Intrauterine Insemination (IUI)
When should you use intrauterine insemination (IUI) –also known as artificial insemination–over IVF? What can you do to increase the odds that you will get pregnant with the IUI? Host Dawn Davenport, Executive Director of Creating a Family, the national infertility & adoption education and support nonprofit, interviews Dr. Marcy Maguire, reproductive endocrinologist at RMA New Jersey and clinical professor of reproductive endocrinology at the Robert Wood Johnson Medical School.
* Note this is an automatic transcription, please forgive the errors.[00:00:00] Today we’re going to be talking about intra uterine insemination. You also hear it or see it written as you why or even hear your doctor talk about you. Sometimes it’s called artificial insemination and it’s often the first step in infertility treatment. It’s also of course used for single moms or lesbian couples. What can you do to increase the odds of success with success of course is getting pregnant from you. Today we’re going to be talking with Dr. Marci Maguire. She is a reproductive endocrinologist at our in New Jersey. She is also the clinical professor of reproductive endocrinology at the Robert Wood Johnson Medical School. This is a real airing of a show that we did a number of years ago. Again important topic. The information is as they call it evergreen and so often what we’re finding is that we have shows that are buried in our archives and they are too good to miss. So we periodically whip them out when we’re not able to record a new show for you to hear. I hope you enjoy Dr. McGuire. [00:01:10] Welcome back to creating a family. Hi thank you for having me. Yeah. [00:01:16] You know as I mentioned I you guys can be used as part of infertility treatment but there also used by single women and lesbian couples who are using donor sperm and we’re going to be talking about all of these. On today’s show I’m going to start with a question from Carolyn. She sent us a question that kind of gets us started on how you guys might be used as part of fertility treatment. She says My husband and I haven’t been able to get pregnant. We’ve been trying for two and a half years. I’m now 33 at 38. They haven’t been able to find a reason for us not getting pregnant. We look perfect which is kind of weird. Do we automatically start with you. So that kind of leads us Dr. Maguire into the question of what type of diagnosis is most often helped with either of you why and why versus some other type of fertility treatments such as IVF. [00:02:11] Absolutely. So artificial insemination itself the process involves taking the partner sperm donor sperm and washing it to remove some chemicals or portions of that called prostate gland which could induce in anaphylaxis reaction if not removed. It also helps to purify the sample so that really only the fast moving firm in the sample that sperm is then placed via a tiny catheter directly into the uterus and this is beneficial because the vagina is very acidic and has a lot of mucus in it. And typically during intercourse most of the sperm sample is actually lost in the vagina. So we can kind of maximize concentration of healthy sperm producing an artificial insemination. [00:03:00] What percentage of sperm doesn’t make it through the to the cervix through the cervix into the uterus. [00:03:07] In typical intercourse so to be honest I’m not sure of the exact percentage but the majority of it does not make it past the vagina. [00:03:17] OK. [00:03:18] So by bypassing the vagina and the mucous in the vagina vagina it gets directly into the into the uterus and from there where does it go from there. [00:03:35] The sperm actually stays in cervical crypts and other sort of housing area if you will within a uterus and it slowly some of them swim up towards the egg and ultimately the sperm does fertilized egg in the fallopian tube the embryo that results then kind of floats back down the slope into even into the uterine cavity to implant. So it is a bit of a complicated process but at least bypassing the initial part should get the sperm closer to the egg. So what type of diagnosis fertility infertility diagnosis is most often helped with the the very best diagnosis or the most the diagnosis which is most help through Uys actually cervical factor infertility. So for women who’ve had a leap or a cone biopsy or other surgeries on their cervix these are surgeries that are commonly done for abnormal pap smears. Those women have an even less receptive cervix for firm transport. So that can be a physical blockade in itself for the firm to get into the uterus and ultimately meet the egg. So to bypass the cervix in that way is very helpful in them and tend to have a very high pregnancy rate just from artificial insemination alone. That being said artificial insemination is used for many different other diagnoses including unexplained infertility. Its efficacy for unexplained infertility is debated and certainly use of artificial insemination alone probably doesn’t offer a dramatic improvement in pregnancy versus just timed intercourse and couples that have completely unexplained infertility and other diagnosis that you could consider using artificial insemination for is very mild. Male factor infertility. [00:05:29] So there are certain parameters within a semen analysis that physicians look for to ensure that that couple would have a good chance of conception via either timed intercourse or artificial insemination. So generally there needs to be at least 15 million sperm per milliliter of fluid motility needs to be better than 50 percent more than half the sample should be moving there are certain volume parameters and shape parameters as well for sperm. So if there is a borderline concentration issue you may get some benefit from again kind of taking out the weaker sperm concentrating in and putting it directly into the uterus rather than letting some of this Hample get lost in the vagina there are other parts of the semen analysis for instance the sperm shape which is not aided by doing an artificial insemination. So