When your timeline to start a family is compromised, alternative options are available to increase your chances of becoming a parent. In-vitro fertilization (IVF) and intrauterine insemination (IUI) are fertility treatments that benefit hopeful parents who need assisted reproductive therapy (ART). These procedures are performed by reproductive endocrinologists, commonly referred to as fertility doctors. The differences in IVF vs IUI vary immensely, and the outcomes are influenced by factors including your age, underlying medical issues, and medication protocol.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI), commonly called artificial insemination, is a process where you are monitored via blood work and ultrasound, and sperm insemination is carefully timed when your hormone levels and follicle sizes are adequate.
A typical IUI cycle involves making an appointment around cycle day 3 of your period and going in for a baseline visit, which entails a pelvic ultrasound to visualize the ovaries and blood work to check hormone levels. After this visit, the fertility doctor may start you on oral medications to stimulate your ovaries. You will go back for routine ultrasounds and blood work (every few days) to see how your ovaries and hormone levels respond to the medication.
Once your follicles are deemed an adequate size (usually around 18-20 mm), and your hormone levels are acceptable, the doctor might give you a trigger injection to stimulate ovulation. The doctor will perform the insemination based on the time of the injection. On the day of the insemination, your partner will provide a semen sample for insemination.
The andrologist in the lab processes the sample to ensure good quality sperm is isolated. The IUI procedure is done in an exam room, and no anesthesia is involved. Most women claim the procedure is painless, with only mild discomfort like a Pap smear. You will then be given dates to return to the office for blood work to check for progesterone levels and pregnancy tests.
The success rate of IUI in a medicated cycle is a 40% chance of pregnancy in 4-6 months, barring there are no problems with your partner’s sperm and no issues with your fallopian tubes. Eighty percent of women who use Clomid have ovulation. The pregnancy rate is 10-15% per ovulatory cycle. Rates are higher for women who were diagnosed with anovulation (irregular cycles without ovulation) vs. unexplained infertility.
In-Vitro Fertilization (IVF)
In-vitro fertilization (IVF) is a medical procedure in which you are given injectable hormone medications that is carefully timed. Like an IUI, the schedule is the same: coming in for a baseline visit (usually around cycle day 3 of your period); however, the significant difference is that you will be put on injectable hormones. In some IUI cycles, you may also take daily hormone injections; however, this is typically not the case. You will then be asked to come in every few days to be monitored via ultrasound to see how the follicles in your ovaries respond. The goal is to make multiple follicles of an adequate size. You will also do blood work at these visits to check your hormone levels. Once your follicles and hormones are adequate in measurement, you will be given an injectable trigger medication to make you ovulate.
Based on the time the trigger medication is taken, you will have a scheduled egg retrieval, which is a medical procedure under anesthesia performed in the operating room. On the day of the egg retrieval, your partner will provide a semen sample, and an embryologist will perform insemination in the lab. One week later, you will know how many viable embryos were created.
Fresh vs. Frozen Embryo Transfer (FET)
A fresh or frozen embryo transfer may take place, depending on the options reviewed with the fertility doctor. This procedure involves taking additional hormones to thicken your uterine lining so an embryo transfer can be performed, which is also timed accordingly.
A typically frozen embryo transfer cycle:
1. Takes about four weeks
2. It is not performed under anesthesia since there is minimal pain and discomfort.
3. On the day of the transfer, the embryo is thawed (if not doing fresh transfer), placed into a catheter, and then transferred into the uterus by the fertility doctor.
Medications in IUI Cycle
Clomid
Clomid (generic clomiphene citrate) is an oral medication typically prescribed at the beginning of an IUI cycle. Clomid works by increasing two reproductive hormones (FSH and LH), which stimulate the ovaries to produce follicle-containing eggs.
Side effects include mood swings and possible visual disturbances (rare), thin lining, and alterations in cervical mucous, which may prevent a natural pregnancy. Due to the side effects, Clomid is more effective with an IUI cycle versus trying to conceive on your own.
Letrozole
Letrozole (brand Femara) is an oral medication more routinely prescribed for patients who have PCOS in an IUI cycle. It does not affect the uterine lining and may not increase estrogen levels. Similar to Clomid, letrozole is given at the beginning of your IUI cycle, typically for five days. Afterwards, the response to the medication is measured via blood work to check hormone levels and ultrasound to check follicle development in the ovaries.
Medications in IVF Cycle
Hormone injections are an integral part of IVF cycles. Part of overcoming the hurdles of hormone injections is understanding how they work and having valuable resources that can provide guidance and support to you throughout your fertility journey.
Hormone injections, also known as gonadotropins, are purified versions of natural hormones involved in the reproductive process. These injections are designed to stimulate the ovaries or testes to produce eggs or sperm, respectively, and improve the chances of conception.
Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) Injections
FSH and LH injections are the most commonly prescribed hormone injections for fertility treatment. They work by directly stimulating the ovaries to produce multiple mature eggs, increasing the chances of successful fertilization. Common brand names for FSH/LH injections are Follistim, Gonal-F, and Menopur.
Human Chorionic Gonadotropin (hCG) Injections
hCG injections are often used in conjunction with FSH injections to trigger ovulation. This hormone mimics the hormone naturally produced by the body after ovulation, preparing the uterus for implantation and supporting early pregnancy. Common brand names for hcG are Pregnyl, Novarel, and Ovidrel.
Ganirelix
Ganirelix is a medication that belongs to a class of drugs known as gonadotropin-releasing hormone (GnRH) antagonists. It is primarily used in fertility treatments to prevent premature ovulation during assisted reproductive techniques such as in vitro fertilization (IVF). Ganirelix works by stopping luteinizing hormone (LH) surges in you undergoing controlled ovarian stimulation for assisted reproductive technologies (ART) like IVF. It is used to help regulate the timing of egg retrieval during IVF to optimize the success of fertility treatments.
Leuprolide
Leuprolide is a medication that belongs to a class of drugs known as gonadotropin-releasing hormone (GnRH) agonists. It is commonly used in fertility treatments to suppress the natural hormone production in the body, allowing for controlled ovarian stimulation. It is also used to suppress the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), enhancing the success of IVF or assisted reproductive techniques.
IVF vs. IUI
The choice between IVF vs IUI is a complex decision that should be based on individual circumstances and preferences. IVF offers a higher success rate and is suitable for couples with severe infertility issues or specific medical conditions.
On the other hand, IUI is a less invasive and more affordable option that can be effective for couples with mild fertility problems. Ultimately, the decision should be made in consultation with a fertility specialist, considering factors such as fertility diagnosis, age, reproductive history, and financial considerations. Each couple's journey is unique, and it is important to consider all options and make an informed choice that aligns with your goals and values.
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