Unfortunately, despite the lack of evidence to support it, many couples are prescribed gonadotropin injections and artificial insemination (COH/IUI) as a first line of treatment on the basis that “injections are better than tablets.” In reality, most studies agree that pregnancy rates are similar for both options. It makes perfect sense. https://dallasfertilitycenter.com/fertility-blog/walid-saleh-md-iui-with-injectables-a-waste-of-time-and-money/

1. Dr. Walid Saleh from CRE Dallas on IUI with Injectables Success
Rates
Unfortunately, despite the lack of evidence to support it, many couples are prescribed
gonadotropin injections and artificial insemination (COH/IUI) as a first line of treatment on the
basis that “injections are better than tablets.” In reality, most studies agree that pregnancy
rates are similar for both options. It makes perfect sense. If someone already ovulates on her
own, why would the “boost” provided by exogenous FSH injections be any superior to the
endogenous one achieved with a $4 tablet like clomiphene. Nothing in those injections
addresses or bypasses the “unexplained” factor causing infertility in the first place.
Furthermore, unlike clomiphene and IVF, COH/IUI treatments are associated with a 30% risk of
unpreventable high-order multiple births.
While unexplained infertility is a frustrating condition, it usually has a good outcome. For these
couples, 3-6 cycles of superovulation with oral clomiphene citrate combined with intrauterine
insemination (CC/IUI) have provided a less invasive option before proceeding to low cost or
micro-IVF.
IUI with Injectables provides a 7% monthly chance of pregnancy, with a 6 month cumulative
pregnancy rate of 35%. This treatment probably works by improving timing of conception, by-
passing potential cervical factors or increasing the number of eggs ovulated. It is very important
to keep in mind that the chance of pregnancy is NOT affected by the frequency of your office
visits, serial blood tests and ultrasounds or hCG administration. All these procedures only
increase your cost and anxiety, not your chances of conception.
While it is true that prolonged use of clomiphene occasionally causes thinning of the uterine
lining, this ultimately does not affect chances of pregnancy and resolves spontaneously after
taking a month off. Adding estrogen orally is another cost-effective way of resolving this non-
issue.
Besides the high cost of medication, injectibles also require serial office visits, ultrasound
monitoring, and blood tests ranking up the cost of conception in the thousand of dollars. By the
time a couple completes the 6 cycles of COH/IUI they did not need in the first place, chances
are they can no longer afford the IVF they now need.

2. In conclusion, while injectibles are useful in an anovulatory patient that is resistant to
clomiphene, their use in the treatment of unexplained infertility is unjustified.
Please visit: https://dallasfertilitycenter.com/fertility-blog/walid-saleh-md-iui-with-injectables-
a-waste-of-time-and-money/