it turns out that human eggs are surrounded by a rather thick membrane and sperm heads need to be perfectly shaped to kind of wiggle their way through unfertilized egg. So if the sperm shape generally is not perfect maybe they’re more around or there two heads or for whatever reason they’re a bit misshapen then just simply putting the sperm closer to the egg is not going to solve the problem of the sperm actually getting into the egg and fertilising it. [00:06:54] So that makes sense. You know one of the problems however is that at least in the past certain insurance and let’s be honest people don’t have insurance that will cover fertility treatment but assuming you do certain insurance have required in the past it’s almost as a mandatory first step that you try X number of new eyes before they will consider paying for IVF. Is that still something you see. [00:07:25] Yes and it’s actually a pretty interesting requirement. So yes regardless of the. Well that’s not exactly true. Unless there is a dramatic factor such as very low sperm count or blocked fallopian tubes which would justify your argument to allow a couple to go directly to IVF a lot of insurance companies will require sometimes two three or six artificial insemination cycles before approving. Moving on to in vitro fertilization. It’s an interesting phenomenon especially in light of some recent literature that was published on the topic. One in particular called the fast trial in Boston and that looked at both the pregnancy rate per cycle and the cost effectiveness of having patients moved from Clomid directly to IVF versus having patients move from Clomid to artificial insemination to IVF. And it turns out that moving from Coloma directly to IVF is much more cost effective. With about ten thousand dollars less per spent per delivery and has a higher per cycle chance of pregnancy than taking that longer step wise route. So based on that study perhaps insurance companies should rethink their their requirements. But at this time I do see a lot of insurance that is requiring is an intermediate step before IVF. [00:08:53] It’s a very interesting thing to come back and talk about some different things that are related to that in just a bit but I wanted to touch on. We’ve got questions from single women considering using donor sperm as well as lesbian couples so I kind of want to touch on that before we get into more of the detail. Let’s see. This is a question actually she didn’t give her name so I’m a single mom to be I’m a single mom to be and will be trying to get pregnant with donor sperm probably at the beginning of next year. Is it better for me to have the artificial insemination done. In the uterus or cervix you versus. I see. So let’s talk about. And that would apply with lesbian couples. We actually have a similar question from Shaynna. That’s the first part of her question who is asking the difference in pregnancy rates between IQ versus ISCI and that she also asked if there was a significant difference in costs between the two. So let’s talk about intra uterine insemination versus intra cervical insemination. [00:10:02] Absolutely. So they’re actually very similar procedures. The biggest difference is that the sperm has to be washed more thoroughly for an intrauterine insemination. Out of fear for that anaphylaxis reaction that you can have if the prostate gland in content is too high in the seminal specimen. So there are just the assessments are processed slightly differently although often physicians will use a UI process sperm specimen to do an entire cervical insemination to just to play it safe. That’s the biggest difference between the procedure now in terms of pregnancy rate the pregnancy rate with artificial insemination is slightly better than with intra cervical insemination and really there’s not that much difference in what the patient experiences. There is still a speculum exam there still a catheter it’s just a matter of the catheter moving forward by a centimeter or two rather than being just right at the third. [00:11:05] So in my opinion it is worth the worth it to go through with full artificial insemination if you’re at the point where you’re going to do an entire cervical insemination because really the only difference is where the catheter stops whether it stops right at the cervix or whether it pushes through the cervix and goes into the uterus Ron. [00:11:24] That’s correct. It’s not a difference in pain or anything like that most patients have no pain at all with an artificial insemination. [00:11:33] So yeah totally a matter of how hard you push. I people that different from still not ok. Shane had some other questions as well and there she is she says. My wife and I will be using donor sperm to start our family. All right she’s asked the questions about you versus ISCI she would also says we would really like to do a home and stay home insemination but don’t want to if our odds of success are lower. So that’s a different form of artificial insemination. Can you talk some to that. We often call it home insemination and that tends to be a popular option with certain same sex couples and couples. [00:12:19] Absolutely. So have a home insemination type of procedure that sperm or the semen specimen is deposited directly in the vagina and there is not an effort to place it in the uterus itself. This can be done at home so it can be more of an intimate kind of procedure and interment happening between the couple which is appealing I think as you said too many same sex couples. I think it’s perfectly fine in a couple that is otherwise fertile so have good numbers in terms of their ovarian reserve. There’s no known issue with the uterus or the slopy into being blocked. I think it’s fine in that case to try home and insemination a couple of times prior to coming in to the office for that matter more medicalize procedure of an artificial insemination of course in any circumstance you’d want to be careful that the firm specimen that’s being used has been properly screened for sexually transmitted diseases. [00:13:20] And don’t