Ask the fertility doctor
Q: Should I do two IUIs in a cycle or not. And if so, why or why not?
Dr. Carol Redmond (Toronto): Fertility & Sterility [April 2001, 75:4, pp. 656-660] reported a study that compared IUI and ICI in fertile single women. Interestingly they conclude that two are better than one. A single ICI had 5 percent success; double was 9 percent. A single IUI had 14 percent success; double 15 percent. I have interpreted that as: one IUI is better than two ICI, and one IUI and two IUI look the same to me. I've been doing only one - it's a great cost and time saver - and have been very happy with results, although my numbers are not large enough to confirm their findings, especially if I break it down into different age groups.
Dr. Arthur Wisot (LA): It depends if the ovaries are being stimulated. We try to figure out the right time. By using an ultrasound, if the follicle is still there, we do a second one. If the patient has ovulated already, there is no need to.
I caution patients to be aware of unethical physicians or clinics that will do unnecessary procedures, from two IUIs every cycle without checking to see if it's really necessary, to transferring high numbers of embryos, thereby increasing the risk of high-order multiple pregnancies.
These processes can be done unethically. Ethical rules are a set of values that protect the consumer. I know one doctor who transfers up to eight embryos in his under-35 patients. We usually transfer no more than two for women in that age group. Ethically, to me, it is not right to transfer such a high number, but that doctor does it to increase his success rate.
Dr. Fred Licciardi (NYC): We don't think there is an advantage in two IUIs per cycle. Since the egg is good for one day and the sperm two, one well-timed IUI should cover it.
However, I have many patients that just feel better having two IUIs. I have no problem with this. Sometimes it's hard to figure out when to do the first. If you are getting a human chorionic gonadotropin (hCG) shot and want two, probably the first UI should be the day after the hCG.
For donor sperm, should you use one vial or two at each insemination? It depends on the recommendations of your lab and the counts from each vial. You would like to get around 10 million motile sperm for each IUI. If you are a little under that's okay. So if one vial is giving you 13 million, that's enough. If you are getting 6.5 million, maybe two (vials) would be better.
