If you are having a difficult time conceiving, you might have infertility. Infertility is when there is no pregnancy after a year of unprotected intercourse. If you are less than 35 years old, a year of trying without success is a good time point to reach out to your doctor. If you are over 35, the doctors like to see you after 6 months. And you can go see a fertility doctor anytime if you have known risk factors like being 40 years of age or older, irregular menstrual cycles, endometriosis, male factor, fallopian tube issues, or you desire family balancing just to name a few. When you see the fertility doctor, usually they will want to do a few tests to get a better understanding of all the issues such as checking hormone levels, doing a follicle count and a semen analysis, and performing a transvaginal ultrasound. Once the tests are complete, that is the time to start considering your options, especially when it comes to treatment.
There is a lot of information out there, and it can be hard to understand what makes some methods different from each other. Often when looking into fertility treatments, you will find suggestions that point to In Vitro Fertilization (IVF) or Intrauterine Insemination (IUI) as the next step to treat infertility. But what is the difference between these two procedures? And how do you know which one is right for you?
IUI is often the first method that will be recommended to achieve conception because insemination is easier, less invasive, less expensive, and less hassle than IVF. It is a method that is ideal for couples who may want a little boost in helping the sperm reach the egg. IUI can be recommended for a number of reasons including either an issue with the cervix making it difficult for sperm to pass through, low sperm count/mobility on the male side, or for Lesbian couples or single women who need a sperm donor.
During IUI treatment, the doctor and patient will time the procedure to align with the peak of the patient’s ovulation cycle increasing the chances of success. When a woman ovulates, her egg passes through one of the fallopian tubes and awaits fertilization by sperm. Timing an IUI for when an egg is awaiting fertilization allows the procedure to be the most effective. Often, a patient will also be prescribed oral fertility drugs which can women ovulate one or more eggs which can further increase the chances of a successful IUI.
The sperm that will be used in this procedure are collected, washed, and sorted, and then the most mobile, high quality and quantity of sperm are chosen to be used. By choosing the best and healthiest sperm, an egg has the highest likelihood of being fertilized. These sperm are inserted directly into the uterus through a catheter, an easily insertable tube that can be put in and taken out without anesthesia and with minimal discomfort. The whole procedure usually only takes a few short minutes and is done in a normal exam room, allowing you to return to your routines and daily activities shortly after it is completed. Remember, the IUI procedure acts as an extra boost to help sperm reach an egg by shortening the distance it must travel to achieve fertilization. It has a low cost and is highly recommended as a procedure to explore when first seeking fertility treatments.
In Vitro Fertilization is a bit more extensive and is usually used if IUI does not achieve successful conception, if a woman is not a good candidate for IUI or other fertility treatments, or if these treatments have been unsuccessful. Some of the common reasons a woman may need to seek out IVF instead of IUI is damaged fallopian tubes, endometriosis, inheritable genetic diseases, male factor infertility, unexplained infertility, or family balancing to name a few. IVF also involves taking fertility drugs, but this time the medications are usually injections that are more effective in growing several eggs grow that cycle. It also involves retrieving eggs from the body, fertilizing them with sperm in the lab, growing embryos, and then the transfer of embryos back into the uterus.
All the tests that were done to help figure out what is going with your fertility will help the patient and doctor develop the ideal plan to proceed with while pursuing IVF. The injections of fertility medications usually start with a menstrual cycle and last for approximately 10 days. Over that time a patient will come into the office every 2-3 days to meet with a doctor and be monitored. Once the eggs are ready, you will inject a medication that will make you ovulate in 36 hours, and right before you ovulate, you will have an egg retrieval.
The process of egg retrieval uses transvaginal ultrasound and a needle that goes through the vagina and into the ovaries to take the eggs out while you are asleep and under anesthesia. Usually, the procedure is over quickly and only takes about 15 minutes, though due to the anesthesia it will feel like the blink of an eye. The eggs are then transported to the lab to be fertilized with the collected sperm specimen.
This fertilization is done either through conventional insemination, where the eggs are put in a petri-dish and are surrounded by sperm, where much like in natural conception, one sperm will fertilize the egg out of all the rest. Or it is done using intracytoplasmic sperm injection (or ICSI) where an embryologist will take a single sperm and directly inject it into the selected egg. Once an egg is fertilized, it is kept in the lab to grow, be monitored and nurtured for about 5 days, and then inserted back into the uterus during an embryo transfer. This is done when the uterine lining is ready to accept a growing embryo and when the embryo has matured enough to have the highest chance of implantation success. During the embryo transfer, a very small catheter is inserted and is used to place the embryo directly at the top of the uterus while guided by an ultrasound. Sometimes multiple embryos are inserted to increase the likelihood that one will implant and grow.
Before transferring embryos, patients also have the option of having their embryos tested for chromosomal issues, specific genetic diseases that run in the family, and even gender. Embryos can also be frozen and used for a future IVF cycle. IVF is the most effective fertility treatment available today. It’s results are up to 5 times more effective then IUI at creating a successful pregnancy, but it is a more expensive and involved procedure, so it has to be carefully thought out before being pursued.
In short, IUI helps boost sperm to reach an egg that is waiting to be fertilized, it is an extra step to the natural conception process, and is easier, faster, and cheaper than IVF, and usually recommended as the first procedure to explore when looking into fertility treatments. IVF involves the extraction and fertilization of an egg and then the implantation of the resulting embryo/embryos back into the uterus. IVF has the highest success rates, but is expensive and requires much more planning and involvement than IUI. It is important to meet with your fertility doctor and make a plan for which treatment is right for you.
Both IUI and IVF can be excellent options for fertility treatments and can increase the likelihood of successful conception by a significant amount. If you are interested in learning more about these treatments or think you may want to pursue one as an answer to any infertility issues, the Reproductive Health and Wellness Center has top-notch fertility specialists and staff that specialize in these methods and can provide you with incredible care helping to get you well on your way to building your happy family!