PCOS and IUI

A lot of people are interested in infertility treatment for PCOS and how it relates to IUI.  

What is IUI?

Intrauterine insemination (IUI), which is a type of artificial insemination used in treating infertility, involves the use of a small catheter, and sperm is put into the uterus directly. The sperm before being placed in the uterus would have been washed and concentrated. The aim of this is to ensure fertilization chances are improved, thus allowing for pregnancy to occur. This is made possible by the increased number of healthy sperm that get to the fallopian tubes during the most fertile period of the woman (which is when the ovary releases an egg allowing for the sperm to fertilize the egg).   

Problems Associated with Infertility

There are different reasons why a couple may not be able to get pregnant. For couples with the following factors, intrauterine insemination is most often used.

• Endometriosis-related fertility:  In such situations, the use of drugs to get eggs of good quality, combined with IUI is sometimes the first approach to treatment.
• Infertility due to cervical factor:  the cervical mucus is necessary for the sperm to travel to the fallopian tubes from the vagina. The mucus is usually made by the cervix at about the time of ovulation. Apart from too thick mucus hindering the sperm from getting to its destination, the cervix itself can also be an inhibiting factor. Certain procedures that will cause scarring like that from a biopsy can cause thickening of the cervix. With a procedure like IUI, depositing the sperm directly into the uterus will enable the cervix to be bypassed thereby increasing the sperm’s number that will meet the egg.
• Sperm of Donor: IUI is most often used for women who intend to use the sperm of a donor to get pregnant. 
• Infertility due to ovulatory factor: for those who have infertility due to issues with ovulation including no eggs or a reduced number of eggs, IUI can be performed on them.
• Unexplained infertility: the first treatment for infertility that cannot be explained is IUI together with medications that induce ovulation.
•  Mild male factor infertility (subfertility): during the medical assessment of infertility, one of the first steps is the analysis of the semen. This may show abnormality in the size and shape of the semen, weak motility of the semen, and concentration of the sperm may be below average. These issues can be overcome with IUI as during the preparation of semen for the procedure, normal sperm that are highly motile are separated from those with lower quality
• Semen allergy: it is very rare for infertility to be caused by an allergy to proteins in semen. With IUI, before sperm is inserted, many of the proteins in the semen are removed.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a problem that affects the hormone level of a woman. Polycystic means many cysts. In this situation, the male hormones are produced in a quantity that is higher than normal in the woman. As a result of this imbalance in hormones, menstrual periods are skipped making it difficult for the woman to get pregnant. PCOS can also cause baldness and the growth of hair on the body and the face.

PCOS is a group of symptoms that affects both the ovaries and ovulation. It is characterized by high male hormones, periods that are irregular or skipped, and cysts in the ovaries. In PCOS, inside the ovaries sacs that are small and filled with fluids are seen. Each of these sacs which are also known as follicles contains an egg that is not matured enough to cause ovulation. The levels of estrogen, progesterone, FSH, and LH are altered due to lack of ovulation. The level of androgen is higher than normal while the level of progesterone is lower than normal. This higher level of androgen will alter the menstrual cycle hence causing the period to be fewer. 

It usually affects women within their childbearing ages (ages 15 to 44). PCOS affects the ovaries of a woman which is the organ responsible for the production of the estrogen and progesterone hormones and these hormones are responsible for the regulation of the menstrual cycle. In addition, a low amount of androgens (male hormones) is also produced by the ovaries. 

PCOS and IUI: Pros and Cons

IUI deposits sperm directly into the uterus. This procedure significantly decreases the distance sperm must travel to get to an egg. This makes it more likely that the conception will be a success. As far as PCOS is concerned, IUI is beneficial because it gives women better chances of conceiving during ovulation, which is very important when ovulation occurs infrequently.

In IUI, the sperm is deposited directly into the uterus thereby reducing the distance of travel of the sperm to the egg making it likely for conception to be successful. For PCOS, since ovulation is not frequent, IUI becomes beneficial due to the fact that when ovulation occurs, it gives women a better chance of getting pregnant. For women with PCOS, IUI can be successful however after two or three unsuccessful IUI cycles, alternative fertility options should be considered.

PCOS patients can gain more benefits when IUI is done together with ovarian induction. In this case, some drugs are given to the patient to induce ovulation. This allows for ovulation to be tracked, thereby allowing for a well-timed IUI cycle. In addition, the increase in egg production thereby gives the patients more opportunity for conception.

References

• https://www.healthline.com/health/polycystic-ovary-disease#causes
• https://www.mayoclinic.org/tests-procedures/intrauterine-insemination/about/pac-20384722 
• https://www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/fertility-center/infertility-services/intrauterine-insemination.html
• https://www.azarh.com/blog/iui-for-pcos.html#:~:text=IUI%20can%20be%20very%20successful,in%20vitro%20fertilization%2C%20or%20IVF.

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