you think if depending on the age of the couple or the woman who the the woman who is trying to get pregnant that you need to give some thought to how many how long you ought to try home insemination or any lower odds of success method just because time is not on your side. [00:13:39] Absolutely and certainly in a woman that’s older than 35 I wouldn’t spend too much time with the home insemination route only because time is not always on your side and you wouldn’t want to waste precious months on a undertreatment that wasn’t as effective. Also the sperm specimens themselves can be quite expensive too. So you know that can be costly to go through a number of different inseminate or home home insemination and then inseminations in office to right you are listening to creating a family. [00:14:13] Today we’re talking about intrauterine insemination and how you can increase your odds of success. Creating a family has the largest infertility and adoption communities on the social networks and we would love to have you join us. There are three ways next with us on Facebook of course we have are creating a family page which you can find Facebook dot com slash creating a family. We also have a very large very active and very supportive support group. It’s a closed Facebook group so you have to request to join and only those on within the group can see the posts you can find that Facebook dot com slash group slash creating a family. And you can also connect with me personally and I am on Dot Davenport won. And we love Pinterest around here. We also love Twitter and you can find us on both of those at creating a family. All right. Now I want to talk some. And it’s one of those interesting things that we talked about the insurance issue requiring you guys. It’s always struck me as interesting because once you’ve moved into what you’re doing and why you have the choice of medicated and unmedicated cycles and then end with medication they give a choice between oral meds and injectables. I want to talk some about that. Do you generally start with an eye to eye on oral meds but by Clomid are our Amera or whatever people are using it. [00:15:45] It depends a lot actually on the diagnosis coming into it. So for women with Aviel a Tory infertility or Polycystic Ovarian Syndrome Clomid is a wonderful medication and and there wouldn’t there wouldn’t be a need for the Aui without the Clomid so we typically would start with the Clomid Aui and those couples have a pregnancy rate of about 50 percent in the first three months of trying. So that works really very well in women or couples with unexplained infertility. The pregnancy rate with you alone is not really different than the pregnancy rate with time intercourse and actually the addition of Clomid does not necessarily have a dramatic impact on improving the pregnancy rate either. So for couples with unexplained infertility I do recommend to move directly to ganap a trope an artificial insemination or FSE each new eye which is the injectable medicine in those couples and those the the pregnancy rate with Iwai alone is about four to six per cent the pregnancy rate with Clomid Aui is six to eight per cent and the pregnancy rate with msh and Aui is somewhere in the neighborhood of 15 to 20 percent depending on obviously other factors. But it makes sense in that group to move directly to the injectables within artificial insemination and this is unexplained infertility. Got [00:17:20] you. All right. So if that kind of begs the question of how do we define success when we talk about you guys and I’m probably preaching to the choir here. But I certainly say this a lot on our shows and throughout our website is that the goal from any form of fertility treatment is one healthy baby and one of the concerns with which are calling sh you guys are you with injectable good editor open medication is the risk of multiple. So I wanted to talk some about that. What is the risk of multiples when you’re when you’re using injectable drugs. [00:18:07] Absolutely. So the risk of multiple with injectables is about 20 per cent and that makes sense because the basis for the treatment is the idea that these couples who have been having regular intercourse with the release of one egg each month have not had conception. So the idea behind giving the injectable medicine is to purposely make them ovulate 2 3 4 eggs per month to improve the chance of conception of course coupled with artificial insemination as well. But if you’re having a woman obviously two or three eggs each month then it makes sense that her risk of twins or even higher order multiples would be higher than it’s approximately 20 percent. [00:18:51] What about people with PCOS because we hear about some of the more famous recent multiples. The Kate Plus 8 I believe her she was PCOS with injectable and some of the other large some of the Quint’s more recent fact probably a lot of the higher order multitudes have resulted from women receiving in at least some of them I know four were diagnosed with PCOS. So what about PCOS some women with PCOS going through a Ayyu Kohl with injectable Orvieto towards stimulating medication. [00:19:32] Absolutely. So women with PCOS often actually can be pretty tricky to maintain to monitor and control their ovarian response to the intractable medicine they’ll often be resistant or their bodies will be resistant to the medication initially and their estrogen level won’t budge no follicles grow. And then all of a sudden they hit a magic point in their ovaries take off like a rocket ship and five or six eggs grow. So it is absolutely imperative that all women but especially women with Polycystic Ovarian Syndrome her having a child you either F.S. h you die then intractable be monitored by trained physicians so that if in fact they do get five or six eggs to grow their doctor can say hey you know what this cycle isn’t working out there’s too many eggs here it’s not safe to proceed. The alternative to doing that is to proceed and then have a fetal reduction procedure which essentially means if are more than twins to