Taking a leap from IUI to IVF

Infertility has always been a curse for couples willing to conceive a child. But the positive phase of this condition has now begun as science now has answers to address such conditions. Infertility is not just a medical and biological condition; it is also subjected to public scrutiny and can be easily deemed as a social stigma. But does labeling it as a social stigma help our case? Not really. There are certain facts that need to be set straight first; firstly infertility is certainly not a disease rather a condition that science has successfully combated; second treating it as a stigma doesn’t help the situation rather it delays and complicates the medical procedures that could genuinely combat this condition.

Let’s try and define infertility beyond the realm of social description of the same. To put it simply in a layman’s term, it refers to the condition in which a couple is unable to conceive or the inability of the woman to cope with a full term pregnancy even after 1 year continuous sexual intercourse without birth control. Infertility in women of age 15 years to 44 years is 8% to 10%. But fortunately most of it is treatable, and couples struggling with infertility can now conceive with the help of some treatment. In many of the cases (on an average 45% to 50% of the cases), the root cause of infertility can be traced back to the man.not for

But what causes infertility in men?

The issue of sperm and semen:

Science defines semen as the white fluid that a man’s penis releases during orgasm. This semen consists of sperm. Sperm is produced in the testicles. Now how does this work to fertilize the egg in the woman? When a man ejaculates, The released semen from the penis helps the sperm transport itself to the egg in the woman for fertilization of the same. This is the normal process of egg fertilization, but what happens when this normal process is hindered? That may cause some problems and possibly cause infertility as well.

Some of the common factors that are probable cause of infertility in men are:

1. Sperm count: One of the most common reason or factor that affects the fertility of a man is the low sperm count. Sperm count which is lower than 15 million is considered low. On an average, one third of the couples tackling the problem of infertility is because of low sperm count.
2. Motility of the sperm: Motility of the sperm refers to the ability of sperm to move/swim. In this condition the inability of the sperm to swim well results in its failure to reach the egg to be fertilized.
3. Quality of sperm: At times the sperm can be abnormal, As in the shape of the sperm can be unusual making it difficult for the sperm to swim efficiently and fertilize the egg.

Even though the shape of the sperm doesn’t sound like a possible hindrance but the shape of the sperm affects the speed of the sperm too. If the shape is unusual then the sperm cannot travel rapidly and accurately thereby sabotaging the conception. According to statistics, almost 2% of men have suboptimal sperm.

But are men born with suboptimal sperm?

There is always the risk of abnormal semen not being able to carry the sperm effectively to the egg.

Some of the causes are:

1. Health issues: Most common reason is testicular infection, cancer or even a surgery.
2. High temperature of the testicles: This condition may result from an undescended testicle, the issue of varicose veins in the scrotum, excess use of hot tubs, wearing tight clothes and working in hot conditions.
3. Ejaculation problems: At times, the ejaculatory ducts are blocked and the semen in this case has a probability of being ejaculated into the bladder.
4. Hormones: Hormonal imbalance is one of the other leading reasons behind infertility both in males and females. In males, hormonal imbalance leads to a testosterone deficiency.
5. Genetic: Genetic abnormalities are not that common but may be a reason behind infertility. For instance, men are supposed to have an X and Y chromosome under normal conditions. But if he is suffering from Klinefelter’s syndrome then he will have two X chromosomes and one Y chromosome. In this condition the testicles develop abnormally and have low testosterone and sperm count.
6. Mumps: Mumps after puberty in certain cases cause a problem in the fertility. As the inflammation of the testicles may affect sperm production.
7. Hypospadias: In this condition, the urethral opening in under the penis. This abnormality can be altered surgically in infancy. If left unattended this may be a problem as with this abnormality it would be hard for the sperm to get deposited in the female’s cervix naturally during intercourse.
8. Cystic fibrosis: This is a chronic disorder and in this case, there is a production of sticky mucus. Even though it mainly affects the lungs, but in males it may cause the absence or obstruction of the vas deferens. Now vas deferens carries the sperm to the ejaculatory duct and the urethra and its absence obviously affects the process of conception.
9. Beside all these above reasons, there can be some more common issues affecting the fertility in males such as: Use of steroids, chemotherapy, Overuse of drugs, age, excessive workout, obesity, and excess consumption of alcohol, mental stress, and even unhealthy diet.

In women, the risk factors affecting the fertility include age, smoking, alcohol consumption, obesity, eating disorders, bad diet, lack of exercise, mental stress and exposure to chemicals & toxins.

Apart from these, there are medical conditions which affect fertility in women and some of such conditions include:

1. Ovulation disorders: ovulation refers to the monthly release of a mature egg. Most of infertility in women is because of the problem with ovulation. It can be because of premature ovarian failure; in this case the ovaries stop working beyond the age of 40. Polycystic ovary is one of the most common problems in women today. In this case the ovulation may or may not occur. Poor egg quality is yet another reason. Damaged eggs cannot sustain pregnancy and this risk is higher in the older women.
2. The problem of fallopian tube: This most likely will prevent the sperm from travelling to the fallopian tubes. And if the sperm cannot travel then it becomes harder to conceive. Problems relating to fallopian tube blockage can be a result of issues like surgery, mostly pelvic surgery; The presence of benign or non-cancerous tumors might occur in the wall of the uterus. This can block the easy passage in the fallopian tube, thereby preventing the fertilization of the egg. Endometriosis is another condition in which the lining of the uterus grows outside the uterus or elsewhere in the body.

What are the treatments for such conditions and problems of infertility?

Among all the options that science has to offer couples mostly opt for IVF (In-vitro fertilization) and IUI (Intrauterine insemination).

IUI v/s IVF:

IUI is a simple process which involves the insertion of sperm sample directly into the uterus through the cervix with the help of catheter at the time of ovulation. But before the insertion the sperm has to be washed and separated to exclude any infection or complexities. This treatment is opted for, when there is a problem of sperm count, decreased sperm motility.

IVF is a medical process in which sperm is placed with unfertilized eggs in a Petri dish and here the fertilisation takes place. And after that the embryo is placed in the uterus to begin the pregnancy. The advantage here is that the embryo can be frozen for future use.

What about the IUI v/s IVF success rate?

IUI is a successful procedure but some complications and unwanted outcomes are involved. With IUI there is a risk of multiple pregnancies. As this procedure involves the administration of medicines to regulate the ovulation hence the possibility of pregnancy of higher-order multiples is considerably high. IUI has considerable amount of risk factors as a lot of the factors are variables and subjected to changes from person to person. But the normal success rate of IUI treatment is somewhere between 8% to 15% for a patient above 35 years and 2% to 5% for patients above 40. Compared to this IVF has a better success rate. But this doesn’t mean we should think of IUI failure. Doctors often advice IUI as the first option and in case of failure they suggest IVF.

IUI v/s IVF cost

One of the most important differences in both these treatments is the financial side. How cost effective are they? There is no doubt that a much simpler procedure like that of IUI is much less expensive and hence highly opted for as compared to IVF. But IVF is significantly more helpful that IUI in such cases. Moreover it is easier to control the repercussions of the procedure.