If you’ve recently begun to suspect you may have fertility issues, or if you’ve received an infertility diagnosis, you’re probably wondering about your next steps. You have a number of options, but sorting through them can be complicated. The acronyms IUI and IVF almost always come up in conversations about infertility, but what are they? Understanding these common infertility treatments can help you make the right choices for treatment. Herein, we’ll look at te ways in which IUI vs. IVF are different, their advantages and disadvantages, and the chances of successfully conceiving using them.
What’s the Difference Between IUI vs. IVF?
Intrauterine insemination, or IUI, is one of four types of artificial insemination. Artificial insemination is a common solution to infertility that involves inserting sperm directly into the vagina, cervix, uterus, or fallopian tubes. During IUI, sperm is placed directly into the uterus.
In vitro fertilization, or IVF, is a procedure involving extracting a woman’s eggs and placing them in a test tube or petri dish, where they’re fertilized by a man’s sperm. The embryos are then transferred directly to the uterus.
In general, couples struggling with infertility will first undergo IUI before trying IVF.
A Closer Look at IUI
Artificial insemination, including IUI, can be successful for a variety of infertility issues, such as when:
- A couple is unable to have intercourse because of erectile dysfunction or another problem.
- A man doesn’t produce enough sperm, or the sperm has trouble reaching the egg.
- A man or woman is allergic to sperm.
- A woman’s cervical mucous contains an antibody that kills sperm before they can reach the egg, or the mucous won’t allow sperm to pass through.
- A woman has mild or moderate http://www.pregmed.org/endometritis.htm endometriosis, which occurs when tissue from the uterus grows outside of the uterus and affects the functioning of the fallopian tubes, ovaries, and uterus.
- A same-sex couple wants to conceive with donor sperm.
- The cause of infertility can’t be found.
The IUI procedure is scheduled for just after ovulation, when you’re more likely to get pregnant. For women with a regular 28-day cycle, the procedure will typically occur on day 14. For those with an irregular menstrual cycle, an ovulation prediction kit will be used to detect hormones to accurately predict the day of ovulation.
If your partner’s sperm will be used for the IUI, a sample will be collected through masturbation on the day of the procedure. If he is unable to ejaculate because of a medical condition, the sperm will be removed surgically from the epididymis or testicles. If donor sperm will be used, it will be tested for transmittable diseases before insemination. Prior to the procedure, the sperm is washed to separate them from the seminal fluid, and the sperm with the highest motility—the healthiest, fastest sperm—are collected for the procedure.
The procedure itself is simple. A speculum opens the vaginal walls, and a catheter is inserted through the cervix. The sperm are injected through the catheter and into the uterus. After resting for a short time, you’ll go home. After six to 14 days, a home pregnancy test will give you the results, and a follow-up blood test will confirm the results either way.
A Closer Look at IVF
In vitro fertilization is far more complex than intrauterine insemination. IVF is an option when:
- An ovulation disorder, such a premature ovarian failure, results in infrequent ovulation or no ovulation.
- The fallopian tubes are damaged or blocked.
- Uterine fibroids, which are benign tumors, grow in the uterus wall and affects the ovaries, fallopian tubes, and uterus.
- A woman has endometriosis and IUI was unsuccessful.
- A woman has had a tubal ligation. IVF is alternative to a tubal ligation reversal.
- A woman chooses to have healthy eggs harvested for later use before undergoing chemotherapy or radiation treatment.
- Poor sperm motility or impaired sperm production makes natural fertilization difficult.
- One of the parents has a genetic disorder. IVF enables the eggs to be screened for genetic problems, although the screening can’t identify all genetic disorders.
- Fertility problems can’t be explained, and other infertility treatments have been unsuccessful.
How IVF works for a particular couple depends on a range of variables, but in general, it occurs in five steps.
The first step of IVF involves taking fertility drugs to stimulate the ovaries into producing a number of eggs instead of just one. Having more eggs increases the chance of successful fertilization.