reduce the fat number of fetuses to two but ideally the physician will be watching closely with daily or every other day monitoring so that the medication dose can be adjusted in an effort to have really only one egg be released. Those women with PCOS where the issue is not that the sperm and egg aren’t meeting but that the egg isn’t being obsoleted at all. And so the monitoring is done which weighs vegetal ultrasound typically a transvaginal ultrasound and also a serum Estra dial level just to make sure again that there’s you know three or four follicles no more than that and that the estrogen hopefully would stay less than a thousand micrograms. [00:21:16] But the reality for couples that I think sometimes is they don’t think about ahead of time is that significant cost associated with fertility treatment is in the medication and the injectable medications that are open. So by the time you have spent a fair amount of money getting these injectables and then if your body does overproduce the eggs and then you have five or six eggs and your doctor suggests that you cancel the cycle you’re out boatloads of money oftentimes multiple thousands of dollars usually. [00:21:50] So how does that work at that point. How receptive are people are to just saying OK well you know that was just scratched the cycle at that point. [00:22:00] Right. Absolutely it can be incredibly frustrating especially for like you said women with probably cystic ovarian syndrome who initially had a had very resistant ovaries and were on the medication for days and days with no response when all of a sudden a profound response is seen. And you know I’ve seen many tears shed but I think when you show the patient all the Sokal that are there and she’s seen the shows about multiples and she knows of the consequences both to her and the babies of having so many then I I have never had an I’ve never had an issue where the patient really refused to cancel the cycle when it’s indicated. [00:22:45] What about at that point people will ask Can we switch to an IVF cycle where you go through the egg retrieval OK I’ve I’ve grown all these eggs I produced all these eggs. Can you just go in now and harvest these eggs and let’s use them let’s say we will do IVF is that an option. [00:23:03] So it is and some insurances will be receptive to that and allow the patient just to converted over to IVF. Of course the cycle wasn’t set up exactly how it would be if we were just trying to do IVF from the get go. So sometimes the follicle development is a bit synchronous there are you know there is a cohort of six or seven eggs that are bigger and the rest are smaller but depending on the particular patient’s response and their willingness to try to move on to IVF that does make sense in some cases especially as you said not to waste that effort for the medicine cost of the medicine and all the monitoring to that point was nothing. [00:23:43] You know having gone through having to you know the wear and tear on the woman’s body. You know listen if you can. But the timing at that point is it possible to do a fresh is the timing such that you’re off sync with the window of implantation that you may not be able to do a fresh vital tip. [00:24:04] So it depends how often that they actually can do a fresh cycle still the implantation window is relative to the time that the uterus initially exposed to progesterone. So long as they haven’t obviously did. Typically we can still do a fresh transfer as long as the estrogen doesn’t get too high and in these women that are very what we call Priddle Polycystic Ovarian Syndrome patients and the estrogen gets high. Kind of at the drop of a hat. Then we would often freeze the embryos not for just Synchrony but for a risk of ovarian hyperstimulation yeah that would that would make sense. [00:24:43] And of course this also begs the issue that the couple can’t afford IVF and can for assuming that insurance is not paying for it and they’re paying for it out of pocket. They have to make the decision if they can if they can afford it at that point. [00:25:01] That’s right. Yeah and it does become tricky I think in couples that are paying for fertility treatment completely out of pocket. IVF can actually make sense and then for the reasons that we had talked about before with the fast trial and the per delivery cost of er the cost per delivery is lower. Women who go right to IVF. But for couples whose insurance only cover artificial insemination it does become very tricky and those are the women who are more inclined to can’t fly. [00:25:29] Yeah because at that point it’s being it’s being covered. So in your opinion is it possible to do a medicated with injectable medication. I do I cycle what you called an F F S H cycle with low enough odds of multiples with experience monitoring. Is it possible to do it safely. [00:25:53] It’s possible to do it safely to some degree. I guess with a caveating or an asterisk only because twins themselves are not always safe. And you’ve talked about this plenty on this show too. Almost twins do fine. They deliver early more often than singletons. And certainly the greatest tragedies I’ve ever seen are couples who try for so long to have a conception and then they conceive twins and they’re so happy. But you know later face the devastating delivery or early delivery or or problems in the pregnancy related to having to. [00:26:32] We underestimate the most twins are born healthy. But the reality is if you look at the stats you know just just cerebral palsy alone it’s I don’t know it off the top of my head but it’s significantly greater risk for twins versus singletons as well as other complications. So yeah that’s a bit of a frustration and I understand it from the patient’s standpoint that there’s a there’s a lot of draw to the idea of an instant family. But we try to educate people that there comes you have to weigh the risk to your instant family into you as well. That’s one of the big concerns we have with our eyes particularly if it’s with injectables. You are listening to creating a family. Talk about