When a couple has been trying to get pregnant for a long time and it does not come, they should consider what their reproductive options are depending on the causes that are causing infertility.
The simplest strategy for getting pregnant when there are no serious infertility problems is timed intercourse, i.e., having sex on a woman's fertile days.
However, the effectiveness of this method is not much higher than that of sexual intercourse and, therefore, many couples doubt whether it is really worth a try or whether it is better to go directly to artificial insemination (AI).
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Which assisted reproduction technique is best?
In a situation of infertility, the first step is to go to an assisted reproduction clinic to make a fertility study in both members of the couple.
Depending on the results obtained, the specialist will inform which is the most appropriate way to become parents, since the natural way has not worked.
There are several fertility treatments available to achieve pregnancy, although in general, there is no one technique that is better than another. It all depends on the conditions of each couple.
At first, if all fertility tests are successful, the couple will start with low complexity or non-invasive techniques, looking for the closest approach to natural pregnancy.
The most common assisted reproduction techniques, from less to more complex, are the following: programmed intercourse, artificial insemination and in vitro fertilization (IVF).
IVF is considered a more invasive technique, since it is necessary to perform a small surgical intervention to obtain the eggs.
Timed intercourse
Programmed intercourse or directed intercourse consists of controlling the woman's ovulation, naturally or with hormonal medication, in order to have unprotected sex on fertile days, when pregnancy is most likely to occur.
It is indicated in very young couples, no more than 30 years old, and with a good reproductive prognosis, that is, who do not present any serious alteration in their fertility and who have not been trying for a long time.
Depending on whether or not hormonal medication is used, there are the following types of timed intercourse:
- Natural directed intercourse
- no medication is used and no medical supervision is required. You simply check your fertile days using ovulation tests and have sex on those days.
- Directed intercourse with ovulation induction
- an ovulation-inducing drug is prescribed to control the exact moment when the egg leaves the ovary and to promote sexual intercourse with ejaculation at that moment. It requires ultrasound monitoring by the specialist to determine the most appropriate time to induce ovulation with drugs containing the hormone LH or hCG.
- Directed intercourse with stimulation
- the patient receives a low dose of ovarian stimulation to better control follicular development and ovulation. This increases the probability of pregnancy. It also requires the supervision of a medical specialist.
The choice of one type of directed intercourse or another will depend on each patient's situation and needs. Pharmacological treatment may be basic or even unnecessary, so that programmed sexual intercourse is the least complex reproductive treatment.
Advantages
Because timed intercourse uses the woman's natural cycle to try to achieve pregnancy, it is the simplest and least invasive reproductive strategy. Among its advantages, we can name the following:
- It is the technique most similar to natural conception.
- It is the most economical fertility treatment.
- It increases the probability of pregnancy in young couples and when the woman has alterations in her ovulation.
- Ovulation control is very simple and the technique itself is less stressful for couples than other treatments.
If you need more detailed information about timed intercourse, you can visit the following article: What is timed intercourse?
Disadvantages
The main disadvantage of timed intercourse is its low success rate. The probability of achieving pregnancy through timed intercourse is around 10%.
In addition, it is only indicated for couples with very mild infertility or without apparent cause, so it is a technique of limited use.
Specialists recommend scheduled intercourse after 6 months of trying to get pregnant. However, after 3 or 4 unsuccessful cycles, it will be necessary to resort to other techniques such as AI.
Artificial insemination
Artificial insemination consists of performing a mild ovarian stimulation in the woman to induce the development of one or two follicles in the ovaries. Then, using an insemination cannula, a capacitated semen sample is deposited inside your uterus.
The capacitated semen is the one that has undergone a washing process to eliminate the seminal plasma and dead cells and, in this way, to keep the best spermatozoa.
This technique is indicated for women under 35 years of age, with little time of sterility and permeable fallopian tubes. As for the male, his seminal quality must be good, as the sperm must be able to reach the egg and fertilize it.
Advantages
AI is also considered a low complexity technique. Although sperm are artificially introduced into the uterus, the process of fertilization occurs naturally. The fastest sperm is the one that reaches the egg first and can get inside it.
Other advantages are the following:
- It is a comfortable and quick process for the woman. It can be done at the gynecologist's office.
- It is painless for the woman and does not require anesthesia. The side effects of the medication are also few.
- Sperm quality is improved thanks to sperm capacitation.
- Success rates are higher than with timed intercourse.
- It is still a low cost technique compared to IVF.
- It allows single women or lesbian couples to become mothers through sperm donation.
For more information about this fertility treatment, we recommend you to continue reading here: What Is Artificial Insemination (AI)? - Process, Cost & Types.
Disadvantages
As with timed intercourse, artificial insemination also has some drawbacks. They are listed below:
- It has some requirements, such as seminal quality and tubal functionality.
- It is necessary to give the woman hormonal medication for stimulation, which can lead to some uncomfortable symptoms.
- The woman should visit the clinic regularly for check-ups.
- It has a higher risk of multiple pregnancy than timed intercourse.
