When you’re eager to start a family, struggling with infertility can feel overwhelming, marked by uncertainty and a sense of isolation.
Yet, amidst the heartache, there is hope to be found in modern fertility treatments using fertility treatments and assisted reproductive technology. Advances in medicine offer individuals or couples a way to navigate the challenging path through infertility.
Two of the most common fertility treatment options are:
— Intrauterine insemination (IUI)
— In vitro fertilization (IVF)
Each approach has its own set of benefits, considerations and emotional challenges. Understanding the differences between IUI and IVF can help you make a more informed decision as you explore your options to have a child.
Fertility Treatment Options
Infertility is defined as not being able to get pregnant after 12 months or more of trying to conceive with unprotected sexual intercourse. However, women age 35 or older, which is medically referred to as advanced maternal age, should seek an infertility evaluation with their health care provider or a reproductive endocrinologist after six months of trying to conceive.
Dealing with infertility can be isolating, but you’re not alone. Infertility affects about 15% of couples in the U.S. It’s estimated that 1 in 8 women between the ages of 15 and 49 have received fertility assistance in their lifetime, and according to recent data, 2.3% of all U.S. births were conceived using assisted reproductive technology.
Although infertility has historically been considered a women’s issue, research shows that male infertility is the cause in 20% of infertility cases and plays a contributing role in another 30 to 40% of all cases.
For many, fertility treatment options like IUI and IVF are available with the help of a fertility specialist.
When to see a fertility specialist
If you’ve been actively trying to conceive for 12 months, or for six months if you’re 35 and older, without success, it may be time to see a fertility specialist.
“About a third of the time, we don’t have any clear explanation for why the couple hasn’t been successful so far,” says Dr. Katherine Cameron, an assistant professor of reproductive endocrinology and infertility at Johns Hopkins School of Medicine and director of third-party reproduction at the Johns Hopkins Fertility Center in Baltimore. “It’s important to use as much as we can (of) our own clinic data with their clinical characteristics.”
In the initial fertility consultation, the medical provider is generally evaluating:
— Ovarian reserve (egg supply)
— Ovulation
— Tubal patency (if their fallopian tubes are open)
— Any anatomical considerations, like something structurally happening inside the uterus that needs addressing
— Any conditions that may affect the ability to conceive, like endometriosis and polycystic ovary syndrome (PCOS)
— Sperm quality and quantity
The initial evaluation requires a comprehensive blood test, vaginal ultrasound to examine the ovaries, semen analysis of your male partner (if you have one) and other steps, so it’s important to keep in mind that establishing a baseline takes time.
“Usually, within the first or the second month, you have an idea of the best route of treatment, options of treatment and — in the end — their ultimate success rate,” says Dr. Eric Knochenhauer, director of reproductive endocrinology and infertility at Staten Island University Hospital and director of Island Reproductive Services in Staten Island, New York.
Direct communication from your doctor helps establish a clear understanding of what to expect.
“The best way to manage expectations is just to be very upfront,” Cameron says. “I always say this is a very intensive process, and then describe what a typical schedule looks like to make sure that they are going into things with eyes wide open.”
[Read: How to Find a Good Fertility Clinic.]
What Is IUI?
Intrauterine insemination, or IUI for short, is when sperm is injected directly into the uterus to decrease the sperm’s travel time to the egg. Sometimes, medication is also used to help stimulate egg release. However, medication is not always needed in all cases, such as when there’s a same-sex couple using a sperm donor or when there’s no issue with the woman’s egg reserve.
“For somebody in that situation, we would just use their own natural ovulation,” Cameron says.
Otherwise, using fertility medication when it isn’t medically necessary increases the risk of twins or multiple births.
IUI process
The IUI procedure is performed at or around the time of ovulation. The semen sample is “washed” in a lab, meaning it’s separated from seminal fluid, and the medical provider uses a catheter to insert the sperm directly into the uterus through your cervix.
The procedure only takes a few minutes.
“It’s essentially to the woman a little bit more than a Pap smear, and there is minimal discomfort in doing the procedure,” Knochenhauer says.
Ideal candidates for IUI
You may be a good candidate for IUI under any of the following conditions:
— Healthy ovarian reserve
— Female has at least one patent (open) fallopian tube
— Normal semen analysis results, meaning the male has a healthy, reasonable sperm count
— No genetic concerns
IUI can be useful for couples who are having trouble conceiving because of their work or travel schedule, or sexual dysfunction.
