Intro
The journey to parenthood looks different for everyone and may lead some individuals and couples to explore assisted reproductive technologies (ART). The most widely used ART methods include intrauterine insemination (IUI) and in-vitro fertilization (IVF). These methods involve distinct indications and procedures and may offer hope to those facing fertility challenges.
Intrauterine Insemination - What is IUI?
Intrauterine insemination (IUI) is a fertility treatment designed to place sperm directly into the uterus. The goal of this procedure is to increase the number of sperm that reach the Fallopian tubes, which can increase the likelihood of fertilization.
Here’s what an IUI procedure looks like:
An IUI will be carefully timed to coincide with ovulation. In some cases, medications like clomiphene citrate (Clomid) or letrozole (Femara) will be used to enhance ovulation. Before insemination, a sperm sample is collected and undergoes a process called “sperm washing,” which concentrates the sample, removes debris and dead cells and separates only the most active sperm. Once the sperm is prepared, the insemination procedure is relatively quick and easy! This process can be performed in a doctor’s office and does not require anesthesia. During the insemination, a small tube called a catheter is inserted through the cervix, and the sperm is injected directly into the uterus. Some women may have mild cramping following the procedure, but usual activities can be resumed immediately in most cases.
In-Vitro Insemination- What is IVF?
In-vitro fertilization (IVF) is a multi-step fertility treatment whereby eggs are extracted from a woman’s ovaries and fertilized with sperm in the laboratory setting, to create embryos. The embryo can then be transferred directly into the uterus with the hopes of achieving pregnancy.
Here’s what the multi-step IVF procedure looks like:
Stimulation
An IVF cycle typically begins with suppression of the menstrual cycle, to allow the care team to fine-tune the delivery of hormones to the reproductive organs. The next phase of the IVF process is ovarian stimulation. This phase, which typically begins on cycle day 1, involves injectable hormones, like FSH and LH, which will stimulate the ovaries to produce more eggs. While using these medications, it is common to have a few transvaginal ultrasounds to monitor the body’s response. Towards the end of the stimulation phase, a “trigger injection” is given, which will prepare the eggs for the retrieval process.
Retrieval
Once the eggs are mature, they are ready to be retrieved! This is a surgical procedure where eggs are collected from the ovaries via “follicular aspiration.” This procedure involves the insertion of a thin needle through the vaginal wall and into the ovary. Patients are given a general anesthetic, so they are asleep for the duration of the procedure which typically takes about 30 minutes. A fertility specialist will draw up the egg cell from within each large follicle through ultrasound guidance. Ideally, this procedure will result in the retrieval of 8-18 egg cells. Following the procedure, patients will wake up in a recovery room where they will be cared for until they are ready to go home.
Insemination and Fertilization
Following the retrieval process, the eggs are brought to the lab where they are added to a culture dish with sperm cells that have been carefully prepared to optimize fertilization. In some cases, sperm will be injected directly into the egg cell in a process called “intracytoplasmic sperm injection” (ICSI). Following insemination, the eggs are placed in incubators where their progress is monitored to ensure fertilization is successful. At this point, genetic testing may be performed to test for abnormalities in the developing embryo.
Embryo Transfer
The final step of IVF involves the transfer of an embryo into the uterus. During embryo transfer, a catheter is inserted through the cervix to place the embryos directly into the uterus. This is a very quick procedure and requires no anesthesia. After the embryo is transferred, it is secure within the uterus. Normal activity can be resumed!
Comparing IUI VS. IVF
While both IUI and IVF are designed to facilitate pregnancy, they have significant differences. Let’s explore some key aspects to consider when choosing between IUI and IVF.
Why Choose IUI?
There are a variety of reasons individuals or couples might choose IUI. This procedure is often used as a first-line therapy for those with unexplained infertility as the lower cost and complexity make it a suitable initial option. Those who have been diagnosed with cervical problems, like issues with cervical mucus production, may benefit from IUI to bypass the cervix and deliver sperm directly into the uterine cavity. In cases of mild male-factor infertility, including low sperm count or motility, IUI may enhance the likelihood of conception by placing sperm near the eggs. Further, IUI is also an option for those using sperm provided by a sperm donor.
Why Choose IVF?
IVF is used to treat a variety of fertility issues. This treatment may be recommended as a first-line treatment for women over the age of 40, due to the higher success rate when compared to IUI. Tubal damage, closure, or removal due to pelvic inflammation or ectopic pregnancy will necessitate IVF, as the procedure bypasses the Fallopian tubes by transferring the embryo directly into the uterus. Those with severe male factor infertility may require IVF with or without intracytoplasmic sperm injection (ICSI). IVF is an option for those who are interested in fertility preservation before the treatment of cancer or other illnesses requiring medication that may affect the health of the ovaries. Further, preimplantation genetic testing during IVF may be beneficial for those at risk of passing on a genetic disorder to their children.
The Bottom Line
Choosing to utilize IUI or IVF can be a beacon of hope, opening doors to conception that may have otherwise remained closed. The decision to pursue these treatments should include a thoughtful discussion that accounts for fertility goals, pre-existing conditions, age, sperm-and-egg health, and financial resources. For those embarking on this journey, seeking information, support, and guidance is a crucial first step.