When the eggs are ready for harvesting—around 36 hours after the last dose of medication but before ovulation occurs—they’ll be retrieved. The most common method of retrieval is transvaginal ultrasound aspiration. During this procedure, an ultrasound probe is inserted into the vagina to locate the follicles containing the eggs, and a thin needle inserted through the vagina collects the eggs. If the ultrasound can’t locate the follicles, a tiny incision is made near the navel, and a laparoscope is inserted to find the follicles and guide the needle to the eggs. The collected eggs are kept in a culture medium and incubated.
The sperm are collected the same day through masturbation or by extracting them with a needle. The sperm are then washed to separate them from the seminal fluid. The healthiest, most mobiile sperm are chosen for fertilizing the eggs.
Once the sperm and eggs are collected, the eggs are fertilized. Fertilization takes place in a glass test tube or dish, where eggs are fertilized using one of two methods.
- Insemination involves combining the eggs and sperm and leaving them to incubate overnight, during which fertilization occurs.
- Intracytoplasmic sperm injection, or ICSI, is used when insemination fails or when the sperm quality is low. This procedure involves injecting a single sperm directly into a single egg.
Anywhere from two to six days after the eggs are fertilized, one or more embryos are transferred to the uterus using a long, thin catether inserted through the vagina and cervix.
If IVF is successful, an embryo implants itself into the lining of the uterus. A pregnancy test is taken around two weeks later. If the IVF cycle is unsuccessful, the couple may choose to try again.
How Invasive is an IUI vs. IVF?
Intrauterine insemination is less invasive than in vitro fertilization. Both procedures require a catheter to be inserted through the cervix to deposit the sperm (IUI) or the embryo (IVF) into the uterus. This can be painful, but pain medication and a sedative are typically administered ahead of time to reduce discomfort during and after the procedure. This is the most invasive part of the IUI.
IVF involves the additional invasive step of retrieving the eggs, which involves inserting a needle through the cervix and may also require an incision near the naval to accomodate a laparoscope.
Neither procedure is invasive for the man unless the sperm needs to be retrieved with a needle.
Use of Fertility Drugs in IUI vs. IVF
Fertility drugs can help increase the chances of success for both IUI and IVF. While they’re not always used during IUI, these medications are an integral part of IVF.
Drugs may be used during IUI if the cause of infertility is unknown or if ovarian function is impaired. The most commonly used fertility drugs associated with IUI include:
- Ovary stimulation medications, such as Clomid, which stimulate egg development.
- Gonadotropins, such as HCG and HMG, which promote the development of the eggs in ovarian follicles. When the follicles are large enough, a shot of HCG will trigger the release of the eggs into the fallopian tubes.
- Aromatase inhibitors, such as letrozole, which suppress estrogen levels and increase the production of follicle stimulating hormone, or FSH.
IVF begins with taking fertility medication to stimulate the production of multiple eggs. A variety of medications may be used during IVF, including:
- Ovary stimulation medications.
- Oocyte maturation medications, which help the eggs mature.
- Medications to prevent premature ovulation.
- Progesterone supplements to prepare the lining of the uterus and promote implantation.
What Are the Risks of IUI vs. IVF?
Intrauterine insemination carries fewer risks than in vitro fertilization. The risks of IUI include mild cramping and spotting after the procedure. In some cases, a bacterial vaginal infection may occur, causing burning, itching, discharge, and a foul odor.
The risks of IVF include:
- Bleeding or infection after egg retrieval.
- Ovarian hyperstimulation syndrome, which is caused by the fertility drugs used and may cause the ovaries to become painful and swollen.
- Ectopic pregnancy, which occurs when the embryo is implanted outside of the uterus—usually in a fallopian tube—and can’t survive.
- Miscarriage. Although the rate of miscarriage with IVF is similar to that of natural pregnancies, older women are generally at a higher risk.
- Premature birth or low birth weight. IVF may increase the risk of pre-term birth and low birth weight.
- Stress. IVF can be very stressful, which can negatively affect the mother’s health. Support from friends and family is essential during IVF.
Fertility drugs carry their own risks and side effects, which may include headaches, fatigue, nausea, hot flashes, bloating, and stomach or pelvic pain. The most important risk of taking fertility drugs is the increased chance of becoming pregnant with multiples. Twins, triplets, and higher orders of multiples increase the risk of pregnancy complications, including miscarriage, premature birth, and low birth weight.
