IUI vs IVF. What Don’t You Know Yet About These Procedures?

Infertility always disrupts your reality. It involves you in a new world. The world of the deepest frustrations and inspiring moments. The world where scientific touch and pharmaceutical chemistry really does wonders. The world where you have not just some envisioned dreams, but gorgeous miracles which happen in your life.

If you had an appointment with your Reproductive Endocrinologist and have already discussed the Treatment Options that is awesome. If your doctor told you that you may choose both IUI and IVF that is perfect. Thinking what should you choose? Wondering why should you prefer one option to the other? Let’s have an ‘inside look’ to the world of IVF and IUI and compare these Treatment Options.

1. Both Treatment Options won’t be started until Infetility Testing is done.

The first appointments with the Reproductive Endocrinologist will be unbelievably overwhelming. They could be inspiring, supportive and even thrilling. So many wonderful options and now you have your choice. Surely, there are so many various Treatment Options and Treatment Protocols. Some of them are even flexible which makes everything else so easy. You will need to discuss and consult everything with your doctor, including the medications you need and listed further testing to undergo.

But there is still one but. Any Infertility Treatment Option starts with Testing and Screening. 

Doctors don’t always tell you that Infertility Testing is a long, emotional, exhaustive, and sometimes a physically painful process. They probably won't tell you how many tests you're going to take in total. They disclose this information step–by–step. A ‘little’ surprise from the medical team especially done for you. Special Gift ‘From heart to heart’. Everything for you starts from your menstrual history, a blood progesterone level test, your basal body temperature charting, and external ultrasound.

After that, there are ovulation predictor kits. Then, they start to investigate the Abnormalities of your Uterus and Fallopian Tubes: Hysterosalpingogram, Sonohysterogram, Hysteroscopy (HSC). And then, they perform the Post–Coital Test or Tests (if they need two or more results) to ‘glance’ if there is Cervical Factor Abnormal Sperm/Mucus Interaction.

Invasive testing is also included in some Fertility Treatment packages. Surgery is the ‘special present’, included to these ‘testing bundles’. They may need to investigate the Evaluation of the Pelvic Structures, and here the surgical intervention has its place, it is called ‘Laparoscopy’, ‘Hysteroscopy’, and other invasive testing and screening which brings many pain and sufferings. They may perform even biopsies if they are not sure in the diagnosis. But invasive testing is for extreme cases only.

Infertility Testing includes not only Female Factor Infertility. It is an all–inclusive ‘thing’. Your husband will be also involved in the testing for Male Factor Infertility. Everything starts with his medical history and Male Fertility Physical Exam. After that some blood work for evaluating the hormone levels and Semen Analysis [Sperm Test]. Yes, his tiny ‘dudes’ will be also accurately investigated.

After that Testicular Mapping takes place. Then the doctor may perform the Testicular Biopsy. Genetic Tests may be also performed to evaluate whether the sperm chromosome abnormalities cause infertility. Anti–Sperm Antibody Tests may be performed to evaluate whether his body produces antibodies that bind sperm, affecting its motility and/or viability.

2. What are IUI and IVF? Non–invasive Treatment Option vs invasive Treatment Option

What is Intrauterine Insemination (IUI)? 

Intrauterine Insemination (IUI) is the non–invasive procedure where sperm are washed (to remove dead sperm and proteins), concentrated (to increase the volume of the viable sperm), and injected in a woman’s uterus via catheter (a very small tube that is passed up the cervix and into the uterus) around the most optimal time of ovulation. This option is used to bring the sperm very close to the released oocyte. 

The fertilization [embryo ‘CREATION’] occurs in your body naturally. And your tiny gorgeous embryo–lady or tiny handsome embryo–dude (as the gender of the embryo–baby was determined by the spermatozoon’s gender chromosome, spends five days traveling through the fallopian tubes and arrives into the uterine cavity at the blastocyst stage. Here the blastocyst invasion scene stars!

Fallopian tubes are complex organ where fertilization occurs after inverse transfer of spermatozoa and oocyte. After the ovulation [after the release of a mature oocyte from the follicle], an oocyte is picked up by the fallopian tube and waits there for the sperm. Since the IUI procedure deposits higher concentrations of perfect to good quality sperm close to where the oocyte is waiting, the chances that the oocyte and sperm will find one another, and fertilization will occur [the spermatozoon will penetrate the oocyte, and it will result into the tiny embryo], are increased.

Another method of introducing sperm is Fallopian tube Sperm Perfusion (FSP). Fallopian tube sperm perfusion ensures the presence of higher sperm densities in the fallopian tubes at the time of ovulation than does standard IUI. These Treatments are often used in combination with Ovarian Hyperstimulation.

