When first confronted with infertility and researching through your treatment options, you are bound to consider both intrauterine insemination (IUI) and invitro fertilization (IVF). But should you try IUI before IVF? Or is it just a waste of money and time, which can be extremely crucial in fertility treatments?
Before you start the treatment, learn about the differences between the two procedures, understand how they work, and finally discuss with the doctor on what is recommended in your situation.
While IUI is significantly cheaper than IVF and usually the first line of treatment in cases of unexplained infertility in young couples, it is totally contraindicated in some cases. For e.g. if your tubes are blocked, spending money on IUI would be a total waste.
As you weigh IUI vs IVF, here’s what you need to know:
What happens in IUI?
As the name suggests, IUI is the process of introducing the sperm into the female’s uterus artificially. It is a simple and straightforward process which usually requires a single session. It is scheduled to coincide with the female’s ovulatory cycle which can be induced naturally or chemically with the use of drugs.
What happens in IVF?
IVF is a more complex procedure where instead of the female’s uterus, the egg is fertilized with the sperm in vitro (test tube). This a more rigorous than the IUI as the IVF uses the embryo transfer method where the fertilized embryo is directly implanted on the uterus.
Unlike the IUI, which uses natural methods of ovulation, this process uses heavy drugs which help stimulate the ovaries before the procedure, so that more eggs can be collected to improve the chances of success in a single cycle.
IUI vs IVF
Whatever the treatment, the final goal is to have a baby. While success rate is one of the main factors to consider, you will also take into account the complexity of the procedure, its cost-effectiveness, age of the patient, and time.
Here’s comparing the two for different factors:
- Success rates – If the patient is below 35, the success rates of IUI could be between 8 percent to 15 percent, whereas for IVF the success rates are roughly around 50 percent. However, success rates in IVF can be misleading and it is always advisable to talk to a fertility expert before deciding, so you know what is likely to bring positive results, given your specific situation.
- Cost – IVF costs could be up to 20 times the cost of IUI in most countries but that does not mean you keep trying with the lower priced option, without any success. Infact, in some situations, it may be more cost-effective to go directly to IVF.
Remember, even if it doesn’t cost much, any money you spent on a failed cycle, is only wasted.
- Drug usage – Drug usage in IUI is often optional though a few hormone inducers are usually given to help increase the success rate. IVF often relies on heavy drug use to stimulate the ovaries. These drugs are not only expensive, they can sometimes cause certain side-effects.
- Health risk –– While there isn’t much risk in either of the procedures, the safety of IVF drugs has often been questioned by the critics. In rare cases, the drugs administered in an IVF cycle may cause ovarian hyperstimulation syndrome (OHSS).
- Multiple births – The risk of multiple births is higher in IUI if it is performed with the usage of fertility drugs, as the washed semen can fertilize several eggs; while in IVF, this risk is minimized because only one or two embryos are transferred these days.
- Time required – IUI is a rather simple procedure and it will take only 1-2 visits to the clinic. If it works, it may be the quickest possible treatment to make you pregnant. However, patients in their late 30s and 40s, may not have easy success with IUI and will only end up wasting too much precious time before IVF, when their fertility is already on the decline.
IUI before IVF
IUI is a popular option to begin with as it is less aggressive with fewer risks and side effects. It is not an invasive procedure with only occasional use of hormones and fertility drugs.
As compared to IVF, it also requires minimal monitoring with no risk for contracting health complications such as ovarian hyperstimulation syndrome (OHSS).
The procedure can be done quickly and painlessly, without much discomfort to your body or your wallet.
Given that all other factors related to yours and your partner’s fertility are favorable, before you undergo IVF, it is advisable to partake at least three cycles of IUI. This is especially advised to women below the age of 35 as they have higher chances of conceiving with IUI.
When should you try IUI before IVF?
IUI is recommended if you have:
- Open fallopian tubes
Before the procedure, the physician will ensure that you have open fallopian tubes by conducting the HSG test (hysterosalpingogram). Your suitability for IUI is completely dependent on the patency of your tubes.
- Healthy ovulation
IUI can be done only if you have a perfectly healthy production of eggs. Only after testing the cycle and hormonal levels, is the process begun.
If you have minor ovulation issues, IUI may still be recommended with the aid of some drugs.
- Unfavorable cervical mucus
The sperm needs to enter the uterus without any barriers. Cervical mucus makes natural conception challenging, whilst it has no effect on IUI procedure as the sperm is introduced directly into the uterus and not the cervix.
- Mild male-factor infertility
If your infertility problems are attributed to minor male fertility issues such as slightly lowered sperm count or ejaculation problems, IUI may prove highly beneficial as the process involves introduction of a good concentration of healthy sperm into the uterus.
- Requirement of donor sperm
In cases of azoospermia, where even surgical sperm extraction is not viable, using a donor’s sperm is recommended. If the female partner has no fertility issues and the requirement of the donor sperm is absolutely necessary, there is no need to consider IVF or ICSI.
For female couples of the same-sex, IUI may be performed with a donor’s sperm.
Researchers have pointed that in an attempt to achieve pregnancy as soon as possible, clinics may be prematurely jumping to IVF-ICSI, even in cases where the much-milder IUI could easily bring the desired results.
When should you avoid IUI?
Despite being useful in many cases, IUI could be a total waste in some situations. You will be recommended to straight away go for IVF if you:
- Have blocked fallopian tubes
- Have an abnormal ovulation cycle
- Suffer from endometriosis.
- Suffer from some genetic disorders that require PGS/PGD screening for the embryos
- Need eggs from a donor
- Are in your late 30s, as fertility in women typically starts to decline around the age of 35 and the chances to succeed with IUI (and even IVF) are significantly lowered.
In these situations, moving directly to IVF would be the better option, as chances of success with IUI are almost nil.
Even if all the factors related to your fertility are seemingly favorable, doctors usually recommend only three and not more than 5- 6 cycles of IUI before moving on to IVF.
It is imperative that you get your fertility tests done and find the reason for not being able to conceive before jumping into any of these expensive treatments.