What Are the Success Rates of IUI vs. IVF?
In vitro fertilization is the most effective infertility treatment, with a success rate of 20 to 40 percent per cycle. The success rate of IUI is between eight and 22 percent.
A number of factors affect the success rate of both IUI and IVF.:
- Age. The more advanced the age of the mother, the lower the success rate.
- Length of infertility. The longer infertility has been a problem, the lower the chances of conceiving.
- Type of infertility. Some causes of infertility, such as endometriosis, reduce the success rate.
- Sperm motility. The more fast, healthy sperm in a sample, the better the outcome. High motility is associated with an 18 percent success rate, while low motility is associated wth a 2.7 percent success rate.
- The number of dominant follicles. A higher number of pre-ovulatory follicles may increase the chances of conceiving.
Before undergoing IUI or IVF, it’s important to make healthy lifestyle changes that will increase your chances of success, no matter your age.
- Get plenty of exercise. Exercise improves the functioning of all of your body’s systems, including the reproductive system.
- Eat healthy food. Good nutrition is essential for good reproductive health, and it will be important once you conceive.
- Stop smoking. Smoking can dramatically reduce your chances of conceiving.
- Don’t drink or use drugs. Drugs and alcohol can impede conception and put the health of you and your baby at risk if you do conceive.
- Take folic acid. Between 400 and 800 micrograms of folic acid each day may improve ovulation, and it helps prevent against birth defects.
- Lose or gain weight. Being overweight or underweight can reduce your chances of successful conception by up to half.
- Reduce stress. Keeping your stress levels down can help improve your chances of success, and it’s important for a healthy pregnancy and your own mental health.
IUI vs. IVF: Your Doctor Can Help You Decide
If you’ve been trying to conceive unsuccessfully for at least one year without success, it may be time to see your doctor about infertility. Schedule a visit sooner if you’re over the age of 40, your menstruation cycle is irregular, your periods are painful, or you’ve been diagnosed with endometriosis or pelvic inflammatory disease.
Before your doctor recommends any type of treatment, you’ll undergo an infertility evaluation so that your doctor can suggest changes in your lifestyle or sexual habits that could lead to conception without expensive infertility treatments.
Before undergoing IUI or IVF, a number of tests will help determine the cause of infertility, which will guide the protocol for any infertility treatments, including IUI and IVF. Tests for men may include semen, hormone, and genetic testing, imaging tests, and a testicular biopsy. Tests for women may include ovulation, ovarian reserve, and other hormone testing, imaging tests, and a hysterosalpingography, which evaluates your uterus and fallopian tubes for problems like blockages or growths.
Once testing is done and the cause of infertility is found—or no cause is found—your doctor will work with you to determine your options, which may include medication, surgery, fertility drugs, artificial insemination, assisted reproductive technologies like IVF, adoption, or using a gestational carrier, a woman who carries the baby to term for an infertile couple.
Whatever path you choose to take, you’ll need plenty of emotional support along the way. Let your friends and family know what you’re going through, and ask for patience, understanding, and support as you embark on your journey to parenthood.
The nourishment of the placenta and umbilical cord in creating your baby is an amazing thing. With scientific advancements in the field of stem cells, some families are choosing to save their baby’s umbilical cord in a process known as cord blood banking. While the uses for cord blood are evolving, parents are choosing to save the umbilical cord for potentially treating childhood diseases. If you or a loved one is considering cord blood banking, here are some considerations and information regarding the option.
What Is Cord Blood Used For?
Cord blood contains stem cells, which are cells that form blood. These cells are not yet differentiated, which means they don’t have a purpose in the body. They could become red blood cells, platelets, or white blood cells. As a result, they could potentially be used to treat many different types of blood-related disorders. Examples include leukemia, lymphoma, sickle cell disease, aplastic anemia, and other conditions.
If a child develops a condition that affects blood cells in the body, the cord blood could potentially be used for stem cell transplants. These are used to encourage growth of healthy cells.
