Dr. Walid Saleh of CRE (previously SIRM-Dallas), gives some background on the effectiveness of injectables with IUI treatment. for more information, please visit: https://dallasfertilitycenter.com/fertility-blog/walid-saleh-md-iui-with-injectables-a-waste-of-time-and-money/

1. Dr. Walid Saleh from CRE (previously SIRM-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

2. 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.
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/