IUI Guidelines For Multiples From IUI

In the UK, the National Institute for Clinical Excellence (NICE) has made a point of issuing guidelines on the subject of multiple pregnancies that occur as a result of intrauterine insemination (IUI) used in tandem with ovarian stimulation medications so as to increase the success of the IUI procedure. The Institute's experts cite statistics from a U.S. study showing that intrauterine insemination is responsible for a 22% increase in twins, a 4% increase in triplets, and a 3% increase in quadruplet births arising from IUI procedures used together with ovulatory stimulation.

Natural Cycle

In cases in which IUI is used in rhythm with a woman's natural ovulatory cycle, NICE discovered that the IUI procedure did not increase a woman's chances for multiple births. Because of this apparent difference in pregnancy outcome, NICE issued its guidelines on the subject of multiple births and IUI. These guidelines state that in the case where IUI is used in an effort to counteract male factor infertility, ovulatory-stimulation is better avoided since the success rate for IUI with these medications approximates that of IUI without such ovulatory stimulation. Also, ovarian stimulation, in and of itself, poses a similar risk for multiple pregnancy.

In any event, IUI, whether in tandem with ovulatory stimulation or not, is better for treating idiopathic (unexplained) fertility than no treatment whatsoever. But since NICE says it's better to avoid ovulatory stimulation since it poses a risk for the dangers of multiple pregnancy, even though it does afford a slight improvement on pregnancy rates, NICE offers a different solution: a double course of IUI. Having IUI twice within a short period of time can bolster a woman's chances for conception. The double course makes it more likely that the woman will have ovulated during one or the other of these two IUI treatments.

Multiple Pregnancy

It is a delicate balance: the decision to risk a multiple pregnancy and a possible negative pregnancy outcome, as against having IUI with a woman's natural cycle and risking that the procedure will not be successful, even with the double course of treatment. But at the very least, a couple must be aware of all the options and risks involved with the IUI procedure. Some frank discussion with a physician can go a long way in detailing the exact nature of the complications and risks that are linked to multiple pregnancies and births. In some cases, a physician is well-prepared with pamphlets and materials on this issue. 

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