infertility and adoption. And today we’re talking about intrauterine inseminations and how to increase your odds of success. We are really glad to have you with us. We primarily keep in touch with our audience through our weekly newsletter. We have two newsletters one for infertility and one for adoption. They both come out once a week. We let you know about the latest developments in infertility as well as the upcoming weeks blog and show topics and whatever new resources we’ve added to our site that week. We’d love to have you on our list. You can. We value privacy and never share your address with anyone. You can sign up for the weekly newsletter at the top right any page of our website. Creating a family org. [00:28:11] We have a question that we received from someone she says My husband has male factor infertility low volume and we have sex every other day during ovulation time. We will be doing and will doing and I do. I mean we have to forgo having sex on those days in favor of him giving a semen sample for the Ayyu procedure. Having a normal sex life during infertility is hard enough. Please say that there is an advance caption capture and release program for his boys so that Artex life is not obliterated. You know the fact that she points out having a normal sex life during infertility is hard. So how does for someone who would like to be having sex every other day during their obvious Leyshon time. Is that still possible. If you are doing sperm samples for you why. [00:29:07] So generally it is recommended that the male abstain for two to three days prior to the collection of the specimen. That being said I’m not sure how much of an effect that truly has on the chance of success and certainly we at times do you back to back and it’s not always the case that the specimen on the second day is lower or a worse quality than the first. In fact often it’s better than the first. So I haven’t made it personal. Yeah it’s kind of interesting so I have my personal doubts that third a rule or guideline of two to three days of absence is absolutely necessary but that certainly is currently the recommendation. So for a couple who doesn’t want to stop having intercourse during that time period or perhaps their partner happened to be traveling or other things like that we can and most fertility clinics can Freeth or cryo preserve a specimen in advance of the day and then it’s just thawed and used for insemination when the time is right and is do you see a difference in the quality of the sperm sample. If it’s been frozen versus fresh a small decrease in the quality or not the quality so much as the concentration. So if you’re starting off with a good concentration anyway it doesn’t really matter. But if a particular partner has a borderline concentration then it’s probably better to use the fresh specimen as opposed to a frozen one. [00:30:43] Gotcha. OK. Now I want to switch gears here and talk about things that couples who are going through a artificial insemination can do that might give them a slight edge. I would be interested to know if any of these would be significant in some of the lifestyle ones might be but tips for people who are trying to conceive. Start with foods. Are there any suggested foods that you’re getting ready to do and I you I know you know it’s coming up in the next couple of months. Things that you should be focusing on or your partner should be focusing on eating or avoiding. [00:31:29] Absolutely. So this is actually a very common question among my patients. I think it’s something that people can really kind of wrap their minds around and something that they have control over which is kind of a unique feature during fertility care where a lot of things are outside of a patient’s control. So I do get this question a lot. And actually the answer is not that complicated it’s sort of what doctors have been recommending for for eons that you know a balanced diet is recommended. Some will lean towards a more low carb diet especially in women with Polycystic Ovarian Syndrome. Try to avoid excess sweets and fats and but eat a healthy balanced diet. Obviously alcohol too much caffeine those kinds of things are to be avoided. But at the same time we don’t want patients to lose complete control of their life or have no fun during fertility treatment. So you know a glass of wine from time to time is okay certainly after the artificial insemination while you’re waiting for the pregnancy test I would discourage alcohol intake by time but during this cycle leading up to that it’s okay to lead a normal healthy lifestyle OK. [00:32:49] So just our standard balanced diet to a variety of foods aiming for a lot of different colours in your food. What about protein. What is considered the optimum amount of protein to be consuming. [00:33:08] So again there isn’t there isn’t an optimum amount per say in women that have polycystic ovarian syndrome it is better to increase the protein intake and lower the carbohydrate intake but exclusively ingesting protein sort of in an Atkins diet style would not be good either. That does have a factor on part of their general chemistry within the body and wouldn’t be ideal in a person attempting conception it’s better to kind of stay at the top of that bell curve in a normal normal range of all carbohydrates proteins fats kind of thing. [00:33:48] OK so you’ve talked about diet. What about other specific lifestyle choices that people can make that might make their UI be successful versus having to go through the procedure again and again. So lifestyle issues. [00:34:06] Absolutely. So again I think the main focus should be on balance and wellbeing. So you know continuing with exercise is fine although I wouldn’t probably start training for a triathlon during the typical cycle. It is fine to go for a walk and maintain a normal exercise regimen. Also you know again getting out and doing things that you enjoy to have things other than fertility high on your mind are important. So keep going out with your friends you know go out with your husband don’t make fertility the sole focus of