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What Is IVF?
In vitro fertilization, or IVF for short, is a procedure that uses assisted reproductive technology to fertilize an egg with the sperm in a lab, then place it back in a woman’s uterus. IVF is a longer, more intensive process than IUI. It is also more costly.
Ideal candidates for IVF
If a couple has been unsuccessful trying IUI, they may consider IVF.
For women, you may be a good candidate for IVF if you have:
— Diminished ovarian reserve
— Blocked fallopian tubes
— Endometriosis, PCOS or other health conditions causing infertility
— Age-related infertility
For men, you and your partner may be good IVF candidates if you have:
— Low sperm count
— Low sperm motility
IVF may also be a good option for those experiencing unexplained infertility and if pre-genetic testing shows high risk of certain conditions.
For those who are older and planning to grow their family in the future, IVF is a good option for fertility preservation. By freezing — or “banking” — any unused viable embryos, women have the option of using them in the future without worrying about egg count.
“Even if she goes into ovarian failure, you can transfer embryos as long as the rest of the anatomy is okay,” Knochenhauer says.
IVF process
The basic steps of IVF include:
1. Ovarian stimulation. The female takes medication, usually as a series of injections, to stimulate the ovaries to produce multiple eggs. A fertility specialist closely monitors the growth of the ovarian follicles with regular vaginal ultrasounds to make sure the eggs are primed for retrieval.
2. Egg retrieval. A doctor uses an ultrasound-guided need to extract the eggs from the ovaries through the vaginal wall. This is a minor surgical procedure usually done under anesthesia.
3. Sperm collection. Usually performed either before or on the same day as the egg retrieval, a sperm sample is collected from a partner or donor. Collection may be done surgically if sperm are unable to be obtained via ejaculation. A semen analysis is done to separate motile and high-quality sperm.
4. Fertilization. The egg and sperm are then combined in a lab and fertilized.
5. Embryo development. The fertilized eggs are then monitored over several days as they develop into embryos.
6. Embryo grading. At three days and five days after retrieval, the embryologist grades each embryo based on their development and appearance to determine their viability and potential for successful implantation. During this time, genetic testing to screen for certain genetic disorders — such as the BRCA gene mutation — is available.
7. Embryo transfer. After you select the desired embryo, your doctor will use a thin catheter to transfer it into the uterus, where it will — hopefully — implant. Any unused embryos may be frozen for future use.
[What Is Surrogacy and How Does It Work?]
Cost Differences: IUI vs. IVF
Compare the cost breakdown of IUI and IVF procedures:
IUI costs
The average cost for a single IUI cycle ranges from $3,500 to $8,500. Some may need more than one cycle to successfully conceive.
IVF costs
A single cycle of IVF can range anywhere from $15,000 to $30,000 or more. As with IUI, it may take more than one cycle of IVF to successfully conceive. The average number of IVF cycles needed to become pregnant is 2.5, so costs could land upwards of $40,000.
Comparing costs of IUI and IVF
Generally speaking, IUI is far less expensive. However, depending on services, the state you live in and your insurance coverage, costs for either procedure can vary greatly.
Currently, 21 states and Washington, D.C. mandate insurance coverage of fertility treatment and, therefore, require health insurance plans to include coverage for certain fertility treatments. To find out if your state passed fertility insurance coverage laws, visit the National Infertility Association’s Insurance Coverage by State page.
Even for states with coverage mandates, laws can vary depending on the scope of coverage, eligibility criteria and limitations or caps, so you should always check with your insurance company to verify coverage.
Hidden costs of fertility treatment
Costs can vary, depending on your individual circumstances and preferences. Common costs beyond the standard treatment may include:
— Diagnostic tests
— Monitoring or follow-up visits
— Sperm or egg donor
— Surgical procedure costs, such as anesthesia or medical supplies
— Embryo freezing and storage
— Pre-genetic testing
What’s important is that your medical provider is upfront with all costs, even as they change based on your individual case, along the way.
Success Rates: IUI vs. IVF
Success rates vary widely depending on each individual or couple.
IUI success rates
According to the Society for Assisted Reproductive Technology, IUI is significantly less effective than IVF. The success rate of IUI per cycle is about 11%.
