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04/23/2018 11:15 EDT | Updated 04/23/2018 13:32 EDT

Here's How To Choose Between Insemination And In Vitro Fertilization

As a fertility doctor, I believe it's important that couples have a good understanding of their options.

Infertility affects one in six couples. If you're currently struggling to conceive, there is hope! Excellent treatments exist to help boost your fertility. The tricky part is cutting through the medical jargon and choosing the treatment that best suits your needs.

As a fertility doctor, I believe it's important that couples have a good understanding of their options. Sometimes the choice is easy. If you have blocked fallopian tubes, severe endometriosis or the sperm count is extremely low, in vitro fertilization (IVF) is the best choice. In other circumstances however, the choice is not so straightforward.

Couples with more modest fertility challenges can select between intrauterine insemination (IUI) and IVF. Those eligible might have diagnoses that include: moderately low sperm count (10 to 15 million/ml), irregular periods, mild endometriosis, advanced reproductive age (over 35 years old) or unexplained infertility.

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Intrauterine insemination (IUI) is the most basic treatment that fertility clinics offer. It's a process by which the sperm is placed in the uterus with a skinny tube called a catheter. First, a man will produce the sperm sample on site so that it can be evaluated within 30 to 60 minutes. The sample will then undergo a washing process in a centrifuge. The wash removes all of the seminal fluid, dead sperm and extra cells, leaving behind only the fastest swimming sperm. Finally, the sperm is loaded into a catheter that passes through a woman's cervix and into her uterus.

Most of the time, women are able to pick the best day for IUI by using a simple ovulation predictor kit (OPK) at home. For more information on ovulation testing, read my previous blog on the topic.

Occasionally, an ultrasound is required to monitor the ovarian follicles and pick the best day to trigger ovulation with a shot. This can add cost and complexity to a cycle, so if it's not necessary, it should be avoided. Research shows that ultrasound monitoring and ovulation trigger shots provide no benefit for women who can reliably detect ovulation on their own.

IVF is the strongest fertility treatment, and often the most efficient

Insemination offers infertile couples a smallboost in their monthly pregnancy chances. To put things in perspective, even couples in their twenties with no fertility issues have about a 25 per cent chance of conceiving every month. After a year or two has passed without achieving a pregnancy, the monthly chances drop to less than 5 per cent. Adding a mild treatment such as pills (e.g. clomiphene or letrozole,) and IUI, bring the monthly pregnancy rate up to 8 to 12 per cent.

IVF is the strongest fertility treatment, and often the most efficient. It involves injections for approximately 10 days, followed by a short procedure to harvest the eggs. In contrast to fertility pills that garner one or two eggs, the hormone injections for IVF aim to grow eight to 15 eggs at once.

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Eggs are combined with sperm in the laboratory to create embryos. The embryos grow in an incubator for three to five days before one or two are transferred back into the uterus. Extra embryos can be frozen for future use.

A study was done to compare couples that did six cycles of IUI versus only three cycles of IUI before moving on to IVF. The overall pregnancy rate with IVF was more than four times higher than IUI (30.7 per cent versus 7.6 per cent). The researchers concluded there was no benefit to using hormone injections combined with IUI (commonly called superovulation,) and that it was most cost effective to do IVF instead.

In summary, there are effective treatments available to help you get pregnant. Your fertility specialist can guide you toward the right one. Most importantly, remember that you're not alone. Infertility awareness is growing and so is the public support and compassion for this heartbreaking condition.

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