your all of your attention or it will it will cost you a lot of stress and stress is probably not the best or most helpful condition to have while trying to conceive. Acupuncture is something else that people have tried. There is no data to suggest that acupuncture has a profound impact on improving pregnancy rates but it certainly does help patients deal with the diagnosis and treatment involved in infertility much better. And there is mixed results relating to how the degree to which it actually does improve pregnancy rates. [00:35:28] I was going to ask about what have you been say I have in this area I’m interested in and we’ve done a couple of shows but I haven’t seen anything recently from the research standpoint that’s talked about efficacy of acupuncture for increasing pregnancy results with Iwai or IVF or any form of treatment. [00:35:48] Have you seen anything like within the last year or two I haven’t seen anything within the last year or two related significantly to pregnancy rates. But again the overall feeling of patients undergoing fertility treatments is better and improved in those that are take the time for acupuncture OK got it. [00:36:08] Before we go off of lifestyle choices and move to talking about alternative treatments what about things like smoking. We know smoking is not good for our health. That I think is pretty well established. But has there been anything done that specifically talks about smoking in relation to success for infertility treatment and in particular you are. [00:36:31] Absolutely. So there is a greater degree of infertility overall in smokers compared to nonsmokers. Miscarriage rate is higher in smokers. Pregnancy complication rates higher in smokers menopause occurs earlier and women who smoke. So there’s often an issue related to diminished ovarian reserve in women who smoke. And then of course after the baby is delivered the problems continue and there’s a higher risk of sudden infant death syndrome and asthma in infants. So whether actually it’s the patient herself who’s a smoker or the partner is a smoker it doesn’t have a helpful impact on the chance of conception and then a healthy life for where you address. [00:37:15] You touched on my next question which is secondhand smoke. So if the woman is not a smoker who has stopped smoking what about the risk of secondhand smoke. [00:37:26] All right. Absolutely. So there is less data on that although certainly there’s less data on that with regard to fertility in particular although there is significant data to show that secondhand smoke does also impact the outcomes of pregnancy. So you know you work so hard to have this conception and then it would be a shame to damage the pregnancy itself through exposure to secondhand smoke and that obviously applies also after delivery to the children themselves. And one has to imagine that if a patient can reduce their fertility and increase her miscarriage rate by smoking herself then there’s probably at least a subtle impact on inhaling secondhand smoke from a partner. [00:38:12] And when you set out pregnancy outcomes do you mean there’s there’s research that would say that exposure to secondhand smoke increases your odds of miscarriage or premature birth. Sperm delivery yes ok yes. Preterm deliveries are probably within. Interesting. OK. All right. 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Fairfax has been a leader in sperm donation for over 20 years and is dedicated to supplying updated verified and accurate medical and personal information on their donors. Alright let’s talk what this will go ahead and talk about other alternative treatments. We’ve mentioned acupuncture. What about Chinese medicine herbs Chinese medicine other. Has there been any research recently. We’ve done some shows in the past on this. [00:39:54] The frustrating thing is that if you talk with Chinese medicine specialist they’re frustrated that that are that the Western approach to research they don’t feel like is particularly conducive to teasing out the efficacy of their of their treatment. But nonetheless I can’t help but I still have to ask about research. So what what do we know about Chinese medicine is that worthwhile for people who want to give it their all to increase their chances to the highest degree possible. [00:40:29] So I unfortunately don’t know that much about the specifics of herbal or Chinese medication remedies for infertility so I would suggest this sort of followed the guidelines of the original provider on that. That being said a lot of different supplements that herbs may contain hormonal properties for instance soy has estrogenic properties to it and those may affect the progression of the UI cycle the development of endometrial lining. So I would I would advise caution when supplementing an IUD type of stimulation with other herbs and supplements as it’s unclear what what effect they would have on the cycle itself and the ability of the embryo to implant and you would certainly want your reproductive endocrinologist to know about what it is that you are you might be taking. [00:41:27] All right. And what about meditation. [00:41:31] Absolutely. So the sort of mind body continuum I think is important. Again there’s not a great deal of data out there that I’m aware of to suggest improved pregnancy rates with meditation but these type of mindful behaviour yoga and meditation and the like are helpful in reducing stress for patients who are undergoing fertility treatments and that can be helpful not only for the success of the cycle but also for that patients overall experience the health of their marriage the health of their relationship their attitude toward the pregnancy and ultimately towards their child down the road. [00:42:11] Let’s talk a little about the impact of stress it’s it’s a touchy subject. The reality is being infertile is for most people extremely stressful. And you know it ranks right up there is one of the most stressful life events. So when somebody is stressed to the max because of disease and you tell them that they’re that they’re not. What are