IUI or IVF: The Big Dilemma
IUI or IVF? The big dilemma… Sometimes the decision of which method of assisted reproduction one should try first is very difficult indeed.
When a couple has “entered” the process of “investigating” the different pathways that may help them have a baby, the simple and only truth is one: their individual lab results and diagnostic tests are those that will eventually determine whether the couple should be taken directly to IVF without “losing” precious time or may try, in the first place, the much simpler, easier and quicker method of intrauterine insemination.
At this point I want to make it clear that Intrauterine Insemination (IUI) is a great method of Assisted Reproduction, but it is clearly not a method of In Vitro Fertilisation (IVF / ICSI) as I often hear some couples to call it. During IUI, the fertilization of the mature oocyte(s) (egg) from the “lucky” spermatozoon (a) is happening completely by chance, and has nothing to do with the fertilization as it is performed during an IVF or an ICSI cycle. That means, that even a “good”, under the best of circumstances, insemination has only got a 15-20% chances of success, while a correspondingly “good”, under the best of circumstances, In Vitro Fertilization reaches an average of 35-40% pregnancy rate per cycle in a woman of a “good prognosis” reproductive age (30-35 years).
Blocked / dysfunctional fallopian tubes, severe endometriosis, ovarian failure, a significant degree of male infertility are all “clear” diagnoses that lead directly to IVF or ICSI.
Women of advanced reproductive age, older than 38-40 years old, even if they have a satisfactory hormonal profile for their age, it is suggested to move directly to IVF treatment; even if the sperm, fallopian tubes and the uterus “look” normal. That is because IVF is a more “controlled” procedure, and the couple has, as I already mentioned, more possibilities to succeed.
If all the necessary diagnostic tests come out normal (unexplained infertility) or there is a mild male factor infertility, or there is not a clear diagnosis which requires mandatory IVF / ICSI, then the insemination is an extremely useful tool in the hands of the experienced doctor.
Many couples can try 2 to 4 inseminations before making their first IVF cycle. Several times, what happens is, first, the woman undergoes insemination in a natural cycle, “taking advantage” of the one and only egg her ovaries produce and release during that cycle. If this does not succeed, then she may proceed to another IUI, after a mild ovarian stimulation in order to produce more than one egg, ideally three, in order to avoid the likelihood of multiple pregnancies, that are high risk. If that method again is not successful and does not result in pregnancy (it can be repeated up to four times – from then on the chances of success with this method are considered minimal), then IVF seems to be the only way unless the doctor decides not to proceed to IVF for some reason.
In any case, when things are not very clear of what should be done, it is very important for the couple to discuss with their physician about their choices. In any case, the couple should understand completely the success rates and advantages / disadvantages of each method, but also consider the financial and, perhaps even more importantly, any psychological parameters.
Do not give up, trust your body and try, the best way you can, to be patient. It is the best advice I can give.