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Fertility Treatments

Male Fertility

Do I Need To Do IUI Before IVF?

Explore the journey to parenthood with RGI's expert guidance on choosing between IUI and IVF treatments. Understand the pros and cons of each option to make an informed decision for your unique situation. Start your path to parenthood with confidence.

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.  

image showing in vitro fertilization -- an egg fertilized with sperm in a lab

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.

doctor explaining iui vs ivf to patient

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.

doctor explaining fertility treatments to patient

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.

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Fertility Treatments

How Does Letrozole Boost Fertility Success?

Learn how letrozole can boost fertility, its success rates, side effects, and when it's needed in fertility treatment.

Infertility is a common struggle for many people who want to build a family. Worldwide, about 1 in 6 people deal with infertility. Luckily, there are many ways to treat infertility, including a medication called letrozole. But how, exactly, does letrozole work?

woman taking letrozole to help boost fertility

How Does Letrozole Work?

Some people experience infertility because of ovulation problems. Letrozole boosts fertility by promoting ovulation. It does so by suppressing estrogen production in the body, which ultimately leads to increased follicle-stimulating hormone (FSH) levels. This stimulates follicle growth and egg development, increasing the chances of ovulation.

When is Letrozole Needed in Fertility Treatment?

Ovulation problems stem from different causes, such as Polycystic ovarian syndrome (PCOS). Therefore, letrozole may be recommended for those with PCOS, unexplained infertility, or low egg count.

Letrozole is also commonly used as part of an intrauterine insemination (IUI) During IUI, sperm is inseminated into the uterus around the time of ovulation. Letrozole is often used during  IUI to stimulate ovulation and thus increase the chances of becoming pregnant.

Success Rates and Evidence of Letrozole

Success rates vary from person to person, depending on the root cause of infertility and your unique situation. Evidence suggests that letrozole is more effective than other medications in people with PCOS, and studies show that letrozole appears to help treat infertility stemming from endometriosis or unexplained causes.

Other Fertility Medication Options

Clomiphene is another medication that's commonly used to promote ovulation. According to research, letrozole is more effective than clomiphene for PCOS patients. Letrozole may also cause fewer side effects than clomiphene. Some people may not respond to clomiphene, making letrozole a good alternative.

Gonadotropins are hormonal medications given by injection and sometimes used during an IUI or IVF cycle. Gonadotropins include FSH and luteinizing hormone (LH), two hormones that stimulate follicle production and egg release in the ovaries. Sometimes, gonadotropins may be used alongside letrozole during fertility treatments.

Letrozole is an oral medication, which can make it easier to take than an injection. Some research suggests letrozole may also come with a lower risk of multiples than other medications.

woman understanding the risks and side effects of letrozole

Risks and Side Effects of Letrozole

Like any medication, there are potential risks and side effects when taking letrozole.

While taking letrozole, you may experience:

• trouble sleeping

• hot flashes or night sweats

• breast tenderness

• fatigue

• dizziness

• stomach upset

• spotting

• headaches

Don't hesitate to call your doctor if you have side effects that are severe, persistent, or concerning while taking letrozole.

Getting Started with Letrozole for Fertility

It's worth being evaluated by a caring fertility specialist before pursuing any fertility treatment. They can assess you to determine what might be causing your infertility and then decide on an appropriate treatment plan, which may include an oral medication like letrozole. A fertility specialist can advise whether IUI or IVF may be right for you and discuss your treatment options.

Helping You Every Step of the Way On Your Fertility Journey

Reproductive Gynecology & Infertility is committed to compassionate, personalized fertility care. We offer various advanced fertility care options to provide each person with the highest quality care possible. If you are having trouble conceiving or have questions about letrozole or other fertility treatments, contact us today to schedule a consultation.

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Fertility Treatments

Is IVF Painful?

IVF comes with risks and discomforts, and most report that pain is minimal. We break down what pain to expect during IVF and what's recommended to help manage it.

Navigating the IVF Process with Comfort and Reassurance

In vitro fertilization (IVF) is a fertility treatment that fertilizes eggs with sperm in a lab. Couples may choose to have IVF if they have been unsuccessful in getting pregnant on their own or if they are a same-sex couple. While you might worry about how this process will affect you and if it will be painful, our team is here to guide you through each step. 

Infertility is more common than you might think. About one in six couples globally experience infertility each year. IVF is one of the options couples may choose to conceive.

The IVF Process and What to Expect During Each Stage

IVF is a complicated process that involves extracting an egg from a woman's ovaries and combining it with sperm in a laboratory. These are the steps that you will want to prepare for during IVF:

Ovarian Stimulation

woman talking to doctor about ivf process and what pain to expect

The first phase of IVF is ovarian stimulation. During this process, you will give yourself an injectable medication that contains a follicle-stimulating hormone (FSH), a luteinizing hormone (LH), or a combination of FSH and LH. Synthetic hormones encourage the ovaries to produce multiple eggs, which are gathered during the egg retrieval process.

Ovarian stimulation can cause bloating as your ovaries grow follicles from the stimulating medication. Some women experience a weight gain of five to six pounds during this phase, which can be lost after egg retrieval. Women may experience heightened emotions due to the injection of hormones during ovarian stimulation.

