If you have been trying to conceive for some time and are considering fertility treatment, you may have been told about the options of intrauterine insemination (IUI) and in vitro fertilization (IVF).
In this Q&A, Devora Aharon, MD, reproductive endocrinologist and infertility specialist at RMA of New York, explains the advantages of each approach and how to choose the path that is right for you. RMA of New York is the Division of Reproductive Endocrinology and Infertility for the Department of Obstetrics, Gynecology and Reproductive Science at Mount Sinai Health System.
What is IUI?
Devora Aharon, MD
IUI involves preparing a concentrated sample of sperm that is inserted into the top of the uterus using a soft catheter. This brings the sperm in closer proximity to the egg to fertilize it, bypassing some of the barriers in the vagina and cervix. IUI is timed around ovulation, but for patients who do not ovulate regularly, oral medication may be used to augment your chances of success. In you ovulate monthly, these medications may cause multiple eggs to be released, increasing the chance that at least one egg will be healthy and result in pregnancy.
What is IVF?
IVF involves the use of injection medication for 1½ to 2 weeks to stimulate the ovaries to mature multiple eggs in one cycle. The eggs are extracted through a vaginal egg retrieval procedure under anesthesia and then fertilized with sperm to form embryos. The embryos can be biopsied to test for chromosomal abnormalities or specific genetic conditions before being frozen. In the same or subsequent cycle, the uterus is prepared for embryo implantation using estrogen and progesterone.
What are advantages of IUI vs. IVF?
From a practical perspective, an IUI cycle involves fewer medications and visits for monitoring and does not involve a procedure under anesthesia. However, IVF has a higher chance of success compared to IUI. Moreover, more than one healthy embryo is often created from one IVF cycle. All of these embryos can be tested and frozen for future use when age may present a greater barrier.
What are specific situations in which one might choose IUI vs. IVF?
Depending on your individual diagnosis and personal circumstances, there are important factors to consider when choosing between IUI and IVF to build your family. While the following is not an exhaustive list, below are diagnoses and factors that might lead one to choose IUI or IVF:
- Male factor infertility: If sperm counts are low, IUI can help give sperm a boost and increase chances of pregnancy. If sperm counts are extremely low, IUI is less likely to work and IVF is typically recommended.
- Tubal factor infertility: If the fallopian tubes are blocked or abnormal, IVF is needed to bypass the tubes.
- Polycystic ovary syndrome (PCOS): Many patients with PCOS do not ovulate regularly. Oral medications can induce ovulation, and intercourse or IUI timed around ovulation can be effective in achieving pregnancy. IVF is also effective in patients with PCOS because these patients often have a high ovarian reserve, which can lead to a high response to ovarian stimulation.
- Advanced reproductive age: Pregnancy becomes more difficult to achieve in your late 30s and 40s due to decreases in the quality and quantity of eggs. IVF with preimplantation genetic testing can help identify normal embryos that have a high chance of achieving a healthy pregnancy.
- Using sperm donation, egg donation, or surrogacy: Patients using a sperm donor will often start with IUI, especially if the patient does not have an underlying diagnosis of infertility. However, even in these cases, IVF can increase chances of achieving a healthy pregnancy sooner. Egg donors will undergo ovarian stimulation and egg retrieval, and the eggs will be fertilized with sperm and then transferred to a patient’s uterus or that of a gestational carrier. Patients using a gestational carrier with their own eggs will undergo ovarian stimulation and egg retrieval before the eggs are fertilized with partner or donor sperm, and an embryo will be transferred into the uterus of the gestational carrier.
The choice to undergo IUI or IVF is highly personalized based on individual factors like your age, diagnoses, timeline, and desired family size.