What is the difference between IVF and IUI?
IUI (Intra Uterine Insemination) and IVF (In Vitro Fertilization) are the two most common infertility treatments in Australia and the world. However, these are two very different techniques.
This article intends to take a closer look at both these techniques and understand the differences and similarities between them. We hope that the following in-depth analysis might help you in your journey to motherhood.
Intra Uterine Insemination (IUI)
During this infertility treatment, a concentrated amount of healthy, motile sperm is injected directly into a woman’s uterus. Often, medications are used to stimulate ovulation by stimulating the ovarian reserves before performing this procedure. Common medications used in IUI include Clomid, Gonadotropin, and Letrozole. All these medications stimulate the ovarian reserve to release an egg for the best possible chance of conception.
The chance of conception for women older than 38 years old, without any help of medications, is quite small, standing at 1-5%. With the help of drugs that stimulate ovarian reserves, the chances can be significantly improved. For example, The chances of pregnancy with IUI using Clomid or Letrozole is 4-9%, and with Gonadotropin is about 8-10%.
Due to the nature of the treatment itself, IUI is not indicated in all women, especially in tome who have a diminished ovarian reserve. The treatment is also not indicated if the woman has two blocked fallopian tubes or if the male partner has an extreme case of male factor infertility. The effectiveness of IUI falls significantly after the first three cycles, and an IVF might be needed to get pregnant at this stage.
The time factor in IUI is also crucial. It takes longer to get pregnant using IUI compared to IVF. There is also a higher chance of multiples and miscarriages using IUI. That said, the one thing that is advantageous about IUI is that it is much cheaper and much less invasive than IVF.
The IUI Procedure
An IUI cycle, like most fertility therapies, starts on the first day of your period. Your doctor will then use bloodwork and ultrasound to check your menstrual period for 12–14 days and ensure that an egg matures correctly for ovulation. When a mature egg breaks away from the ovary and continues its path down the fallopian tubes, where it will be fertilized in the hopes of becoming pregnant, this is known as ovulation.
This surveillance leads up to the cycle’s climax—the final IUI, done either on the day of ovulation or a day following ovulation. A male partner or sperm donor must have a semen sample ready as the first step in the IUI procedure.
The sample is “washed,” which refers to the method of isolating stable and healthy sperm from the rest of the seminal fluid to maximize the likelihood of fertilization. Finally, a thin catheter is implanted into the uterus, and fertilization is allowed to occur as it does in a normal cycle—the sperm swim into the egg, hopefully finding and penetrating it.
Only a few IUI processes are performed without the use of medications. This could be suitable for people who don’t have any fertility problems and are using donor sperm, as well as couples who don’t have any ovulation issues. An IUI procedure that does not use medications requires less supervision but may be less reliable.
Your doctor can prescribe an IUI cycle, which uses medicine to induce ovulation, depending on your condition. This procedure is often used for women who are having trouble ovulating independently (possibly due to PCOS) or who want to maximize their odds of being pregnant in a single cycle.
In-Vitro Fertilization (IVF)
IVF is a five-step procedure that is much more invasive and complex compared to IUI. The steps in the IVF procedure include:
- Diagnostic testing that is done before the IVF cycle
- Ovaries are stimulated to induce ovulation
- Eggs are removed from each ovary
- The eggs are then allowed to be fertilized by sperm fertilized outside the body.
- The formed embryo is then transferred into the uterus for implantation.
IVF can be a very effective technique to overcome infertility, but the success and effectiveness of the method depend on the cause of infertility and the woman’s age. Younger women have higher chances of conceiving using IVF compared to older women. Women who start IVF sooner, not waiting for more IUI cycles, tend to get pregnant quicker. IVF has lower rates of multiples and even lower rates of miscarriages. Multiple embryos are formed using a typical IVF cycle that can be frozen to be used later as well.
Many women don’t want to undergo IVF owing to its invasive nature. Furthermore, a cycle of IVF typically requires many medications compared to IUI. IVF also involves using a surgical procedure, albeit minor, to retrieve the eggs from the ovaries.
Cost is yet another factor not in favour of IVF. A single IVF cycle will cost up to $10,000, not involving ovulation induction (the use of oral or injectable medications to induce normal ovulation) or IVF-related treatment. Medicare in Australia can help reduce the cost, it is best to speak to them directly before starting your IVF process.
The IVF process
Since IVF works well when physicians will try fertilization on a large number of eggs, a female patient is usually put on a series of injectable ovary-stimulating drugs to encourage her body to develop multiple eggs in a single cycle. These meds are administered for 8–12 days, and the patient is checked with ultrasounds and blood tests.
Once the female is ready to donate eggs, a minor surgical procedure is done to retrieve the eggs from each ovary. The male partner then donates the sperm, and the fertilization is done outside the body in a lab. An embryologist closely monitors the embryogenesis for five days. The embryos that survive and healthy can be either transferred to the uterus in hopes of implantation and pregnancy or can be frozen to be used for a later attempt.
IVF with ICSI
One of the many reasons for the higher success rate of IVF procedures than IUI, especially with males with severe male factor infertility, is ICSI. It stands for Intracytoplasmic sperm injection. In this procedure, a single sperm is injected directly into one egg, contrasting to letting the eggs and sperm mix and figure out the whole fertilization process. ICSI is a great alternative for couples in which the male partner has a very low sperm count or his sperm with an atypical shape making them incapable of penetrating an egg.
IVF with genetic testing
Yet another benefit of IVF technology is the possibility of genetic testing of the embryo. The procedure allows the couple to test the source for genetic health and screen any abnormalities before the embryo is implanted. Such a process is not available for IUI procedures.
IUI Vs. IVF success rates
Although an IVF cycle is significantly more expensive than an IUI cycle, the extra cost might be of great worth for some couples. IVF has substantially higher success rates compared to IUI. The chance of success of IVF is significantly higher in older females compared to IUI.
For example, if you are below the age of 35, the success rate of IUI and IVF are 13% and 54 %, respectively. For females between 38-40 years of age, the success rate with IVF is 26% compared to 7% with IUI.
Hence, if you are young and don’t have any significant ovulation problem or your partner has no sperm count and motility issues, you can start with IUI and save some money. But if a couple of IUI cycles do not yield results, it is wise to shift to IVF as you can save a lot of money; in the long run, this way and the success rate is also high.
IUI Vs. IVF Side effects and risks
The side effects, if any, of both IUI and IVF procedures are not because of the procedures themselves but because of the medications prescribes to stimulate ovaries. If you go for the IUI without a prescription, the side effects are practically non-existent. The risk of an infection by an IUI procedure is 1 in 10,000.
Even with the medications, the side effects are generally quite mild. Some common side effects of Clomid and Letrozole include-
- Hot Flashes (Experienced by about 10% women)
- Breast tenderness
- Mood swings
- Headaches, and
- Weight changes
We hope that this article helped you to understand the differences between IUI and IVF. Both methods are successful and can help people having fertility issues. The choice between them is, however, a personal preference and any specific situation. You can talk to your fertility experts before deciding whether to go for IUI or IVF.