How Many IUI Cycles Are Too Many? - Dr G Rohini Kanniga | Doctors' Circle

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What are some of the criteria or situations where the couple is advised to undergo IVF first? When the woman has already undergone multiple cycles of IUI and there is no success, then she's advised IVF. Then second, when the woman is requiring more number of hormonal injections and higher and higher dosages of hormonal injections, which is overall bringing up the cost of the whole stimulation process, as well as not giving adequate growth of follicles, then in that case she should go for IVF.
And third, when despite using hormone injections and multiple tablets, there is no folliculogenesis, that is growth of the follicle is not seen on scan. Now, fourth, when you do an HSG and you find out that the Fallopian tubes are blocked, then it's a direct indication to go for IVF. We also have to consider the woman's age. If the woman has advanced maternal age, if she's more than 40 years, and the egg reserve is low, then we should directly advise IVF for these patients. And along with the woman's parameters, we have to keep the husband's parameters also in mind. If the sperm count is too low, that is, even after post-processing in IUI, if the sperm count is less than 5 million, then it's a direct indication for IVF. As well as the count, even if the motility is very bad, we should send this patient for IVF. Now next thing is ideally how many cycles of IUI are advised. So, as per evidence, you can do IUI up to even six cycles of IUI, but practically all the fertility specialists do not like to give a trial more than three to four cycles of IUI because usually the success rate as we keep on doing IUI keeps on reducing from the first cycle onwards. So preferably not more than 3 to 4.

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