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Navigating the journey to parenthood can sometimes lead us down unexpected paths. At RGI, our team is here to help guide you through your options so you can move forward with confidence.

Two common procedures you may have heard of are intrauterine insemination (IUI) and in vitro fertilization (IVF). But should you try IUI before moving on to IVF? There is no one-size-fits-all answer to this, as fertility treatment varies significantly from one couple to another. The choice between IUI and IVF depends on a variety of factors, including the specific fertility issue you are facing, age, medical history, and financial considerations. By understanding the factors influencing where you start your journey, and in consultation with a fertility specialist, you can make the decision that best suits your unique situation.

Understanding IUI and IVF

What is IUI?  

Intrauterine insemination (IUI),involves taking sperm and placing it directly into the uterus. On the day of the IUI, the sperm is typically washed and concentrated to include a dense volume of mobile sperm. Ideally, this is done just prior to ovulation and helps increase chances of fertilization by making it easier for the sperm to reach the egg.

IUI is helpful for those with mild male factor infertility such as mildly low sperm counts or motility but may also be recommended in conjunction with oral medications such as clomid or letrozole (Femara) for patients or couples with unexplained infertility, anovulation and PCOS. It is used as a first-line treatment for many couples who have been unsuccessful in becoming pregnant on their own.  

What is IVF?

In vitro fertilization (IVF) is a treatment in which eggs are fertilized with sperm outside of the body in a laboratory setting before being transferred to the uterus. First, eggs must be retrieved from the ovaries. This is done by stimulating the ovaries to produce multiple eggs using a series of injectable medications, followed by an egg retrieval procedure performed under anesthesia. Once the eggs are retrieved, they are placed with a sperm sample in a lab to facilitate successful fertilization and embryo formation. Then, an embryo is transferred into the uterus.

The entire process can take around three months and is a good first choice for people who have issues with their fallopian tubes, poor sperm quality, unexplained infertility, severe endometriosis, and more.

IUI is often considered a less invasive and less expensive option when compared to IVF and may be recommended as a first step in fertility treatment for certain conditions. Per cycle, IUI is typically lower chance of success than IVF. IVF may be recommended directly in cases of more severe infertility issues.

The decision between starting with IUI or going directly to IVF depends on various factors:

• Age: As fertility declines with age, especially for women over 35, some may opt for IVF directly to increase their chances of success in a shorter timeframe.
• Medical History: Certain medical conditions may make IVF a better first choice. IVF may be best for those with damaged, blocked, or absent fallopian tubes, severe endometriosis, or people with severe male factor infertility.
• Previous Treatments: Couples who have already undergone several unsuccessful IUI cycles may choose to move on to IVF.
• Ideal Family Size: IVF may be recommended sooner if you plan to have multiple children. This offers more time, opportunities for multiple IVF cycles if needed, and control over the timing of pregnancies.
• Personal Preferences: Your decision might also be influenced by personal preferences, including concerns about the invasiveness of procedures, and the emotional and physical toll.
• Financial Considerations: Starting with IUI may be a preference for some couples due to the higher cost of IVF treatments. Some insurance companies might also require a couple to attempt pregnancy with IUI before covering IVF treatments.

The Pros and Cons of Starting with IUI vs. IVF

When considering fertility treatments, it’s essential to weigh the pros and cons of each option. IUI and IVF each have their own set of advantages and disadvantages.

The Pros of IUI:

Less invasive: IUI is less invasive than IVF, involving a simple procedure where sperm is inserted directly into the uterus. This makes it a less physically demanding process, with few side effects.

More affordable: Generally, IUI is significantly less expensive than IVF – with the cost of a single cycle ending at around $1,000 – making it a more accessible first option for many couples.  

Shorter treatment cycle: IUI cycles are typically shorter and less complicated than IVF cycles, often requiring less medication and monitoring. IUI cycles align with your natural menstrual cycle, so it generally takes two to four weeks from start to finish. With IVF, patients can expect a six to twelve-week process from the start of treatment to the pregnancy test.

The Cons of IUI:

Lower Success Rates: IUI generally has lower success rates per cycle compared to IVF, especially in cases of severe infertility issues. The success rate for IUI is around 7-20% per cycle and is more effective in people under 35.

Multiple Cycles May Be Needed: Many couples may require several IUI attempts before achieving pregnancy, which can increase the overall cost and emotional strain.

Limited Effectiveness for Certain Conditions: IUI may not be effective for all types of infertility, such as significant tubal damage or severe male factor infertility.

The Pros of IVF:  

Higher Success Rates: IVF typically offers higher success rates per cycle, especially for women over the age of 35 or those with certain types of infertility. IVF has a 70% chance of success when the embryo is genetically normal.

Treatment for a Wide Range of Fertility Issues: IVF can be effective for a variety of infertility diagnoses, including blocked fallopian tubes, severe male factor infertility, and severe endometriosis.

Genetic Screening: IVF allows for the option of preimplantation genetic testing (PGT), which can identify embryos with genetic abnormalities before transfer, reducing the risk of genetic disorders and increasing the chances of a healthy pregnancy.