Where Is Cord Blood Stored?
People have several options when it comes to banking cord blood. First, there are “public” banks where people may donate anonymously. This blood is categorized and stored for potential use for research and for a child who may need it one day. However, the cord blood isn’t specifically stored for your child. If needed, you couldn’t retrieve the blood because it is anonymously stored. Think of this option as similar to donating blood to a blood bank.
The second option is private cord blood banking. This requires paying a fee to a private company that will store the cord blood for your family and only for your family. Sometimes these costs can be between $1,000 to $2,000 to initially store the blood, according to The Nemours Foundation. An additional $100 a year to continue to store the blood is also an example fee.
Who Recommends Cord Blood Banking?
For some families with a medical history of conditions that may benefit from stem cell treatment, private cord blood banking is an option that has greater potential to be beneficial to a family. Otherwise, private cord blood banking is simply an insurance policy. There is a good chance a person may never use the cord blood. However, the American Academy of Pediatrics does recommend public cord banking. This increases the pool from which a person can potentially receive a stem cell transplant.
How Is Cord Blood Collected?
Parents who choose a cord blood banking option receive a kit they must bring to the hospital. It’s important that an expectant mother tell her medical team that she wants to use cord blood collection before birth. The medical team will extract the cord blood after the baby is born. This can occur either before or after the placenta arrives, which is known as the third stage of labor.
Ultrasound technology has meant expectant parents can get a small glimpse into their baby’s appearance before the big due date arrives. You may notice when your doctor is looking at the ultrasound that they’re doing so very intently. This is because doctors are visualizing an ultrasound not only to see your baby’s movements and development, but also for several other key factors.
Each obstetrician may have different protocols as to how many ultrasounds are performed. Sometimes, a doctor will recommend an ultrasound with each visit or sometimes at least twice during a pregnancy.
A doctor will typically perform at least a first-trimester ultrasound somewhere between the 12 and 14 weeks of pregnancy. At this time, your doctor is looking at the baby for signs of nuchal translucency. This area at the back of the neck is where fluid can build up. In babies who have certain chromosome defects, such as Down’s syndrome, the nuchal area may have a significant collection of fluid buildup. However, the scan is only an estimate. If your doctor suspects your baby may have an abnormality, further testing is usually recommended.
It’s possible that your doctor could recommend an ultrasound at six to seven weeks into your pregnancy. This is often via a transvaginal ultrasound instead of putting the ultrasound wand over your belly. Your baby is not usually big enough this early in your pregnancy to be easily visualized via an abdominal ultrasound. However, your doctor may use an early ultrasound to ensure your baby has implanted into the right location in your uterus. Otherwise, the pregnancy could be an ectopic one and will not develop further.
At about 18 to 20 weeks into your pregnancy, your obstetrician will often perform a second ultrasound. This one is often significantly more involved as your doctor is checking for the valves in your baby’s heart, presence of healthy kidney development, normal facial growth, and the all-important gender of your baby, if you wish to know. Often, ultrasound is accompanied by listening to fetal heart tones to ensure your baby’s heartbeat is strong and steady.
During the third trimester, your doctor may perform another ultrasound to ensure all is well with your baby’s growth and positioning. At this time, a doctor may be looking at the amount of fluid surrounding your baby to ensure there isn’t too much (or not enough). Your doctor is also looking to see if your baby is head down or if their head is pointed toward your chest, which is known as a breach position. Because you cannot safely deliver a baby vaginally in breech position, it’s important for your doctor to know where your baby is at.
Utilizing New Ultrasound Technology
The advent of 3-D and 4-D ultrasound technology mean that expectant parents, friends, and family can see a baby in much finer detail than ever before. While some doctors have these higher-tech imaging capabilities, other people go to ultrasound facilities to see the images of their little ones. However, it’s important to remember if you do go to an ultrasound facility that the personnel there are not doctors. Therefore, it’s possible they may not see a defect or other irregularity that a doctor might.