What is In Vitro Fertilization (IVF)? 

In Vitro Fertilization (IVF) is a multistage invasive Fertility Treatment that is designed for those cases when non–invasive Treatments fail. It involves four main stages: 

1. the woman takes oral and injectable medications to stimulate the ovaries to produce follicles which are the fluid filled cysts in the ovaries that contain the oocytes; 
2. the removal of oocytes from the woman’s ovaries by an ultrasound guided procedure performed under anesthesia (invasive surgery); 
3. the placement of the oocytes and sperm together in the laboratory to allow fertilization to occur or ICSI method is used for fertilization, and; 
4. the transfer of embryos (fertilized oocytes) into the woman’s uterus.

I. Ovarian Stimulation and shots.

Shots. You will do a medical training session with the nurse. Because you are essentially going to be a nurse by the end of this cycle. It is a joke. Because you will make yourself tummy shots. You’re going to feel your ovaries throughout this process and feel Cramping. After every cycle using injectables, you may have cyst in your ovaries. And finally, once your follicles are mature, you will do a trigger shot that contains HCG, which basically just forces your body to release the eggs and ovulate.

II. Oocyte [Egg] Retrieval is an invasive procedure

To make the perfect tiny embryo or embryos outside your body, the doctors need to collect your oocytes and your husband’s sperm. Speaking about you, one or two days after your trigger shot, you will go to the clinic for your Egg Retrieval. It is a surgery. And it is done under anesthesia. The nurse will inject an anesthetic medication into your IV, and you get the lovely falling feeling. They give you pain medications first. But you will feel the the needle going into your ovaries. They will remove your oocytes from your ovaries using a needle and the ultrasound. Despite it won’t last long, it might hurt a bit. After the procedure, you can relax.

III. Fertilization [EMBRYO ‘CREATION’] happens in the laboratory

Your tiny embryos will be ‘designed’ for you in the laboratory. The Embryologist will take all the MATURE oocytes [eggs] retrieved and toss them in a Petri dish with your husband’s sperm and let them do their thing. Another option is called Intracytoplasmic Sperm Injection (ICSI), where the Embryologists manually fertilize the eggs with the sperm individually, but it is for extreme cases only. You will know the next morning how many of your eggs have been fertilized correctly.

IV. The embryo appears inside your uterus via the catheter 

Your embryo is taken out of the Petri–dish and waits for a ‘BIG TRANSFER’. If it is the time to replace this small embryo–bundle from the tube inside your uterus, it is placed inside a flexible catheter. The procedure of Embryo Transfer takes only several minutes. It takes all of three minutes to insert a weird kind of catheter, get it to where it needs to be, accurately place your little embryo inside your uterus, and that is all. Yes, and it has to ‘LEARN’ so many things inside. Where am I? What has happened? Everything is pulsating around me… Should I curl up here or there? Oh, it is better on the left side? I am scared. I should have some sleep here.

3. When should you try IUI first? 

Your ‘WAY TO SUCCESS’ with IUI is possible if you are a patient who:

1. has unexplained sub fertility;
2. has a healthy ovarian reserve (which means normal to perfect amount of healthy oocytes);
3. is able to ovulate, perhaps after the oral and injectable medications which stimulate your ovaries;
4. suffers non–tubal sub-fertility, your Fallopian tube status will be evaluated but you must have at least one open Fallopian tube;
5. has a normal uterine cavity;
6. has minimal/mild endometriosis;
7. has cervical issues (Scar tissue from cervical surgery);
8. male sub-fertility (issues with sperm quantity (low sperm count) quality (low motility or mobility)), but the strong, healthy, high volume sperm are concentrated into the sperm samples.

4. When should I try IVF Treatment cycle immediately without considering the other options? 

Your Reproductive Endocrinologist may strongly recommend or even insist on IVF cycle if you are a patient who:

1. has reduced ovarian reserve;
2. whose both Fallopian tubes are blocked;
3. whose one or both Fallopian tubes were surgically removed;
4. is diagnosed with the Polycystic Ovarian Syndrome (PCOS);
5. is diagnosed with advanced endometriosis;
6. has the chromosomal abnormalities and the embryos may require Genetic Screening to investigate those embryos which are healthy;
7. is dealing with severe male–factor infertility which may require the use of advanced technologies such as Intracytoplasmic Sperm Injection (ICSI);
8. has experienced recurrent pregnancy losses.

But if you don’t have the strong recommendations for the IVF Treatment cycle, think carefully before you would start it. Maybe it is better to first try IUI cycle as non–invasive one and if it fails several times, only then to try IVF.