Monday, December 28, 2009

When is IVF used instead of IUI for Male infertility?

I was wondering when ivf is used instead of iui to start when male infertility is involved. What do the stats have to be (count, motility, etc) in order to say iui isn't an option?
What are the stats for iui and ivf. Do most women get pregnant using ivf?

Hello Bill from the U.S.,
IUI and IVF are completely different treatments with significantly different pregnancy rates.
IUI is a "natural" treatment option in that the body has to do the same natural processes in order to achieve pregnancy. As such, the highest pregnancy rates are 24% per cycle and drop significantly after four attempts. IUI is mainly used when an ovulation induction/timed intercourse treatment fails or if there are "mild" sperm abnormalities. IUI accomplishes one of the steps required for pregnancy. It gets the sperm into the tube to await the egg, but also helps by timing ovulation better. Usually, it would be indicated with any of the following:
1. Count between 10 -20 million
2. Motility between 30-60%
IVF is not a natural treatment option because almost the entire process is taken out of the body. The only "natural" parts of the process are ovulation induction in the ovary, embryo hatching in the uterus and implantation. Because of these remaining "natural" processes, there is not a 100% pregnancy rate. Pregnancy rates are very dependent on the age of the eggs. In under 35 year olds, pregnancy rates are now up to 70+% per cycle attempt and go down from that age group. At 43+, it is 25% per cycle. With IVF, the ovaries are stimulated to growth many eggs, the eggs are aspirated from the ovaries, fertilization then occurs in the laboratory where the sperm are added or injected into the eggs, the fertilized eggs are allowed to grow into embryos and the embryos are placed back into the uterus. IVF accomplishes 6 of the 9 steps required to produce a pregnancy. Hence, it has a higher pregnancy rates. In terms of male factors, except for no sperm, IVF can be accomplished with any level of sperm abnormalities and is directly indicated when the findings are severe i.e. less than the above parameters including morphology less than 30%. TESA (trans-epididymal sperm aspiration) is a new technique for men that don't show any sperm in a semen analysis, but have sperm production within the testicle. In this procedure, sperm can be extracted directly from the testicle and used to inject directly into each egg. You only need enough sperm for the number of eggs that a present. So, even if a semen analysis shows no sperm, there is still the possibility of a genetic child with this technique.
If there is no sperm on semen analysis, and you can't afford IVF/TESA/ICSI or don't mind not having a genetic child, then IUI can be done with donor sperm. Donor sperm usually costs approximately $500 per specimen, so the overall treatment cycle would cost approximately $3000 per month of trying.
I hope this answers your question.
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
for additional information check out my blog at check me out on facebook and twitter with me at @montereybayivf

1 comment:

  1. Hi Dr. Ramirez! I just found this blog, it is very helpful. I have a follow up question regarding male factor infertility and success rates. We are young - 25 and 26 and have just begun our IVF w/ ICSI cycle. After all the testing, everything is spot on perfect for me, but my husband has the trifecta - low count, morphology, and motility (oh, and antibodies). I've tried to find success rates for male factor only with young healthy women, but have been unsuccesful. Will our individual situation increase our rates of success?



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