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

Question:

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.

Answer:

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 http://bit.ly/9AdrJc ) . 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

http://www.montereybayivf.com/

Monterey, California, U.S.A.

When is IVF used instead of IUI for Male infertility?

Question:
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?

Answer:
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
http://www.blogger.com/www.montereybayivf.com
　
Monterey, California, U.S.A.
　
for additional information check out my blog at http://womenshealthandfertility.blogspot.com/ check me out on facebook and twitter with me at @montereybayivf