Intrauterine Insemination (IUI)
In Vitro Fertilization (IVF)
Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two of the most popular infertility treatments. Understanding these treatments, their success rates and differences are a great place to begin your conversations with an Eden fertility expert.
- Complexity. IUI refers to a single procedure where sperm is placed directly in the patient’s uterus when she is ovulating. IUI may be performed in sync with a woman’s natural cycle or timed with fertility medications to stimulate ovulation. The IVF process consists of several stages and requires more than one procedure: first the ovaries are stimulated using a series of fertility medications; second, the patient undergoes egg retrieval in a day procedure under a mild anesthetic; third, the embryos are created and incubated in the lab, and then the embryo transfer into the patient’s uterus.
- Risk of multiples. IUI with fertility medication carries a significant risk of multiple pregnancies, while recent advances in IVF mean that most modern fertility clinics now transfer only one or two embryos per IVF cycle, lowering the risk of multiple pregnancies.
- Success rates. Statistically, IUI has lower success rates than IVF, and the gap widens as women age.
- IUI with fertility medication: average success rates range from 8-15 percent per cycle for patients under 35.
- IVF using a woman’s own eggs: average success rates range from 40-45 percent for patients under 35.
- Time involved. IUI is a much shorter process than IVF, so if your first cycle is successful, it could be the quickest route to pregnancy. But because of the gap in success rates, some patients in their late 30s to early 40s may get pregnant faster by going directly to IVF rather than waiting until they have had several failed IUI cycles.
- Cost. An IUI cycle costs much less than an IVF cycle, and may be the deciding factor for many patients. However, depending on your diagnosis and your chances of conceiving through IUI, it may be more cost-effective to go directly to an IVF cycle rather than dealing with multiple failed IUI cycles before ultimately proceeding to IVF.
Who are the best candidates for IUI?
- has at least one unblocked fallopian tube
- is able to ovulate, perhaps with the help of fertility medication
- has a healthy ovarian reserve (which means a good amount of healthy eggs)
- has a normal uterine cavity
When does it make sense to go straight to IVF?
- are over the age of 38
- have blocked fallopian tubes
- have reduced ovarian reserve
- decide to use donor eggs
- suffer from advanced endometriosis
- when a gestational carrier is needed
- are dealing with severe male-factor infertility which may require the use of advanced technologies such as intracytoplasmic sperm injection (ICSI), testicular sperm extraction (TESL), or microsurgical epididymal sperm aspiration (MESA).
- may require genetic screening
Mini and Natural Cycle IVF
Natural cycle IVF offers patients the IVF process with fewer medications, fewer side effects and lower costs. There are generally three groups of women who are good candidates for natural cycle IVF:
- For women considered “poor responders,” natural cycle IVF affords the opportunity to continue with the IVF process, even when ovarian stimulation has repetitively failed to produce multiple embryos.
- For couples with infertility due to male factor (low or poor quality sperm), natural cycle IVF can provide an opportunity for fertilization through ICSI and at the same time avoid multiple pregnancies and unnecessary stimulation for an otherwise fertile female partner.
- Women who cannot tolerate or do not desire to take hormonal therapy in order to conceive can still benefit from the IVF process.
Minimal or Mild IVF
With minimal and mild IVF and low doses of injectable hormones are used to obtain a small number of eggs and avoiding premature ovulation, at the same time avoiding hyperstimulation, which can cause produce an excess amount of eggs and swelling of the ovaries. Candidates for minimal IVF are women who do not produce larger numbers of eggs on higher doses and women with poor egg quality in prior cycles.
Benefits and Outcomes
Since small numbers of eggs are retrieved, most women can undergo these procedures with sedation only, thus reducing the cost and risk of anesthesia. In addition, since the egg numbers are low, a thinner needle is used for retrievals, thus decreasing the incidence of post-procedure internal bleeding—a rare complication of conventional IVF.
It’s important to remember that lower pregnancy rates are expected and more retrieval failures are seen since fewer embryos are transferred and the patients themselves usually have a poor prognosis by conventional standards.
Elective Single Embryo Transfer (eSET)
Elective single-embryo transfer (eSET) is a procedure in which one embryo, selected from a larger number of available embryos, is placed in the uterus.
The embryo selected for eSET might be from a previous IVF cycle from the current fresh IVF cycle that yielded more than one embryo.
eSET helps women avoid complications that are associated with carrying multiples, including high blood pressure, high blood sugar, increased nausea and vomiting, other gastrointestinal problems, and problems with bleeding after delivery.
It also helps families achieve success while preventing some risks known to be associated with giving birth to twins or what is called “high order multiple births” (three or more children born at the same time). Infants born in multiple births are more often born early are smaller (low birth weight) and experience more adverse health outcomes than singleton infants.