Author Name: Dr. Nitisha Lath Mentor Name: Dr. Reema Sircar on April 08, 2020

If a couple is trying for pregnancy and cannot conceive in one year, they should seek consultation. One major question faced by all of these couples is- when and how they should proceed for their treatment and which treatment option is best for them.

The infertility specialist will do some tests and then advise on treatment options available and which treatment option is best suited.

Broadly there are two Assisted Reproductive techniques to help infertile couples – IUI (Intrauterine insemination) and IVF (In Vitro Fertilization).
There are major differences between IUI and IVF treatment. Comparing both options can help you determine which approach might be best.

WHAT IS IUI?

IUI, also known as “artificial insemination,” is a procedure that involves placing washed healthy sperms directly into the uterus using a thin catheter. The higher concentration of healthy sperm has to “swim” less to get closer to the egg for fertilisation thus increasing the chance of conception marginally by around 12-15%.

The IUI process is often done in conjunction with taking fertility medications in the form of tablets or hormonal injections which are prescribed to the woman from second day of her periods and help in the process of ovulation. The whole process is monitored by transvaginal ultrasounds for seeing the growth of the eggs, and when they “mature”, a trigger injection is given to induce ovulation which is expected to occur around 36 hours of trigger. IUI is thus scheduled to coincide with ovulation.

On the day of IUI, husband gives semen sample which is washed off the impurities and the processed semen sample with concentrated, healthy and motile sperms is injected into the uterus with the help of thin catheter.

Who should undergo IUI?

For IUI, female must have good fertility potential i.e egg forming capacity, fallopian tubes must be open and sperm count must be normal or just borderline. IUI is best suited for female who are young less than 35 years, with less than 5 years married life, with mild male factor infertility or unexplained infertility or mild endometriosis. Even those couples with male sexual dysfunction or with husband living outside may attempt Intrauterine Insemination.

IUI is less expensive, less invasive and closer to the natural process but the success rate i.e the chance of conception is low just 10 to 15% per cycle of IUI. This is because there can be problems at multiple levels which can’t be investigated or bypassed by IUI process. Sperms are only injected into the uterus directly instead of the vagina (as in the natural coitus); but the sperm has to swim up on its own to the fallopian tube, meet with the egg, should have the capacity to fertilize and then the embryo formed has to travel along the fallopian tube and come into the uterus and has to implant into the uterus lining on its own. Chances of failure IUI may be due to multiple reasons -that is weak or abnormal sperms, with low motility on low potential to fertilize, poor quality of egg, tubal function may not be proper or endometrial receptivity problem.

What is IVF?

Now talking about the IVF or ‘test tube baby’ as it is commonly known as -is one of the greatest advancements in the field of infertility. Patient’s Eggs and partner’s sperms are fertilized in lab and the formed embryo is transferred into the uterus. It is a boon for the childless couples and gives hope and joy of parenthood to them. Medical field has advanced so much that even those women who don’t have their own eggs (menopausal ladies or with premature ovarian failure) or those men with absent sperms ie azoospermia can expect a baby.

What we do in IVF?

In IVF, female partner is given daily hormonal injections and multiple eggs in her ovaries are allowed to grow. This is monitored by transvaginal sonography. When the eggs “mature” they are retrieved vaginally through a long thin needle under short anaesthesia. There is no cut or stitch given. On the day of egg retrieval, husband gives semen sample and eggs and sperms are incubated together to allow the process of in vitro fertilisation or IVF. Alternatively, each egg can be injected with one healthy sperm by the embryologist. This process is called ICSI or intra cytoplasmic sperm injection. It is more useful in cases of few or unhealthy sperms. Embryos thus formed in lab are cultured for 5 to 6 days. Aim is to take them till a more robust stage called blastocyst. At this time, blastocysts are freezed and patient is allowed to menstruate. The couple is again called next month for transferring these embryos.

Who should undergo IVF?

Couples in which female partner has advanced age (more than 35 years with biological clock ticking), history of previous failed IUIs, tubal blockage, no or very less sperm count, poor ovarian reserve i.e. poor egg capacity, with advanced endometriosis or advanced PCOS, couples with prolonged married life and even those with unexplained infertility with more than 2 years married life and those who require genetic test-PGT to select healthy genetically normal embryo in patients with known family history of genetic disorders IVF success varies from clinic to clinic.

So choosing a centre with a good success rate of IVF is critical step. The success rate has drastically improved nowadays with an average of 70-75% per cycle of IVF in a good clinic.
IVF is an advanced and skilled procedure and its cost is much more than IUI.

So how to choose between IUI and IVF and which is the best treatment?

This decision should best be left to the treating doctor. Choosing between IUI and IVF is very much individualized and depends upon number of factors- female partners age, duration of married life, fertility potential of the female partner, blocked or open Fallopian tubes, husband semen report, previous treatment history, affordability of the couple and the psychological aspect of infertility.

After reviewing all the history, examining the couple and running the tests (blood samples, sonography and semen test), the treating fertility specialist decides the treatment plan. Under expertise and guidance of your infertility specialist, opt for the treatment that is best suited to you and enjoy your treatment journey.

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