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.