Age is likely to influence the number of IUI cycles needed. Older women typically require more insemination cycles to be successful, with patients under 25 undergoing 1.91 on average, and women over 43 undergoing 2.42 cycles on average.
IVF success rates
National data shows that about 50% of egg retrieval procedures ended in live-births for patients using their own eggs in women under 35. View the Centers for Disease Control and Prevention’s national data on assisted reproductive technology for more information on success rates based on various factors.
The CDC also has an IVF Success Estimator tool that may help you estimate your personalized chances of success. However, this is not a substitute for a diagnosis or treatment, and you should work with your doctor to determine your predicted IVF success rates.
Comparing IVF and IUI benefits and success rates
Although IUI has lower success rates than IVF, it is also less invasive.
“The majority of patients, as long as the parameters are appropriate, generally prefer to do (IUI) because it’s far less invasive,” Knochenhauer says.
Evaluating success rates is a very individualized determination, but the female age or age of the individual providing the eggs is the main driver of likelihood of success of both treatments.
“Starting at about age 35, we start to see a decrease in the percentage or the proportion of eggs that are of good quality,” Cameron says, explaining that a “good quality” egg is one that is able to pass on the correct amount of genetic information.
Side Effects: IUI vs. IVF
Compare the risks and side effects of IUI and IVF:
IUI risks and side effects
Generally, undergoing IUI carries very few risks of side effects, which may include:
— Infection
— Spotting or light bleeding
— Cramping or discomfort
— Multiple births
— Ovarian hyperstimulation syndrome, or OHSS, a rare complication of fertility treatments that causes the ovaries to swell
IVF risk and side effects
Side effects of an IVF procedure may include:
— Cramping or bloating
— Nausea
— Hormonal changes, causing effects like hot flashes or mood swings
— Multiple births
— OHSS
More serious risks of the surgical procedure may include:
— Bleeding, infection or damage to other organs with egg retrieval
— Ovarian torsion, a rare side effect in which the ovary or fallopian tube twists and cuts off blood supply to the ovary
Comparing IVF and IUI risks
Because IVF is a more intensive procedure, it generally carries a higher risk of adverse side effects.
“The risks are substantially different, primarily because IUI only comprises a small office procedure akin to a Pap smear, whereas IVF requires removal of the eggs from the ovaries through a small surgical procedure under anesthesia,” Cameron says. “(IVF) has all the risks of any surgical procedure that involves anesthesia.”
Emotional Support During Fertility Treatment
Experiencing infertility is a trying time, and seeking fertility treatment options can be an emotionally draining and challenging process.
Here are ways you can seek emotional support during your fertility journey:
— Lean on family and friends. Talking to family or friends can help you cope and find emotional support, especially if you personally know someone who has undergone fertility treatment.
— Look for online communities and support groups. There are many online communities and support groups on Facebook, Reddit and other sites for people going through fertility treatment. This robust online community of people who have faced infertility can provide a safe space to share experiences, ask questions and seek encouragement while you go through the process.
— Talk to fertility counselors. With most fertility clinics, counselors who specialize in fertility issues are typically available to patients who feel they may need additional emotional support through the process. They can help you process complex emotions and offer coping strategies while you navigate infertility.
Is IUI or IVF Right for Me?
Deciding whether to pursue IUI or IVF is a very personalized decision that should be made between you and your doctor. Important factors to consider include:
— Age
— Infertility diagnosis
— Costs
— Time
— Personal preferences
Knochenhauer says the most important thing to keep in mind as the patient is ensuring the thoroughness of the discussion with your doctor.
Questions you should ask your doctor include:
— What are my options?
— Why is this the recommended path?
— Do I need the surgery?
— What are my other options?
How to Find a Fertility Doctor
Word of mouth is a great way to find a good fit for you. As more women and men are more willing to talk about their IUI or IVF experience, it’s helpful to use their experiences and reviews to help guide your decision.
If you don’t know anyone personally with a recommendation, online communities are a great resource to ask questions and look for recommendations. You can also use U.S. News’s Doctor Finder tool to locate a reproductive endocrinologist and infertility specialist near you.
Most importantly, you should research the individual doctor’s credentials and experience, and look at the clinic’s outcomes. Ensure the fertility doctor is board certified, has significant experience treating fertility issues and has a proven track record of successful pregnancies.
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IUI vs. IVF: What?s the Difference? originally appeared on usnews.com