the symptoms of disease and ability to get pregnant because of the stress it’s kind of a Catch 22 and it makes people want to scream or rip their hair out or smack you. So it is a touchy subject but there has been some some research on the effects of stress. So what how does stress impact our ability to conceive. [00:43:02] Right so there they there again not a lot of I guess the good news is there’s not a lot of data to think that that stress has a profound negative impact on the ability to conceive. So couple even if a woman is very very stressed out and unable to sleep at night and experiencing mood changes related to that she can rest assured that despite all those symptoms at least her chance of pregnancy is probably not profoundly affected. That being said those types of symptoms certainly would be expected to affect her interpersonal relationships. Her sense of self her you know potentially her feelings during the future pregnancy that will ensue and also after childbirth to to have experience such a stress Thoren even sometimes traumatic portion of one’s life so if I’m hearing you it’s perhaps less of the actual conception other than for your mental health and your enjoyment of life. [00:44:05] Stress has more impact on that is that we don’t hear you correctly. [00:44:09] That’s right. And actually that that should be somewhat reassuring to patients I think that because if people can do what they can to reduce their stress in their life that’s great. But even if some stress is there it’s not it’s not going to have a big effect on the chance that they will have a pregnancy. [00:44:28] It’s almost I mean unless you don’t care one way or the other whether or not to get pregnant it’s really hard to say. I’m just going to be I’m going to treat this in a non stressful way. But there are definitely things and we’ve got resources and I know your website too I am sure in a New Jersey website has resources on on reducing stress to the extent to the extent you can. Well let’s talk some about supplements. There are a lot of if you go to health food stores or whatever or even just look on the Internet there are definitely supplements that are encouraged for people who are trying to get pregnant both for the mail as well as for the female. And since mild male factor is a potentially can be solved through the eyes or intrauterine insemination. Let’s talk about supplements that might be are are supplements effective for mild male factor infertility. [00:45:37] Absolutely. So there aren’t a great deal of supplements that have again a dramatic impact on the semen analysis. But one of the ones that has been suggested is antioxidant treatment for men with Parado Fermina or abnormally shaped sperm. So you know vitamin C selenium other types of antioxidants have been used as supplements in an effort to improve man’s sperm shape. It’s unlikely again to have a profound effect you know improving the sample cent of normal of normal sperm shape by 20 percent or 30 percent but can increase that percentage by a few percent potentially. [00:46:20] OK and that’s the antioxidant treatment. Did I hear you correctly. [00:46:24] That’s right. Antioxidants one one male supplement that is sometimes misinterpreted to be helpful is testosterone. So sometimes men will take testosterone supplements in an effort to improve their sperm count. When this is actually giving them the opposite effect. So by taking testosterone supplements men will decrease sperm sometimes even to an undetectable level. So testosterone is definitely not a good supplement to take. [00:46:55] Gotcha. OK. And do men take that because of the misinformation of increasing their sperm count or their motility or shape or are they taking it for other reasons and if so what are the other reasons typical that a man might typically have reasons that they might have for taking testosterone. [00:47:19] Absolutely. So yes sometimes people do or men do take testosterone in sort of a misinformed or for misinformed reasons to improve sperm count but there is another contingent of male patients who are placed on testosterone because they presented to their primary care physician with lethargy decreased libido and other symptoms like that and they could be tested and found to have a low testosterone level. And when this is the case testosterone treatment is great. It will help those patients to feel much better. It will give them some of their sex drive back give them some more energy just this hormone supplements can sometimes help women who are going through menopause. But if that man happens to be trying to conceive then testosterone is not the right treatment for him. There are other forms of medicine for instance H injections that can improve the testosterone level without decreasing the sperm count. So treatments like that should be considered a first line for men who are still trying to conceive. OK. [00:48:23] That makes sense. Let’s say that’s for the men for a woman. Are there supplements that she should be on that would help increase her chances of success. [00:48:37] Absolutely. So there actually aren’t a great deal of supplements with definitive proven efficacy prenatal vitamins with a good amount of folic acid of course are important not as much during the for infertility period as during that early pregnancy and pregnancy period when the fetus is requiring those nutrients for itself to grow and develop appropriately. So prenatal vitamins should be started in the preconception window in infertile women just to build a base of nutrients so that their body is fully prepared to take care of that fetus when in fact they do have a conception. The other supplement that has gotten a great deal of press and it may have some efficacy it’s called coenzyme Q10. This supplement would work to improve the energy producing organelles within a cell. So they helped cells produce energy. This of course is really important in infertility patients tooth eggs whose embryos are needing to divide and grow at a really profound rate. So coenzyme Q10 supplementation may be efficacious. Other supplements