Many couples struggle with being unable to become pregnant. The medical definition of infertility is when no pregnancy is conceived after 12 months of unprotected intercourse in women under age 35 or after 6 months of unprotected intercourse in women age 35 and older.
The American College of Obstetricians and Gynecologists (ACOG) recommend an infertility evaluation for women who meet this criteria or for women with underlying health conditions known to cause infertility. It is recommended for women age 40 and older to be evaluated even sooner. Up to 15 percent of couples experience difficulty conceiving.
There are two main treatment procedures for women with infertility: intrauterine insemination (IUI) and in vitro fertilization (IVF). Many couples achieve healthy pregnancies through these procedures. While IVF is more effective, it is also more expensive.
Intrauterine insemination, sometimes called artificial insemination, is a procedure where sperm is inserted directly into a woman’s uterus through a narrow tube. IUI may be indicated in couples where the male partner has a low or abnormal sperm count because the semen can be processed in a procedure called sperm washing.
Sperm washing separates healthy, motile (moving) sperm from the rest of the semen material. The healthy sperm are then concentrated and combined with a special fluid that is suitable for the IUI procedure.
For some types of male infertility, a couple may require a sperm donor. A sperm donor would also be needed for same-sex female couples who wish to become pregnant. In these cases, the donor sperm can be inserted into the woman’s uterus through IUI.
IUI is often used with ovulation stimulation and is a common treatment for women who have difficulty ovulating. Medications are used to allow a woman to ovulate, or produce an egg. The IUI is then timed so that the sperm will be in the right place when ovulation occurs.
IUI is an office procedure that is similar to a routine pelvic exam. A speculum is inserted into the vagina so that the cervix can be visualized and then the narrow tube is inserted through the cervix into the uterine cavity where the processed sperm is inserted.
Because the sperm have to travel to the fallopian tubes, a woman has to have at least one undamaged, open tube for IUI. If a woman’s tubes are damaged or blocked, then it would be recommended for a woman to undergo IVF.
In vitro fertilization is a procedure where the sperm and egg are combined in a laboratory, and then the embryo is transferred into the uterus. Because fertilization occurs in a laboratory, the fallopian tubes are bypassed. IVF may be used for women with blocked fallopian tubes, for women who have not become pregnant with prior IUI, for some types of male infertility, and for other unexplained infertility.
IVF occurs in three stages. First a woman is given medication to stimulate her ovaries to produce multiple eggs. The mature eggs are retrieved with a needle. Next the sperm is added to the eggs in a laboratory. The eggs are monitored for fertilization. Finally, the embryo is transferred into the uterus through the vagina. Often only one or two embryos are placed in the uterus, so remaining healthy embryos can be frozen and stored.
IUI and IVF have been used successfully for many couples struggling with infertility. If you have been trying to conceive and have had difficulty becoming pregnant, it is important to speak with your healthcare provider. Evaluation is often performed by OB-GYN providers, and some practices offer fertility treatments while others will refer you to a specialist for treatment.