- The success rate, although higher than that of timed intercourse, is significantly lower than that of IVF.
If, after a maximum of four inseminations, pregnancy is not achieved, there are other more complex techniques, such as IVF, which offer better results.
Did you know that we can help you to choose a fertility clinic for your IUI cycle? All you have to do is get your Fertility Report now. It is an easy-to-use tool that is capable of filtering the best clinics and tailor an individual report exclusively for you with useful tips that will help you make a well informed decision.
FAQs from users
When is it better to perform intrauterine insemination instead of timed intercourse?
Jana Bechthold, gynaecologist at the Tambre clinic in Madrid, answers us in this video:
A timed intercourse has less success rates than an IUI, an intrauterine insemination. So couples that did, for example, three attempts of timed intercourse without success, in this cupboard is recommended to do an IUI. Also factors like problems with the ovulation or mild male factors. In this cases it's better to do directly an IUI
Is ovulation induction and time intercourse the same?
No, ovulation induction is the process by which the growth of 1 or several follicles of the ovary is produced thanks to the administration of drugs called Gonadotropins. After this, ovulation is usually triggered in a controlled manner.
Once this ovulation induction has been performed, intercourse can be programmed, that is to say, the couple can be told when ovulation will occur approximately and when they should have sexual intercourse to increase the chances of pregnancy.
What is the price difference between timed intercourse and artificial insemination?
Both techniques are simple and low cost. However, the price of artificial insemination is higher, as it includes more ovarian stimulation, sperm capacitation and more medical intervention.
The price of the programmed coitus will vary depending on the medication administered and the necessary ultrasound and analytical controls. Medication costs between 40 and 200 euros, ultrasound scans are around 60 euros and blood tests are around 20 euros.
In the case of natural directed intercourse, the cost is zero, as it simply consists of controlling the moment of ovulation. The cost of artificial insemination is between 500 and 1.200€, although you can check the details here: Artificial insemination.
Which technique has more risks, programmed intercourse or artificial insemination?
Both techniques are very simple, so they do not usually lead to complications or serious side effects, especially timed intercourse. The greatest risk of both is multiple pregnancy if ovarian stimulation is performed, as it is common for more than one follicle to develop in the ovaries. For more information on this, you can read on here: Risks and consequences of AI.
Does timed intercourse or artificial insemination have better results?
In general, artificial insemination (AI) has better success rates than directed intercourse. Specifically, AI has a 13-25% chance of pregnancy when conjugal sperm is used and 18-29% in cases where a sperm donor is used.
In contrast, the success rate of directed intercourse is less than 10%. However, the most important thing is to personalize each situation and propose the best reproductive option for each type of patient.
Suggested for you
You can also learn about the differences between artificial insemination and in vitro fertilization in the article below: What Is the Difference Between IUI and IVF?
If you are interested in knowing all the assisted reproduction techniques and fertility treatments in which it is used, we recommend you to continue reading here: What Are Infertility Treatments? - Definition, Types & Costs.
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References
Abu Hashim H, Ombar O, Abd Elaal I. Intrauterine insemination versus timed intercourse with clomiphene citrate in polycystic ovary syndrome: a randomized controlled trial.Acta Obstet Gynecol Scand. 2021 Jun 23. doi: 10.1111/aogs.14193 (View)
Linda Rossman, Stephanie Solis, Lindsey Ouellette, Christian Kolacki, Jeffrey S Jones. Colposcopic genital findings in female sexual assault victims: Relationship to prior sexual intercourse experience. Am J Emerg Med. 2021 Jul;45:664-665. doi: 10.1016/j.ajem.2020.10.059. Epub 2020 Nov 2.(View)
So Hyun Ahn, Inha Lee, SiHyun Cho, Hye In Kim, Hye Won Baek, Jae Hoon Lee, Yun Jeong Park, Heeyon Kim, Bo Hyon Yun, Seok Kyo Seo, Joo Hyun Park, Young Sik Choi, Byung Seok Lee. Predictive Factors of Conception and the Cumulative Pregnancy Rate in Subfertile Couples Undergoing Timed Intercourse With Ultrasound. Front Endocrinol (Lausanne). 2021 Apr 15;12:650883. doi: 10.3389/fendo.2021.650883 (View)
S van Wessel, T Hamerlynck, V Schutyser, C Tomassetti, C Wyns, M Nisolle, J Verguts, R Colman, S Weyers, J Bosteels. Anti-adhesion Gel versus No gel following Operative Hysteroscopy prior to Subsequent fertility Treatment or timed InterCourse (AGNOHSTIC), a randomised controlled trial: protocol. Hum Reprod Open. 2021 Feb 16;2021(1):hoab001. doi: 10.1093/hropen/hoab001 (View)
FAQs from users: 'When is it better to perform intrauterine insemination instead of timed intercourse?', 'Is ovulation induction and time intercourse the same?', 'What is the price difference between timed intercourse and artificial insemination?', 'Which technique has more risks, programmed intercourse or artificial insemination?' and 'Does timed intercourse or artificial insemination have better results?'.
