When a couple is unable to conceive naturally, they may start considering turning to alternative options to achieve pregnancy.
In the case of straight couples, they are advised to visit a fertility clinic after one year trying to conceive with no luck, or six months if the woman is above 37 years of age. Single mothers by choice or lesbian couples have no choice but to turn to assisted conception if they want to have a child.
Assisted Reproductive Technology (ART) involves a wide range of fertility treatments, so it is only normal that the following doubt crosses most patient's mind when they get started: artificial insemination or in vitro fertilization?
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Choosing your fertility treatment
At first, choosing one or another fertility treatment depends on the specialist, since s/he is the one who best knows the indications of each technique and can take into account the potential risks involved as well as the chances of success. Nevertheless, it is the patient who finally accepts the treatment and decides whether s/he wants to undergo it. In some cases, however, patients prefer to undergo a technique that requires less involvement of the specialist or more risks.
Ideally, patients should trust the specialist and accept his/her criteria, since the aim is to choose that technique that requires as less involvement as possible for real odds of success to be reached.
Differences between insemination and IVF
Artificial insemination is a simpler procedure: it involves the deposition of the semen inside the woman's uterine cavity. Egg fertilization takes place inside the female reproductive system as it occurs in natural conception.
In the case of IVF (in vitro fertilization), however, the eggs are previously retrieved from the woman in order to perform the fertilization in the laboratory and then transfer the embryos obtained. This technique is more complex than intrauterine insemination and requires surgery for follicular puncture, which is done under mild anesthesia.
Medications to induce ovulation and produce a greater number of eggs per cycle are used in both methods. By doing this, we increase the odds of success. Ovarian stimulation varies depending on the technique chosen. In the case of IUI, the dosage of medication is considerably lower that in IVF, since fewer follicles are needed. While for IUI the aim is to get 2 or 3 follicles to get a maximum of two mature eggs, for IVF the goal is to obtain 12 or more without it posing a problem for the patient, as each egg will be retrieved via follicular puncture.
Indications
Indications vary depending on each technique. In the case of intrauterine insemination:
- It is advisable for women under 35-37 years of age.
- Patients should have regular menstrual cycles or with minimal alterations.
- Patients must present tubal patency and no evidence of severe male fertility problems.
- As for the male partner, his semen sample must reach the minimum values, with a Motile Sperm Concentration (MSC) of at least 3 million sperm.
On the other hand, IVF is indicated in cases of more severe fertility problems are detected:
- Ovulating is essential for IVF to be the technique of choice. However, obtaining a response from the ovary is easier in this case, since the dosage of fertility drugs administered is a greater one.
- Having tubal patency is not a prerequisite.
- It is indicated in cases of previous IUI failure.
- Although there must exist a minimum sperm count, it can be carried out even if a mild-to-moderate male infertility issue is detected.
Cost
The cost of a fertility treatment might vary from clinic to clinic. However, whatever the final cost is, there is a significant difference between the cost of artificial insemination and in vitro fertilization.
The cost of artificial insemination may range from €700 to €1,500, whereas in vitro fertilization can reach €3,000 and even €4,000, as it includes surgery, egg fertilization in the laboratory and the subsequent embryo transfer. Given that the entire process requires more involvement of the specialist, it implies a higher overall cost.
Even though fertility medication are not usually included in the overall cost by default, patients are advised to add the cost of medications, as it may vary greatly. For intrauterine insemination, ovulation induction drugs may cost from €200 to €400, while in the case of in vitro fertilization it is around €700-1,000.
Odds of pregnancy
Pregnancy success rates also differ depending on the technique. While in the case of intrauterine insemination they are around 20%, with IVF almost 40% can be reached. It should be noted that these are just approximate figures, which is to say, they depend on the cause of infertility and the woman's age to a great extent.
In general, women under the age of 30 are those with the highest odds of success. With artificial insemination, the woman's age is a key factor and, as a matter of fact, many clinics do not perform IUIs on women older than 37 years of age due to the low chances of getting pregnant they present. In the case of IVF, women under 35 are those with the best prognosis.
To sum up, it should be clear that there is no better treatment than other, yet each one is more adequate than the other depending on the patient. Adapting the treatment as much as possible to the patient is crucial, given that each woman and each individual person has a different personal situation.
FAQs from users
Does artificial insemination involve the same risks as in vitro fertilization?
All fertility treatment cycles involving ovarian stimulating medication have similar risks but the difference is the degree of severity. For cycles using only oral or injectable fertility medications, the risks of an ectopic pregnancy, ovarian hyperstimulation syndrome and ovarian torsion are less than 5% in both IUI and IVF cycles.
The difference between IUI and IVF are the pregnancy success rates and risk of multiple births. In an IUI cycle using oral medication, the risk of a multiple pregnancy is less than 5% but increase to 10-15% when injectable fertility medications are used.
The unique distinction of IVF is the ultrasound guided vaginal egg retrieval and the ability to transfer a predetermined number of embryos. As a result, the risks with an egg retrieval included intra-abdominal bleeding, injury to the bowel and bladder, and infection. Fortunately, all of complications occur in less than 1% of cycles. Further, the risk of a multiple pregnancy is directly related to the number of embryos transferred: a single embryo transfer has a 1% risk of dividing into a twin pregnancy; a double embryo transfer can increase the risk of a twin pregnancy in up to 40% of cycles.
How many IUI cycles should you do before moving on to IVF?
In couples with a good prognosis, that is, under the age of 37, with a normal sperm sample, we recommend 4 IUI attempts before moving on to IVF. In the case of single women or donor insemination cycles, up to 6 attempts are recommended. It depends on the clinical history of each patient, though.
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In our case, based on my problem (PCOS) and that of my hubby (20% sperm DNA fragmentation), doctor told me to give IUI a try but I said ‘no’, we would go straight for an IVF. I was 34 then and my odds of success with IUI were 15%, whilst those of IVF were 40% and the cost difference was not too abysmal… Besides, with IVF you are likely to have spare embryos that can be frozen for second IVF cycle in case the first one doesn’t work. The result was pregnancy!!! My baby is now 1.5 years old 🙂 Besides, IVF is the only way through which one can see whether she’s got high quality eggs or not. I don’t understand why people are advised to undergo IUI in the first place when they’re actually desperate at a psychological level. It’s like wasting their money…