The Cons of IVF:

More Invasive: During IVF, patients will undergo a few different treatments; including injectable medications, egg retrieval, and embryo transfer. Injectable medications will need to be self-administered typically for 10-12 days. The egg retrieval is a more invasive procedure (done under anesthesia). The embryo transfer is similar to an IUI however done in a procedure room with close proximity to the lab.

Emotionally and Physically Taxing: The steps involved in IVF can cause a few different side effects, including nausea fatigue, injection site reactions, mood swings and emotional changes, abdominal cramping, vaginal bleeding, and bloating. The process can also be long and emotionally taxing, especially if multiple cycles are needed to achieve pregnancy.

Higher Costs: The cost of IVF is significantly more per cycle than IUI. This can make it less accessible for some couples without insurance coverage or financial resources. One cycle of IVF can run anywhere between $12,000-15,000, with additional costs for medications, testing, and other necessary procedures.

Who Might Benefit from Starting with IUI?

• Couples with unexplained infertility who have been trying to conceive for at least a year.
• Cases of mild male factor infertility, such as slightly low sperm count or motility. In these cases, sperm count and motility are likely to compromise the sperm’s ability to reach and fertilize the egg, in which case IUI can be a simple solution.
• People with conditions that affect the cervix and prevent sperm from easily entering the uterus. In these cases, the sperm cannot reach the egg, and this issue is bypassed through IUI.

• Couples using donor sperm, including single women, gay or trans couples, or heterosexual couples with severe male infertility.
• People with mild endometriosis who may have endometrial tissue obstructing the sperm’s path to the uterus or pelvic inflammation. IUI places the sperm directly into the uterus, thus bypassing these issues.
• People with ovulatory disorders, such as polycystic ovary syndrome (PCOS). IUI can be used in conjunction with medications such as clomiphene citrate (Clomid) or letrozole (Femara) to stimulate ovulation and increase the chances of timing insemination correctly.

Who Might Benefit from Starting with IVF?

• People over the age of 35, especially those over 40, may opt for IVF due to the higher success rates per cycle. This is crucial given the declining egg quality and quantity with age.
• People with very low sperm count, poor motility, or abnormal morphology. In this case, IVF with intracytoplasmic sperm injection (ICSI) is recommended.
• People with blocked or severely damaged fallopian tubes will need to begin with IVF, as the process of IVF bypasses the fallopian tubes entirely. Without functional fallopian tubes, the egg will not be able to travel to the uterus on its own.
• People with severe endometriosis where the quality of eggs or the ability of sperm to reach the egg is affected.
• Couples with a risk of passing on genetic disorders can benefit from preimplantation genetic testing (PGT) to ensure healthy embryos. If this is desired, IVF is recommended.

How Do I Decide What Treatment Is Best for Me?

Deciding how you approach your treatment can be confusing; we recommend a thorough discussion about which is best for your specific situation with your fertility specialist. Some couples may start with IUI due to its less invasive nature and lower cost, while others might opt for IVF directly to potentially shorten their journey to parenthood.

At RGI, we’re committed to guiding you through every step of your fertility journey with compassion, expertise, and the latest reproductive technology. Whether it’s IUI, IVF, or another path to parenthood, we’re here to support you through your decision-making process.  

Ready to discuss your fertility options? Contact us today to speak with one of our specialists. Together, we can build your path to parenthood.

Coping with infertility can be a difficult, isolating experience. But it is important to remember you’re not alone. Approximately 1 in 6 couples in the United States struggle with some type of infertility. And, while it may be surprising to learn, nearly 30 percent of infertility cases are related to male factor issues. But the good news is there are plenty of options available to help you achieve the family of your dreams.

Diagnosing male factor infertility

Diagnosing male infertility typically includes:

• General physical exam and medical history
• Semen analysis

Common causes of male factor infertility

Here are the most common factors that can contribute to male infertility:

• Structural abnormalities
  This may include abnormalities or blockages along the reproductive tract due to a birth defect, injury or illness.
• Sperm production disorders
  Defects in sperm quality (morphology) or quantity.
• Sperm motility issues
  Poor sperm motility means the sperm can’t swim properly, which decreases their chances of fertilizing the egg.
• Ejaculatory disorders
  A condition in which it takes an extended period of sexual ejaculation for men to reach sexual climax and release semen.
• Immunologic disorders
  This disorder causes the immune system to attack sperm.

What are the treatment options for male factor infertility?

In some cases, your doctor may recommend assisted reproductive technologies (ART), such as in vitro fertilization (IVF), IVF with intracytoplasmic sperm injection (ICSI) or the use of donor sperm. For couples where both male and female factor infertility are an issue, your doctor may recommend donor embryos.

If you and your partner have been trying to conceive for at least 12 consecutive months (6 months for women aged over 35), it’s time to see a specialized reproductive endocrinologist. The caring doctors at Reproductive Gynecology & Infertility can diagnose and treat male factor infertility in Columbus, Akron, Canton and Youngstown. Call 866-537-2461 to get the answers you need.