Sunday, July 18, 2010

TTC For Seven Years & Dealing With Male Factor Infertility: Do We Do IUI or IVF?


My hubby and I have been trying to conceive for 7 yrs. One specialist told us only IVF (in vitro fertilization)would work, but a second opinion told us IUI (intra uterine insemination) would work.

He has a count of 9mill and motility of 60%. I'm perfectly fine, my eggs and tubes are good all blood work came back good, and I have conceived in the past and have a son.What are our chances with conceiving using IUI and how many attempts do you think will be needed? Any additional advice would be greatly appreciated. Thanks, S. from the U.S.


Hello S. from the U.S.,

If you are under the age of 35 years old, then I think that IUI would be an option for you. The sperm findings are abnormal, but there is a small chance. Your chances of pregnancy under the age of 35 would be 20-24% per cycle, and I would not recommend more than 4 attempts. Your best option is IVF with ICSI (intra cytoplasmic sperm injection). In general, if the count is less than 10 million, ICSI/IVF is the recommendation. You have to bear in mind that only 60% of the 9 million are sperm that can fertilize the egg (3.6 million). That is way lower than the normal required for natural pregnancy (20 million is required).

In most cases where the semen analysis is abnormal, that is an indication that there is a problem with sperm function. After all, it only takes one good sperm to achieve fertilization but for some reason, studies have shown that if there is a severe abnormality in the semen analysis, the sperm have difficulty or lack the ability to fertilize the egg. That is how & why ICSI was developed (see my website for further explanation ) . So far, over 10,000 babies have been born with this technique from men who were otherwise considered hopelessly sterile, whose sperm are weak or too few to effectively fertilize an egg. These ICSI/IVF babies have long been proven to be physically, mentally and genetically completely normal, no matter how poor the sperm of the father. If I were your doc, I would have recommended IVF/ICSI as your best treatment option, but would allow a trial of IUI if that is what you wanted to do.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.


  1. Thanks for posting these Q&A's Dr. R!

    I do have one additional consideration that I wish would be talked about a little more in this kind of case. The writer didn't mention it, but as any infertile couple will confirm there is an emotional and financial component to this kind of decision that is just as important as the physical. So often we patients are left alone to navigate the emotional and financial side of treatment decisions.

    In our experience, most doctors don't even know the financial cost of the different options they are presenting us with, and it is hard to make a good decision lacking that kind of information. In some cases IVF might be a cheaper way achieve the best possible odds at a pregnancy.

    The other consideration that I feel is desperately lacking is the medical community is the emotional impact that different treatment decisions have on a couple. No doctor (we're up to 8 now, between UR's and RE's and second opinions) has ever discussed that with my husband and I. Month after month of failed IUI is not something that I have the emotional fortitude to handle, so while IVF might not be medically necessary, it might still be the best option considering emotional and financial factors.

    I'm feeling a little sassy this morning, and have wanted to share these thoughts for a while. I really do appreciate your blog and just wanted to add my 2 cents to the discussion.

  2. Hi thank you for sharing your thoughts. You bring up a very interesting and important topic that few talk about. It is certainly something I discuss with my patients at the consultation and other visits. Patient themselves do not consider the emotional costs of their treatment. Sometimes it can be more than the financial burden. It is a good topic for me to discuss in a blog entry, so I'll probably move your comment to lead into a blog discussion.




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