Doctors and nurses often ask their patients to rate their pain on a scale of 1 to 10 with 1 being little pain and 10 being the worst pain ever – like labor pain. While this may not be reassuring to an expectant mom, there are many pain relief options during labour that can make the process significantly more comfortable for the mom-to-be. When you’re creating your birth plan for labor, it’s important to consider the possible options for pain relief.
Epidural and spinal analgesia can both make you numb from the ribcage and/or waist down, but they aren’t the same thing. Epidural anesthesia involves inserting a thin, flexible catheter through the ligaments between your spinal bones in the spinal canal. A common misconception is that the epidural is placed in your spinal cord, but this isn’t true. Instead, the catheter is placed in the area near where your spinal nerves are. When medication is delivered to the area, it can numb the nerves so you won’t feel pain. An epidural catheter can stay in for several days if your labor is prolonged.
Pros: Epidural anesthesia provides pain relief, most often for women who deliver their babies vaginally. It is possible to “dose up” an epidural should a mother require an emergent C-section if labor doesn’t progress. A mother is much more comfortable throughout the delivery experience than through natural childbirth.
Cons: Epidural anesthesia can result in side effects although the risks are relatively small, including severe headaches and infection risk. Sometimes an epidural doesn’t work. Epidural anesthesia may also prolong the second stage of labor where a mother is “pushing” her baby through the birth canal, according to Live Science.
Spinal anesthesia is similar to administering a “shot” of pain medicine into a deeper area in the spinal canal than an epidural does. The pain relief is often faster and sometimes more potent than an epidural. However, spinal anesthesia is a one-time dose. This method is most often used for C-section deliveries. However, it’s possible to offer a combined epidural that delivers immediate relief and the long-lasting effects of epidural anesthesia.
Pros: Spinal anesthesia can effectively reduce pain for mothers delivering vaginally or surgically. The effects usually last about two hours.
Cons: Like an epidural, a spinal anesthesia technique may not work. Numbing the nerves quickly also can cause a woman to experience very low blood pressure. She may need medications to treat this.
General anesthesia is similar to surgical anesthesia. It involves putting an expectant mom completely asleep during the delivery process. This may be indicated for emergency procedures or procedures where complications could occur.
Pros: Advantageous for mothers who can’t receive epidural or spinal analgesia, yet still require a C-section.
Cons: Typically used only in emergencies. Medications given could cross the placenta. Also, a new mother doesn’t get to see or hold her baby immediately after it’s born because she is waking up from anesthesia.
Doctors must be careful about what medications you’re given during labor because the medicines can cross the placenta and affect your baby’s heart rate and breathing. However, there are some medications you can receive during labor to dull or diminish your pain experience. It’s unlikely they will remove all pain.
Pros: You don’t have to have an invasive procedure to receive anesthesia. This reduces risks for potential side effects. In some cases, spinal or epidural anesthesia can also prolong the birthing process, but not usually to a great extent.
Cons: The small doses of medications aren’t usually enough for total pain control. They also have their own side effects, such as nausea, itching, dizziness, and drowsiness. Medications can also potentially affect your baby.
At its most basic form, prenatal testing is any kind of test you get while you’re pregnant (thankfully, not the multiple choice kind). This could include ultrasounds, taking your blood pressure, or testing your urine. However, there are other prenatal testing types available throughout your pregnancy that can confirm your baby’s gender or test for abnormalities in your baby’s growth and development.
An ultrasound test can be one of the most exciting tests you’ll do while pregnant. Another name for it is a sonogram. That’s because an ultrasound allows you to see your baby, and allows your obstetrician to track your baby’s growth and development. The technology uses sound waves to re-create an image of your baby on a computer screen. Some doctors perform this test twice: in your first trimester and around 20 weeks of pregnancy. Others provide the test more frequently to monitor your baby’s growth and levels of amniotic fluid.
In your second trimester, somewhere between 24 and 28 weeks’ gestation, your obstetrician will have you complete a glucose screening test. Most commonly, you’ll drink a glucose-containing drink (like a Sprite, but with more sugar), and test your blood to see how well your body processes the sugar. The test is to determine if you could have gestational diabetes, a condition that affects your blood sugar in pregnancy.