Egg Retrieval

Once you have stimulated your ovaries, the next step is to retrieve your eggs. This procedure requires sedation to ensure you experience no discomfort while the eggs are retrieved.

After your eggs are retrieved, you may experience cramps, pressure, or a sensation of fullness. These are all normal symptoms. You should notify your provider if you experience excessive pain, are unable to eat or drink, or have any fevers after the egg retrieval process. 

Sperm Collection

Sperm collection is when your partner provides a semen sample. The retrieval is coordinated with the timing of egg retrieval. Some couples may choose to use donor sperm. 

Collecting sperm involves your partner, or donor, ejaculating into a sample cup using masturbation. However, if a fertility specialist has identified that your partner does not contain sperm in his ejaculate, he may need to have his sperm retrieved directly from the testis or epididymis with a needle. The fertility specialist will coordinate a simple sperm retrieval to be collected some time before the egg retrieval. 

Fertilization 

Fertilization of the eggs and sperm retrieved occurs in the lab. The eggs retrieved are screened for quality once they've matured. Either a single sperm is injected directly into an egg, or a small drop of concentrated sperm is mixed with each egg. Some couples may choose to freeze eggs before fertilization to use in the future.

Embryo Transfer

After fertilization occurs, embryos will develop in five to six days. When the embryos have developed, a fertility specialist will transfer one embryo to the uterus.

The embryo transfer is usually painless, but some women may feel discomfort. This is typically less discomfort than having a pelvic exam. Sedatives are generally not needed due to the minimal discomfort.

Tips for Managing Discomfort During IVF Stages

While the side effects of IVF are minimal, women undergoing IVF can take measures during each step to maximize their comfort. Certain over-the-counter (OTC) medications are considered safe for use during IVF. Discuss this with your fertility specialist, as some medicines may interfere with fertility drugs or cause hormonal imbalances. You should avoid the following medications while undergoing IVF:

•      Non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen)

•      Antidepressants and anti-anxiety medications

•      Steroids

•      Anti-seizure medications

•      Thyroid medications

•      Chemotherapy drugs

•      Skin products that contain estrogen and progesterone

Managing Injections During Ovarian Stimulation

woman managing pain during IVF injections

If you fear needles, you can take measures to overcome this when giving yourself hormone injections for ovarian stimulation. When you inject, you can use breathing techniques and keep yourself hydrated to avoid fainting. You may also want to consider talking with your fertility specialist to determine if a local pain patch would be appropriate when giving yourself the injections.

For hormone injections, there are ways to reduce discomfort. Before giving yourself the injection, allow it to come to room temperature. Ensure you use a new needle with each injection and never reuse a needle. After you've given yourself the injection, apply a cold compress or ice to the site. If the injections are causing discomfort, talk with your fertility specialist about trying OTC acetaminophen. Rotate your injection sites. 

Pain Management After Egg Retrieval

When your eggs are retrieved, your provider will use anesthesia to minimize discomfort and pain. It is common to experience mild cramping and abdominal pain after the procedure. You can use OTC pain relievers that your fertility specialist approves to ease this pain. You can soak in a warm bath, place a warm compress over your abdomen, use deep breathing or other relaxation techniques, and ensure you get enough fluids. If you have severe pain or fevers, or cannot eat or drink after the procedure, notify your provider immediately. 

Embryo Implantation Expectations

Many women experience no pain during embryo implantation, while others experience mild cramping. If you experience mild cramping, you can try warm compresses to the abdomen, OTC medication approved by your fertility specialist, take a warm shower or bath, or practice relaxation techniques.

You can take action to improve the likelihood of a successful IVF cycle. These actions can help manage any discomforts associated with the IVF process, which include: 

•      Eat a healthy diet and stay hydrated

•      Take a prenatal vitamin with folic acid

•      Avoid chemical exposure from everyday sources

•      Take time to relax on transfer day and immediately after

•      Don’t use a hot tub

•      Keep taking your medications

•      Abstain from intercourse until approved by your doctor

•      Pay attention to what your body is telling you

•      Use stress-reduction techniques to make the wait easier

Remember not to rush taking a pregnancy test. Pregnancy tests measure the levels of pregnancy hormones in your urine. These hormones take time to build up to show on a pregnancy test. Taking a test too early could result in false results and disappointment.

Lean on your Support Team for a Comforting IVF Experience

We understand that fertility treatment can be an emotional process, making it crucial to maintain your mental health during treatment. Don't hesitate to connect with your fertility specialist or support team with questions or concerns regarding your IVF experience. 

You can take measures to keep your mental health balanced by doing the following:

•      Consider infertility counseling

•      Participate in relaxation techniques like guided imagery or yoga

•      Practice restorative breathing

•      Make sure you get plenty of sleep 

•      Take a warm shower or bath to relax

Focus on the Goal: Building Your Family

While undergoing IVF treatments may be stressful or cause discomfort, you can manage these to ensure a successful IVF cycle. IVF can help you build your family. Talk with one of our specialists today to discuss if IVF is right for you.

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