When couples have fertility issues, there are many ART (assisted reproductive technology) treatments to help them with conception. IUI (intrauterine insemination) is the first line of treatment as it is less expensive and less painful. The success of this depends on various factors such as reproductive health, age and underlying medical conditions. But when this is unsuccessful after many attempts, couples have to decide on the IUI to IVF transition. Read to know when to transition based on medical, emotional and financial implications.
Intrauterine insemination IUI is a convenient, simple, cost-effective and efficient fertility treatment for aspiring parents. IUI or artificial insemination is the first step in a fertility treatment where a specialist inserts prepared sperm from a partner or donor directly into a woman’s uterus when ovulating. The sperm is more likely to reach the egg, increasing the chances of fertilisation because it is travelling a shorter distance and in a shorter time. IUI is best suited for:
● Couples with unexplained fertility issues
● Men with mild fertility issues
● Women with PCOS
● Same sex couples or single women
● Women under 35 with less severe fertility problems
IUI is an effective treatment for many couples and is generally less invasive, less costly, easier to pursue and less advanced than IVF. IVF is a complex, costly, invasive and advanced assisted reproductive treatment option. The IVF procedure includes:
● Ovarian stimulation, in which the ovaries are physically stimulated with hormonal injections so that multiple eggs develop.
● Once the eggs are ready, the mature eggs are harvested from the ovaries through a minor procedure to retrieve eggs.
● The eggs are then fertilised with sperm in a lab, and embryo development is monitored.
● Once fertilised, the best embryo is transferred to the uterus for them to grow.
● A pregnancy blood test is performed after approximately 12 days to confirm the pregnancy.
● Women with diminished ovarian reserves
● Women with ovulation or uterine problems
● Male factor infertility
● Unexplained fertility issues
● Recurrent pregnancy loss
Wondering when to stop IUI? Generally, it may take 3 to 6 IUI cycles to successfully conceive. Still, it really depends on the health and medical history of the couple, age, sperm quality, uterus and the reason for their fertility issues.
Research indicates that 88% of successful IUIs occur within the first few cycles, and 95% occur within four cycles. Repeated unsuccessful IUI cycles mean a more advanced treatment is needed. Specialists suggest transition to IVF after 6 IUI cycles. Younger women may try extended, while women over 35 may need to move on sooner. Unexplained fertility issues may warrant a transition after a few failed cycles. It is highly advisable to see a specialist endocrinologist for direction on the best plan going forward.
● Age: If over 35, you may have a lower success rate compared to younger women, as with age, egg quality and ovarian reserve decrease and sperm quality may also decline, impacting the final result.
● Diagnosis: Endometriosis, PCOS and male factor infertility may affect the IUI success. These issues affect egg quality, hormone levels or sperm functioning, impacting the effectiveness.
● Response to fertility drugs: If given a fertility drug cycle, too many follicles or too few follicles are produced; if either is the case, the likelihood of success is low.
● Medical history: Miscarriages, past failed IUIs, endometriosis, male factor infertility, genetic disorders and damaged or blocked fallopian tubes may lead to a low success rate.
● Financial considerations: The IUI expense per cycle is less compared to IVF, and may need multiple attempts. IVF investment is higher, but it provides a higher success rate.
● Emotional impact: Feeling emotionally drained from multiple IUI cycles contributes to additional emotional distress and anxiety and leads to disappointment as well.
● Severe male factor infertility: When morphology, count and motility of sperm are low, IUI may not be a good choice. IVF is a better choice as fertilisation is done in a lab.
● Blocked or damaged fallopian tubes: IUI may be skipped for women with blocked or damaged fallopian tubes, as the sperm may not reach the egg. IVF is a better choice as fertilisation is done in a lab.
● Women over 38–40: As the maternal age increases, there is a natural decline in the egg quantity and quality. For a woman over 35 with several IUI failures, IVF may be a better choice.
● Poor ovarian reserve or premature ovarian failure: In this condition, the ovaries do not produce enough eggs for IUI to be effective, and IVF is the best treatment in such cases.
● Genetic testing requirement: If one or both have genetic disorders, the doctor may recommend IVF, as the process includes genetic testing of embryos.
Couples start the IUI process with hope and optimism, but after the two-week wait, there is anxiety about whether the treatment will work. A failed IUI can lead to sadness, guilt and hopelessness, though it is no one’s fault. Hormonal treatment may lead to irritability and mood swings. You may seek the help of a psychologist, join support groups or use relaxation strategies.
Cost is a primary consideration between IUI and IVF treatment. While the IUI cost per cycle is less, its limited success rate means that multiple cycles quickly add up. IVF is a large upfront investment, but it has a higher success rate, needing fewer cycles. Additionally, some insurance plans cover only a limited IUI or IVF cycles, necessitating the need to switch.
The transition to IVF is a decision that needs careful thought. But there are indications that this is the best way forward in your fertility treatment.
● Repeated failures suggest higher-level treatment is warranted.
● Age matters; older women may have more success in IVF because their ovarian reserves may have decreased.
● The severity of your condition, such as male factor infertility, blocked fallopian tubes, and endometriosis, requires IVF.
Couples should prepare emotionally and financially for IVF, which is an expensive treatment. IUI before IVF or direct IVF is a decision that should be taken after consulting specialists, as every individual is different and needs a personalised treatment plan based on age, fertility condition and other factors.
IUI is usually the first treatment for fertility issues, and couples have to try at least 3 to 5 cycles to achieve success. At times, this treatment is not enough, and a more advanced IVF may be needed. Understanding when to transition to IVF is a challenging and personal decision that you should make as a couple in consultation with your physician. Both IUI and IVF have helped many couples become parents, so look at the financial, medical, social and emotional factors and make the decision.
Typically, 3 to 6 cycles are recommended before trying IVF.
Certain conditions like male infertility factor, damaged or blocked fallopian tubes, poor ovarian reserve and couples with genetic disorders can skip straight to IVF.
Age, response to fertility drugs, diagnosis of PCOS, endometriosis, finances and underlying health all determine the number of IUI attempts to try.
There is a 40 to 60% chance of success in IVF even after failed IUI cycles, but age and various other factors influence the outcome.
