IUI vs IVF – which one is right for you?

IUI vs IVF

– which one is right for you?

Both intrauterine insemination (IUI) and in vitro fertilisation (IVF) are safe and reliable fertility treatments available to couples who are facing infertility challenges. Knowing the difference between IUI and IVF will provide a better understanding of the many possible causes of infertility and the circumstances in which each treatment is recommended.

By Dr Sulaiman Heylen, Specialist in Reproductive Medicine:

MD (KUL), Obs&Gyn (KUL), Reprod Med, ECRES.

In this article, we look at what IUI is, what IVF is, what each procedure entails, who it is recommended for, and what success rate can be expected.

IUI (Intrauterine Insemination)

IUI is a type of artificial insemination that offers a good success rate.

Intrauterine insemination, or IUI, is a process during which a medical practitioner places sperm directly into the uterus during ovulation. By delivering the sperm directly into the uterus, IUI makes the trip shorter for the sperm and allows the sperm to get around any obstructions.

IUI is the oldest assisted reproductive technique (ART) and remains the most common method of artificial insemination. It is a non-invasive procedure and not as expensive as other fertility treatments. It has also proven safe and effective over time. For all these reasons, IUI is often suggested as a first treatment for infertility.

IVF (In Vitro Fertilisation)

IVF is a type of assisted reproductive technique that is used to treat fertility or genetic problems to help couples to conceive a child. Practiced for more than four decades across the world, IVF is a safe and trusted medical treatment, and its success rate is impressive.

Very simply stated, during in vitro fertilisation the female partner’s eggs are collected and fertilised with sperm in a laboratory. The embryo is then implanted into the uterus to hopefully become a pregnancy.

The IUI procedure

A widely used form of assisted reproductive technique, IUI is a fairly quick and simple procedure, compared to other fertility treatments such as IVF. It is also painless and safe, as the IUI procedure entails little medical risk for the women undergoing the treatment.

The IUI procedure is usually done in a fertility specialist’s examination room, in the late morning, and during the middle of your menstrual cycle. A woman’s natural cycle is often followed with ultrasound and blood tests to check when ovulation occurs, or stimulation can be given to grow eggs. IUI treatment can also be provided with special medications to stimulate ovulation.

During the IUI procedure, semen is introduced into the uterus by means of a syringe or a tiny flexible plastic tube that is inserted into the uterine cavity. Many women say that the procedure feels like a PAP smear.

The IVF procedure

IVF is not a single medical procedure or event, but a series of detailed and delicate procedures that are completed over several weeks.

Treatment usually commences on the first two to three days of the female partner’s cycle, with tablets or injections to stimulate the growth of the eggs, as well as medications to suppress ovulation until egg collection. Patients are carefully monitored using blood tests and ultrasound scans, usually on the 8th, 10th, and 12th days of the cycle.

The next step in the process is the egg collection. It begins with an HCG injection 36 hours prior to the egg collection – this is usually on the evening of day 12. During the next day, the patient will need to spend about two hours at the clinic for the egg collection procedure, which takes around 15 minutes and is performed under sedation, with a very fine needle attached to an ultrasound.

After the egg collection, a progesterone hormone is given to prepare the lining of the uterus (womb) prior to embryo transfer. On the same day, the eggs are fertilised with sperm in the lab and the resulting embryos are grown in the laboratory for three to five days.

The third step is the transfer of the embryo into the uterine cavity. This is a painless procedure, and no anaesthetic is necessary. An ultrasound scan is performed to ensure the embryos are transferred into the correct place. A blood test will be performed to check for pregnancy 14 days after egg collection.

For whom is IUI recommended?

Although the pregnancy rates achieved with IUI are lower than those achieved with IVF, IUI is both less expensive and less invasive, so it is often attempted as a first fertility treatment. It is also recommended for unexplained infertility when the cause of infertility cannot be identified.

IUI is also recommended for women who are physically capable of conceiving and carrying a baby, but cannot fall pregnant through sexual intercourse, for a number of reasons, such male partner infertility or a same-sex partner. It is also recommended for women with minimal or mild endometriosis, and for those with ovulation problems.

Traditionally, IUI was recommended for male infertility, where the male partner is impotent or struggling with erectile dysfunction or is sterile. However, since the invention of Intra Cytoplasmic Sperm Injection (ICSI), many men with low sperm counts can have their own biological children. ICSI is a procedure like IVF, except that with ICSI a single sperm cell – the best available – is injected directly into the egg.

IUI with donor sperm is therefore now reserved for cases in which the male partner has no sperm cell production at all. Impregnation of a woman through IUI may also be used by women or men in same-sex partnerships who wish to produce children of their own. Single women may also choose to undergo IUI using donor sperm.

For whom is IVF recommended? IUI success rates

Pregnancy rates achieved with IUI are lower than those achieved with IVF, but IUI is a fairly quick, simple, safe and affordable procedure, compared to other fertility treatments such as IVF.

The Cape Fertility is proud of its average success rates for IUI with partner sperm at 12 to 15%, and at 24% for IUI with donor sperm. Bear in mind that the success rates depend on many factors – with the most important being the age of the woman having treatment.

Some of the fertility challenges IVF is normally indicated for include damaged or blocked fallopian tubes, severe endometriosis, advanced maternal age, decreased ovarian function, low ovarian reserve, severe male infertility including impaired sperm function or production, and unexplained infertility.

IVF success rates

IVF treatment has a great success rate. It must be remembered, however, that the success rates depend on many factors, particularly the age of the female partner and the fertility clinic chosen. The most crucial factor in determining the success of IVF is the age of the woman having treatment. In a 25-year-old woman an in vitro fertilisation cycle may have a 60% success rate with blastocyst transfer compared with a 40-year-old woman having a 10% success rate with IVF. It is also important to realise that, in many cases, more than one IVF cycle is required to achieve a pregnancy. 

Dr Sulaiman Heylen is an Obstetrician & Gynaecologist and a subspecialist in reproductive medicine. He is one of four specialists at the Cape Fertility Clinic in Claremont and works at Life Kingsbury Hospital. He introduced the use of TESA (Testicular Sperm Aspiration) and ESA (Epidydimal Sperm Aspiration). Dr Heylen was the first to perform laparoscopic tubal re-anastomosis in South Africa. With the embryology team of Cape Fertility Clinic, he had the first Pre-implantation Genetic Diagnosis (PGD) pregnancy in 2003. He devotes himself to the further development.

T +27 (0)21 685 0336 E nazeema@capefertility.co.za W www.capefertility.co.za