attempt for less financial outlay and few potential complications. At the end of the consultation, the couple were given the ‘Patient Information Book’ which describes all treatments at SEFC in detail. Kate was advised to see one of the fertility nurses for a consultation to go through the details of treatment and to complete a number of consent forms. This was carried out within one week of seeing the Consultant.
There was a very short waiting list to start a treatment and the couple were advised that Kate could commence a treatment cycle at the start of her next period.
When Kate started her next period, she contacted SEFC to explain she wanted to start her IUI treatment cycle. An ultrasound scan was arranged for the following day. This scan confirmed the uterus was of normal appearance and the lining of the uterus (endometrium) was thin. There were no cysts in the ovaries. Kate was therefore able to start treatment. The medication was prescribed and dispensed from the SEFC Pharmacy. Kate took one injection daily to block ovulation. This allowed accurate timing for the insemination later in the cycle. A second injection was taken alternate days to stimulate the ovaries to produce 2-3 follicles instead of the usual one. All injections were administered just under the skin, similar to the way diabetic people take their insulin. There is never a need with this medication to inject into a muscle or vein. After a few days Kate found the process very straightforward with a minimum of discomfort. Mark could have attended for the scans but Kate felt comfortable at the clinic and was happy to come by herself.
After one week, a second ultrasound scan showed two follicles to be developing. However the follicle sizes were a little small. This is not unusual and therefore the dose of ovarian stimulation was increased to daily to speed the process along. Two days later two follicles were measured and considered to be mature in size. Kate was ready for the IUI procedure.
Final instructions were written down to plan the IUI. Kate was advised to take an injection to induce ovulation at eleven o’clock (23:00) that night. Ovulation would occur approximately 36 hours later.
At ten o’clock on the day of treatment, Mark attended to produce his semen sample for the IUI. Mark was reassured to see the detailed witnessing procedures in place to ensure all samples are labelled properly and used appropriately. The semen sample took approximately one hour to prepare. This process involves preparing a sperm preparation of the best motility.
One hour later, Kate and Mark were shown to a Patient Room. Kate changed into a surgical gown and the couple were taken to the Treatment Room. Kate was asked to confirm her identity and the sample to be used was confirmed to belong to Mark. The sperm preparation contained 8 million sperm. At SEFC we consider anything above 2 million to be satisfactory. Kate then signed a consent form for the IUI procedure. A speculum was passed and the cervix was identified before being cleaned with a saline soaked swab. A fine catheter was introduced into the uterus and the sperm preparation injected. Kate thought the procedure was just like a cervical smear test.
The procedure took just five minutes. Kate then rested in her room for another five minutes before getting ready to go home. Kate was given two injections of ‘HCG’ to be taken three and eight days after the IUI. These were to prepare the endometrium for implantation. Kate was advised to carry out a pregnancy test 18 days later and to contact the clinic with the result. Occasionally the injections of HCG cause a false positive pregnancy test so it was important that Kate did not carry out the test too early.
Kate and Mark were delighted when the pregnancy test was positive. On contacting the clinic Kate was advised to continue as normal but to avoid over exertion. A pregnancy scan was arranged three weeks later which confirmed a single pregnancy and a heartbeat could be seen beating on the scan. Kate was discharged back to her Family Doctor to arrange for antenatal care.
Cost:
Kate and Mark paid £160.00 for their initial consultation. The IUI cost £575.00 and the total cost of medication was £235.00, a total cost of £810.00 for the treatment cycle. Three attempts, if necessary would gave cost a total of approximately £2400.00 for a pregnancy rate of >50%. A single attempt at IVF would have cost them a total in the order of £3500.00 for a pregnancy rate of 38%. Some women require more or less medication but this case is represents a typical estimate of the costs for treatment. An up to date price list is available from the clinic.
Comment:
IUI is an ideal form of treatment for many cases of unexplained infertility, ovulatory disorders and particularly if you have been trying for pregnancy for up to three years. It is also useful in situations where the male sperm count is borderline or there are low levels of antibodies in the semen. In such circumstances the sperm preparation for the IUI can maximise the quality of the sperm sample. Finally it is particularly effective for women needing treatment using donated sperm.
Typical pregnancy rates for IUI at SEFC are 20-25% per cycle with cumulative pregnancy rates of 50% or more over a course of three treatment cycles. A single treatment cycle of IVF would have given them a pregnancy rate of 35-40%.
Multiple pregnancy rates are in the order of 10-15% which compares favourably with IVF. If the ovaries over-respond to the medication, we recommend that some of the follicles are drained at the time of IUI to avoid multiple pregnancy. This is a simple procedure for which most women require no anaesthetic and avoids the need to cancel the treatment cycle.
At SEFC we believe that IUI offers safe, successful and cost effective treatment for many of our couples. We do not encourage couples to undergo unnecessary and expensive forms of treatment when a safer and cheaper option is available. Not all clinics offer IUI treatment.
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