have less data behind them DHEA is one that a lot of women take although there was a recent article to suggest that really is not very effective and potentially not at all effective in improving pregnancy rates. [00:50:10] And people are taking DHEA before during treatment or before conception. That’s the attempt to increase their fertility. [00:50:19] That’s right. It’s sort of the idea is that it would provide a building block for the hormones that need to be produced during follicle development and then ultimately obviously. But there was a study recently which was fairly large that suggested that help improve fertility or she’s going to ask if is it. [00:50:40] Is it a large enough study for that that we would warrant us paying attention. [00:50:46] Yes. I’m trying to remember the authors and I can’t just now but I can get back to you with that. [00:50:51] Well you know what. Do me a favor. I’ll try to remember to send you a e-mail asking and we’ll link it and the blog tomorrow for four people. OK. So coenzyme Q10 possibly is effective although we’re not certain the degree of effectiveness but DHEA probably not that effective is that kind of a summation of what you were just saying. [00:51:16] That’s right. Exactly. And there are other supplements that you might take during a cycle under the supervision of your physician. One of them is growth hormone. But the advocacy of growth hormone is also debated. It’s only available by prescription. It is injectable and it’s quite expensive and you would only want to take it during a certain part of your cycle. But that is another supplement that has been looked at. [00:51:42] Yeah it’s an it’s an area of of of interest and research and I’m hoping there’ll be some more at the American Society of Reproductive Medicine conference coming up in October because we get a lot of questions from people and I think you alluded to it probably when we were first talking about we shifted and talked about things that we can do to increase success for a lot of people. Everything about infertility is feels out of their control. [00:52:13] So I think that’s one reason there is a great deal of interest in the patient community because this is like one thing that they can do. Give me a pill give me something to tell me what to eat. Tell me what not to do. Tell me a supplement to take because it puts a little bit of control back in. So I I so get that I get. I get the need for that. Absolutely. We have come to the end of our time together. I so appreciate this show. Thank you so much Dr. Marci McGuire for being our guest today audience. If you have enjoyed this show and want to help us grow do us a favor and give us a rating on iTunes. We are ranked as the number one show and this topic areas by iTunes and by far were the number one ranked show and we really want to continue to keep our place there. It also helps others find us. So it’s kind of a win win across the board so you can go to iTunes type in the words creating a family and you can give us a ranking or you can go to our website. The radio page creating a family dot org slash categories slash radio Dasch show that’s along you are 11 and you can click on iTunes there and we’ll take you straight to the ratings page. It’s a star rating really easy to do if you want to participate in a discussion on the topics of this show. You can check out my blog tomorrow at creating a family dot org slash blog. [00:53:41] Also to get more information about Dr. Marci MacGuire are or are in a new jersey you can go to their website which is our M A N J dot com or you can go to our Web. They have been one of our wonderful long term sponsors and their logo is on the right hand page of all of the pages of our site and you could click on their logo and it will take you directly to there. Thank you so much for joining us today. And I will see you next week.
Hit the Highlights
- IUI can be used as part of infertility treatment and by single women and lesbian couple using donor sperm. We’ll be talking about all of these on today’s show.
- Carolyn: My husband and I haven’t been able to get pregnant and we’ve been trying for 2.5 years. I’m now 33 and he’s 38. They haven’t been able to find a reason for us not getting pregnant. We look perfect, which is kind of weird. Do we automatically start with IUI?
- What type of diagnosis is most often helped with IUI vs. IVF.
- I’m a single mom to be and will be trying to get pregnant with donor sperm probably at the beginning of next year. Is it better for me to have the artificial insemination done in the uterus or cervix?
- Shana: My wife and I will be using donor sperm to start our family. What does the research show on if we are more likely to get pregnant with IUI vs. ICI. Is there a significant difference in cost? We would also really like to do a home insemination, but don’t want to if our odds of success are lower.
- Un-medicated vs. medicated IUI cycles.
- Oral meds vs. injectable medication or HSG IUI.
- How do we define success when talking about IUIs? The risk of multiples and how to avoid.
- How to monitor an IUI cycle with injectable gonadotropins in order to avoid higher order multiples.
- If a woman produces too many eggs to do a safe IUI is it possible to switch to an IVF cycle?
- Is it even possible to do a medicated IUI cycle with low enough odds of multiples.
- Why some insurance companies require a certain number of IUI cycles before beginning IVF and is that still the best approach.
- Should you abstain from sex before the man gives a sperm specimen for an IUI or artificial insemination?
- Foods that will increase success of getting pregnant with an IUI?
- Specific lifestyle choices that will increase success?
- Are supplements effective at helping you get pregnant with artificial insemination?
- Should you start taking a prenatal vitamins with good amount of folic acid when you are trying to get pregnant?
- Alternative treatments? Acupuncture? Meditation? Chinese medicine?
- Effect of stress?
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Image credit: J
Show originally aired in 2015.