Patients experiencing infertility most often pursue two primary treatment options: IUI (intrauterine insemination) and/or IVF (in vitro fertilization). This blog post will discuss what they are and when they are used at NYU Langone Fertility Center.
IUI is short for intrauterine insemination. During routine sexual intercourse, only 1% of sperm travel from the vagina to the uterus - some stays in the vagina, while cervical mucus filters out most of the sample. During an IUI procedure, sperm is inserted directly into the uterus using a catheter, bypassing the body’s natural blockades. Doctors recommend IUIs as they allow more sperm to potentially reach an egg, increasing the odds of fertilization and pregnancy. IUIs are a relatively simple procedure that many patients say feels similar to a pap smear.
There are two types of IUI cycles – medicated and natural. Natural cycles are recommended for single women using previously frozen donor sperm and for couples whose main issue is timing intercourse for optimal fertility. For natural cycles, we commonly freeze sperm in advance to have available if the male partner is travelling or the couple has trouble timing intercourse (i.e. military personnel who live remotely from spouses).
Medicated IUI cycles are more commonly used for couples who have been trying to conceive on their own without success for 6-12 months. Medication is usually taken in pill form and women are monitored for ovulation using over-the-counter ovulation predictor kits or a combination of blood tests and ultrasounds in the office to time the IUI with ovulation.
IUI success rates vary considerably depending on a woman’s age and cause of infertility. For women under 40 with unexplained infertility, IUI success rates range from 5-8% per month. For women who go from irregular to regular cycles, pregnancy rates are much higher because they have an identifiable problem that can be easily fixed.
IVF is short for in vitro fertilization. To some patients, IVF may seem overwhelming, but since the technique was first developed, technology has advanced and many patients who cannot get pregnant on their own or following a IUI find success with IVF. For women with blocked or absent fallopian tubes or for patient-partners with very low sperm count, IVF is often the only option for achieving pregnancy. For patients with normal tubes, healthy sperm and normal AMH levels who are still not able to get pregnant following other treatment, IVF is often the next step in their care journey.
An IVF cycle is a two-part process. The first phase, known as “ovarian stimulation,” uses fertility medications to mature multiple eggs which are then retrieved and fertilized to create embryos before the second phase begins. The second phase of an IVF cycle involves transferring an embryo back into the uterus.
Ovarian stimulation usually starts on the second day of a woman’s period. From there, the patient takes at-home injections for about two weeks and visits the office for monitoring visits which include blood tests and ultrasounds. When the eggs are mature, the patient is scheduled for an egg retrieval. Performed under anesthesia, eggs are removed from the ovaries using a needle passed through the vaginal wall. Patients typically spend one hour in recovery before returning home to rest. That same day, mature eggs are combined with sperm and monitored for fertilization and, if successfully fertilized, embryo development over the course of a week.
At this point, many patients request testing of their embryos for chromosomal abnormalities, known as pre-implantation genetic testing (PGT). For patients who choose to perform PGT, embryos are frozen (vitrified) after they reach certain growth milestones and saved for a future frozen embryo transfer (FET).
Once patients receive their PGT results they can schedule their Frozen Embryo Transfer cycle, beginning the second phase of the IVF process. Patients begin their FET cycle on day 2 of their period and are prescribed estrogen and progesterone leading up to the transfer. The transfer itself is typically quick and easy, and anesthesia is rarely required. The patient continues taking their prescribed medications and returns to the clinic for a pregnancy test 9 days later.
Egg freezing (oocyte cryopreservation) is performed similarly to IVF but without embryo creation and transfer. The “ovarian stimulation” phase, including all medications, monitoring and retrieval portions of the process, are the same. The main difference is that during an egg freezing cycle, the goal is to retrieve and store eggs for future fertilization and embryo creation.
The NYU Langone Fertility Center is a world-class facility offering the full spectrum of care for patients who want to have a baby now or in the future. Services range from diagnostic testing to intrauterine insemination (IUI), in vitro fertilization and Egg Freezing. Additionally, we are experts in treatments related to donor gametes including donor eggs and donor sperm. We are proud to serve all members of the LGBTQ community: we work with all individuals, straight, gay, married, unmarried, partnered, or single, to translate the love they feel into the family they desire.
While the doctors at NYULFC are physicians first and foremost, they are also active participants in clinical research to advance the safety, success, and affordability of fertility treatments, continuously shaping the policies and trends in fertility care worldwide. We recognize that you have a choice in care providers, and we are committed to providing compassionate, individualized treatment. We’re happy to go at your pace and answer any questions you may have. At NYU Langone Fertility Center, feel confident placing your trust in one of the most experienced teams in the country.