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In vitro fertilization IVF advantages as compared to other infertility treatments
IVF and embryo transfer vs. artificial insemination, IUI

Advanced Fertility Center of Chicago
Fertility and in vitro fertilization specialist clinic
Gurnee & Crystal Lake, Illinois

Day 5 embryo, high quality human blastocyst
Learn more about IVF with blastocyst transfer

Who should be treated with in vitro fertilization?
What about going from IUIs to IVF - how many intrauterine inseminations should be done before moving on to IVF treatment?
What are the success rates with IUI and IVF?
What are the advantages of in vitro fertilization, IVF over intrauterine insemination, IUI?

Good questions...

In vitro fertilization can be used as an effective treatment for infertility of all causes except for women with infertility caused by an anatomic problem with the uterus, such as severe intrauterine adhesions.

It is generally used in couples who have failed to conceive after at least one year of trying who also have one or more of the following:

1. Blocked fallopian tubes or pelvic adhesions with distorted pelvic anatomy. Women that have had tubal ligation and are considering tubal reversal surgery as well as men that are considering vasectomy reversal surgery might also consider IVF. 
2. Severe male factor infertility (low sperm count or low motility) 
3. Failed 2-6 cycles of ovarian stimulation with intrauterine insemination 
4. Advanced female age - over 38
5. Reduced ovarian reserve, which means lower quality (and quantity) eggs. A day 3 FSH and estradiol test is used as a general screening test for egg quantity and quality. Poor egg quantity and quality is usually treated with either IVF, or with IVF using egg donation from another woman.
6. Severe endometriosis

However, some experts in the field - and many couples experiencing difficulty conceiving are reconsidering traditional treatment regimens as IVF success rates continue to improve over the years.

Delivery rates per IVF cycle (per IVF ovarian stimulation cycle started, all ages) are shown below - national data
IVF success rates for women under age 35 are much higher than shown below (these numbers are for all ages)

Our IVF pregnancy success rates and links to the CDC website (US government) with success rates for all US IVF clinics

As IVF pregnancy success rates increase and IVF and IUI costs change over time, so does the decision making processes regarding the most appropriate fertility treatment options. Pregnancy rates for IUI, intrauterine insemination procedures have not been increasing over time. Therefore, the average number of IUIs done before IVF has decreased very significantly over the past 15 years. Whereas most couples would do 4-6 IUI cycles before IVF treatment in the early 1990's, today most couples choose to move on to IVF after 2-3 failed artificial insemination cycles.

For example, a couple with the female partner age 34 and unexplained infertility that has been trying for 2 years has about a:

• 10% chance per month of conceiving and delivering with clomiphene and intrauterine insemination for up to about 3 cycles (then much lower)

• 12% chance per month of conceiving and delivering with injectable FSH (e.g. Follistim) and insemination for up to about 3 cycles (then much lower)

• 55% chance of conceiving and delivering with one cycle (month) of IVF treatment (at our center - pregnancy rates vary greatly between IVF clinics)

Learn about tubal surgery for infertility

Costs of fertility treatments for women are an important factor in deciding when to move on to IVF from inseminations for many couples. The cost of fertility treatment as well as the cost of the fertility drugs can sometimes be covered by the female partner's health insurance plan. Unfortunately, these costs are not usually covered (by most) insurance plans. That leaves many couples deciding how to best spend their own money on the available fertility treatment options.

Learn more about infertility and IVF insurance coverage

In some IVF programs, such as ours, the cost of IVF is below regional and national averages. Lower IVF treatment costs will influence some couples to proceed with IVF sooner than they might have in the past.

Some couples have the attitude:

"Maybe we would get pregnant if we tried more insemination cycles, but we're tired of this, and it is getting expensive. We just want to do a treatment with high success rates. Let's do IVF now."

When evaluating the cost-effectiveness (cost per baby) of infertility treatments, for some couples IVF will be the most cost-effective therapy.

Should everyone do IVF? Of course not. But many couples would benefit from doing IVF sooner rather than having more tests, more surgery and more IUI cycles that are relatively low yield for getting the baby they want. This is the potential advantage of in vitro fertilization - it has a much higher success rate than any other infertility treatment.

Concerns about high-order multiple pregnancy (triplets and greater) have also caused some couples and physicians to move on from IUI to IVF sooner than in past years. IVF allows the couple to choose how many embryos will be transferred so that they will not end up having 7 like the woman in Iowa, or 8 like the woman in Texas. These women did not do IVF - they had ovarian stimulation with injectable FSH and then either intercourse or insemination. With ovarian stimulation and insemination, the number of eggs released with ovulation and fertilized inside the wife's body is not controllable. Therefore, there is a lack of control over high order multiple pregnancy. Learn more about risks for high order pregnancy from ovarian stimulation treatments

Blastocyst transfer is a relatively new technique that allows us to maintain high IVF pregnancy rates when only transferring 1 or (usually) 2 embryos to the mother. This results in almost no risk for triplets. When we transfer 2 embryos, triplets could only occur if both embryos implanted, and one embryo divided after the embryo transfer procedure to make an identical twin. That is rare, although we do see it in about 1-2% of IVF pregnancies.

So what should you do?

See a Board Certified Reproductive Endocrinology and Infertility specialist such as Dr. Sherbahn and discuss the issues as they relate to your case.

If you do decide to proceed with IVF, make certain that you have a copy of the clinic's pregnancy rates in writing. Then check out the clinic on the CDC website (US government) as well. Links to the CDC site can be found on the IVF pregnancy success rates page.

What to do if the first IVF cycle fails