IUI in PCOS: what happens when tablets don't make you ovulate?
If PCOS tablets have not made you release an egg after a few months, there is little point in carrying on with them. The next step is usually injections to help an egg grow, scans to time a trigger injection that releases it, and IUI with a washed sperm sample on that day, with progesterone support afterwards.
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This video is in Konkani; the guide on this page is in English.
In this video, Dr Mayur Pai does two things at once. In his laboratory he prepares a husband's semen sample for IUI, step by step. While the sample spins, he talks about the woman it is for: a patient with PCOS whose tablets had not made her release an egg. Along the way he shares practical advice on collecting the sample, and an honest view of how many IUIs make sense.
What is PCOS, and why does it stop ovulation?
PCOS (polycystic ovary syndrome, also called PCOD) is a common hormonal condition in which the ovaries do not release an egg regularly. Doctors call this anovulation: no egg is released, so that month there is nothing for the sperm to meet.
How much it affects you depends on how severe it is:
- More severe PCOS. Periods are irregular and can stop for two or three months at a time.
- Mild to moderate PCOS. Periods come and an egg is released, but not every month.
Other signs Dr Pai mentions are a lot of pimples or acne scars, very oily skin, and extra hair growth on the face or body. What PCOS looks like on a scan is explained in PCOS: causes and ultrasound.
What happened in this case?
The woman in the video had already been to two or three clinics and had taken tablet treatment, but she was still not releasing an egg. Dr Pai treated her for two more months with tablets and saw the same thing: on tablets alone, her ovaries did not release an egg.
Month after month without an egg is hard, and she was frustrated. Dr Pai had told her from the start that if tablets did not work, the treatment would need to be stepped up. This month she agreed: start with whatever is needed to get an egg ready, and then do what is appropriate.
What changes when tablets don't work?
From the first day of this cycle, a few tablets were combined with fertility injections. On the scans, the egg began to grow at about day 7 or 8 of the cycle, and its growth was followed until it was ready.
Then came the trigger injection. It makes the ripe egg release at a predictable time, so the IUI can be planned for exactly the day the egg is released.
Injections need careful handling in PCOS, because polycystic ovaries hold many small follicles and can respond strongly. That is why the scans matter so much. See how eggs grow in PCOS ovaries.
How is the sperm sample washed for IUI?
Raw semen is never placed in the womb. In the video, Dr Pai shows the density-gradient wash that picks out the healthiest sperm:
- Two layers of washing medium. A denser layer goes at the bottom of a fresh, sterile tube. A lighter layer, tinted pink so it can be seen, is added on top slowly, drop by drop, so the two stay separate.
- Checking the sample. Semen must first liquefy. How easily it flows through the pipette shows whether it has: a well-liquefied sample is smooth and free-flowing.
- Layering the sample. The semen is placed gently on top of the pink layer, without letting it sink. Dr Pai calls this the step that needs the most practice: rush it and the layers mix.
- The centrifuge. The capped tube spins for about five minutes. Healthy, moving sperm travel down through the layers to the bottom; debris, dead sperm and poor-quality sperm stay higher up.
- Collecting the healthiest sperm. The upper layers are removed. The sperm at the bottom is drawn up with a fresh pipette, without touching the sides of the tube, and moved to a new tube.
- A second wash. The sample is washed once more, so that what goes into the womb is as pure and clean as possible.
The method, and the other common one (swim-up), is explained in more detail in sperm preparation for IUI.
How is the IUI itself done?
The washed sample is now a small amount of concentrated, healthy sperm, about half a millilitre. It is placed high inside the womb, near its top (the fundus), on the day the egg is released. This brings the healthiest sperm much closer to the egg. See what happens on IUI day.
How should the husband collect the semen sample?
Dr Pai gives two simple tips from experience:
- Keep the jar within arm's length. The sample is collected in a sterile, wide-mouthed jar. Keep it close, on the table, counter or wash-basin, not far away. If ejaculation comes suddenly and the jar is out of reach, part of the sample can spill, and many men can give only one sample at a time. A spilt sample means a smaller sample for the IUI, and a disappointed couple.
- Be relaxed. A calm, good mood helps the husband give a good sample, with his wife's company or in whatever private way helps him relax.
Why is progesterone given after IUI in PCOS?
After the IUI, the woman is not simply sent home to wait. Dr Pai prescribes hormone support with progesterone, as tablets and sometimes as injections. Even when a sperm fertilises the egg, the embryo still has to attach to the lining of the womb (implantation), and in PCOS the lining may need this support. Your doctor will explain what to take and for how long.
How long should you try tablets, and how many IUIs?
Dr Pai's advice is to start simple. Tablets are the first treatment for PCOS and should be tried first, usually for three or four months. If they have not produced an egg in that time, there is little point in carrying on. As he puts it, no one gives you a medal for avoiding IUI.
IUI is one treatment option, not the only one, and it does not work every time. Dr Pai recommends two or three well-done IUI attempts, with good-quality medicines and good eggs seen on the scan. If pregnancy has not happened after that, the next step is IVF. Read how many IUI cycles before IVF.
What he advises against is repeating the same IUI again and again. Some couples move from doctor to doctor and end up having six or seven IUIs with the same treatment. There is no scientific basis for that.
Does IVF always work the first time?
No, and Dr Pai is honest about this too. IVF is the next step after IUI, but no one should expect a baby from the very first attempt. If the woman is older, or the couple has been trying for many years, more than one IVF attempt may be needed. Expecting success on the first IUI or the first IVF is, in his words, a non-scientific idea. Hope is natural, but it should be scientific hope. If you are weighing the two treatments, read IUI vs IVF.
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), who treats infertility and performs laparoscopic surgery. Pai Hospital in Goa has its own IVF laboratory, where sperm preparation like the one in the video is done, so the scans, the timing and the IUI are handled by one team. More of Dr Pai's talks in Konkani are on our Konkani fertility videos page.
Questions, or ready to book?
If PCOS tablets have not worked for you, call Sheetal at our fertility reception on +91 95459 20817 to book a consultation; every visit is by appointment. You can also send a WhatsApp message to +91 95185 02773 with your situation and any reports you have, such as scan reports or a semen report. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Your questions
What is the next step if PCOS tablets do not make me ovulate?
Usually injections that help an egg grow, with scans to follow it, and a trigger injection to release it on a planned day. The IUI is then timed to that day. Your doctor decides the exact plan after looking at your scans and reports.
How long should I take tablets for PCOS before moving on?
Dr Pai suggests trying tablets for about three to four months. If they have not made you release an egg by then, there is little point in carrying on, and the treatment should be stepped up.
What is a trigger injection?
An injection given when the egg is ready. It makes the ovary release the egg at a predictable time, so the IUI can be done on the day the egg is released.
How many IUIs should we try before IVF?
Dr Pai recommends two or three well-done IUI attempts, with good eggs seen on the scan. If you are not pregnant after that, IVF is the next step. Repeating IUI many more times with the same treatment has no scientific basis.
Why is the semen sample washed before IUI?
Washing picks out the healthy, moving sperm and leaves behind debris, dead sperm and poor-quality sperm. Only the clean, concentrated sample, about half a millilitre, is placed in the womb.
Why is progesterone given after IUI with PCOS?
After fertilisation, the embryo still has to attach to the lining of the womb. Progesterone, as tablets or sometimes injections, supports the lining. Your doctor will tell you what to take and for how long.
Does IVF work on the first try?
Not always. If the woman is older, or the couple has been trying for many years, more than one attempt may be needed. Expecting success on the very first IUI or IVF is not realistic; hope should be based on science.
Or call +91 95185 02773
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.