Your doctor will draw a sample of your blood for testing for certain conditions that could affect you and your baby. Examples include HIV, anemia, hepatitis B, and your blood type. Your blood type is especially relevant if you have a “negative” blood type, like B-negative and your partner has a positive blood type. This is known as Rh incompatibility and may require the administration of a special medication known as RhoGAM that can reduce the risks for adverse effects to your baby.
Not all expectant moms need (or want) genetic testing, but it is available. Some are known as screening tests that will test for potential risks for a baby to experience a condition, such as cystic fibrosis or Down’s syndrome. Other tests are diagnostic and can more definitively say if your baby has a certain medical condition. There are some instances where a doctor may recommend these tests. This includes if you are older than age 35, have had a premature baby in the past, or are a known carrier for certain genetic conditions.
An amniocentesis is a test that involves taking a sample of the amniotic fluid in your uterus to test for abnormalities. This involves inserting a thin needle into your belly, so it is associated with some risks. The test is usually performed between 14 and 20 weeks into your pregnancy. Doctors don’t usually recommend amniocentesis unless you have had an abnormal blood test or ultrasound that may indicate the potential presence of an abnormal condition in your baby. An example could be if your baby has fetal anemia and may require a blood transfusion.
Is Recovery from a C-Section Longer Than Recovery from a Natural Birth?
Did you know about 30% of babies enter the world via caesarian section? These days, you can even decide beforehand whether you’d like your baby to be born naturally, via a vaginal birth, or by C-section. However, your doctor may recommend a C-section if you’ve had a complicated vaginal delivery in the past or if you have medical problems that make a vaginal delivery risky. Each form of delivery has advantages and disadvantages, including differing recovery periods. Which is right for you? Here are some things you should know to make a more informed decision.
Pros and Cons of C-section vs Natural Birth
As you know, a natural birth is when a baby comes out organically through the vaginal canal. One drawback of a natural birth is you don’t have the option of a scheduled delivery, as you do with a C-section. You can estimate your delivery time but, chances are, you won’t pick the precise date. As a result, a natural delivery leaves you with a certain degree of uncertainty. This makes preparation and planning difficult. With a C-section, the date is pre-planned, so you know when to be ready. If you’re the type that dislikes uncertainty, you may like the idea of a planned delivery via C-section rather than leaving things to chance.
On the other hand, when you undergo a C-section, you’re not an active participant in the birth of your child. You’re in the hands of your obstetrician and staff and not really aware of what’s going on. Plus, a C-section, although safe, is a surgery and all surgeries carry potential risks, including bleeding, infection, reactions to the anesthesia, and scarring. If you don’t like the idea of surgery and subscribe to the most natural way of doing things, a natural birth may suit you better.
Recovery C-Section vs Natural Birth
A major difference between a C-section and giving birth naturally is the recovery period. Because a C-section is major surgery, the recovery period will be longer than if you give birth naturally. When you give birth naturally, you typically leave the hospital after 24 to 48 hours. You also get the satisfaction of holding your baby and breastfeeding immediately after birth.
After a C-section, you generally spend 3 to 5 days in the hospital after delivery and healing at the site of the surgery may take weeks or even a few months to completely mend. Right after surgery, you’ll need pain medications and even after you return home, you’ll have limitations on your activities. For example, you won’t be able to drive for 2 weeks or exercise for at least a month.
Sometimes a C-Section is the Only Option
In some cases, your obstetrician may recommend a C-section for medical reasons. Some instances where a Caesarian section is safer is if you’re giving birth to a large baby or twins or if your baby is situated in such a way that a natural delivery would be risky. An example is when a baby is in a breech position and efforts to turn them around is unsuccessful. Your doctor may also recommend a C-section if you have certain medical problems or anatomical problems that make a natural delivery harder or riskier. If you choose an elective C-section, you’ll most likely need to get a C-section for subsequent births as well, something to keep in mind.
The Bottom Line
Now that you know the difference in recovery times as well as the other pros and cons of C-section vs natural delivery, talk the options over with your doctor.
Medscape.com. “Cesarean Delivery”
WebMD. “The Truth About C-Sections”