IVF has many steps, and it takes several months to complete the whole process. It sometimes works on the first try, but many people need more than 1 round of IVF to get pregnant. IVF definitely increases your chances of pregnancy if you’re having fertility problems, but there’s no guarantee — everyone’s body is different and IVF won’t work for everyone.
While it’s always recommended to consult with a medical provider before making any treatment decisions, this article serves as a great jumping point for those looking to get pregnant using assisted reproductive technologies (ART). In it, we discuss everything you need to know about IUI and IVF.  We start things off with a high-level overview, then jump into the different types of each treatment, discuss treatment details, key decisions within each treatment, success rates, cost comparisons, risks, and who each treatment might be a good fit for.

The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood.[15] One of the main challenges in assessing the distress levels in women with infertility is the accuracy of self-report measures. It is possible that women “fake good” in order to appear mentally healthier than they are. It is also possible that women feel a sense of hopefulness/increased optimism prior to initiating infertility treatment, which is when most assessments of distress are collected. Some early studies concluded that infertile women did not report any significant differences in symptoms of anxiety and depression than fertile women. The further into treatment a patient goes, the more often they display symptoms of depression and anxiety. Patients with one treatment failure had significantly higher levels of anxiety, and patients with two failures experienced more depression when compared with those without a history of treatment. However, it has also been shown that the more depressed the infertile woman, the less likely she is to start infertility treatment and the more likely she is to drop out after only one cycle. Researchers have also shown that despite a good prognosis and having the finances available to pay for treatment, discontinuation is most often due to psychological reasons.[16]


When the ovarian follicles have reached a certain degree of development, induction of final oocyte maturation is performed, generally by an injection of human chorionic gonadotropin (hCG). Commonly, this is known as the "trigger shot."[67] hCG acts as an analogue of luteinising hormone, and ovulation would occur between 38 and 40 hours after a single HCG injection,[68] but the egg retrieval is performed at a time usually between 34 and 36 hours after hCG injection, that is, just prior to when the follicles would rupture. This avails for scheduling the egg retrieval procedure at a time where the eggs are fully mature. HCG injection confers a risk of ovarian hyperstimulation syndrome. Using a GnRH agonist instead of hCG eliminates most of the risk of ovarian hyperstimulation syndrome, but with a reduced delivery rate if the embryos are transferred fresh.[69] For this reason, many centers will freeze all oocytes or embryos following agonist trigger.

Risk of multiples. IUI with fertility medication carries a significant risk of multiple pregnancies, including higher-order multiples (triplets or more). A good clinic will carefully monitor your follicles to make sure that only a safe number are mature before the IUI, but they cannot entirely eliminate the risk. Recent advances in IVF (including blastocyst transfer) mean that most modern fertility clinics now transfer only one or two embryos per IVF cycle. As a result, the risk of multiple pregnancies for IVF patients is much lower than it used to be.

This is less extensively studied. It is not yet known whether the ovarian stimulation and the insemination have independent beneficial effects or whether their beneficial effects are only seen when they are used in combination. Most likely they both independently increase fertility potential, with relatively more fertility benefit coming from the IUI component.
A closer look at the data suggest that the benefit of letrozole over clomid depended on the BMI of the participants. For patients with a BMI of less than 30 kg/m2, the cumulative live birth rate was approximately 30% for each group. However, for patients with a BMI over 30 kg/m2, twice as many patients had a live birth in the letrozole group than the clomid group.
For healthy couples in their 20s or early 30s, the chance that a woman will get pregnant is about 25 to 30 percent in any single menstrual cycle. This percentage starts to decline in a woman’s early 30s. By age 40, a woman’s chance of getting pregnant drops to less than 10 percent per menstrual cycle. A man’s fertility also declines with age, but not as predictably.
Monitoring of egg development is usually done with E2 and LH blood hormone tests and ultrasound scans of the ovaries to determine when the egg is mature. The ultrasound allows the physician to visualize the thickness of the uterine lining and the ovaries, more specifically the number of follicles within them. The bloodwork shows the trend of pre- to post-stimulation hormone levels; increased levels of estrogen indicate follicular development.
Unlike the simpler process of artificial insemination -- in which sperm is placed in the uterus and conception happens otherwise normally -- IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.
Ovarian stimulation – You’ll take stimulation medications to increases both the quantity and quality of eggs. This usually begins during days 2-4 of your cycle and continues for around ten days. You’ll be closely monitored during this time to track your uterine lining, follicular development, and hormone levels. Once the follicles are optimal size, a trigger medication is given to fully mature the eggs.
^ Lasa, JS; Zubiaurre, I; Soifer, LO (2014). "Risk of infertility in patients with celiac disease: a meta-analysis of observational studies". Arq Gastroenterol. 51 (2): 144–50. doi:10.1590/S0004-28032014000200014. PMID 25003268. Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients.(...)According to our results, non-diagnosed untreated CD constitutes a risk factor significantly associated with infertility in women. When comparing studies that enrolled patients previously diagnosed with CD, this association is not as evident as in the former context. This could be related to the effect that adoption of a gluten-free diet (GFD) may have on this particular health issue.
Disclaimer: The information you enter is not stored by CDC and is only used to estimate your chances of success. The IVF success estimator does not provide medical advice, diagnosis, or treatment. These estimates may not reflect your actual rates of success during ART treatment and are only being provided for informational purposes. Estimates are less reliable at certain ranges/values of age, weight, height, and previous pregnancy and ART experiences. Please see your doctor and/or healthcare provider for a personalized treatment plan that is best for you.
In some cases, laboratory mix-ups (misidentified gametes, transfer of wrong embryos) have occurred, leading to legal action against the IVF provider and complex paternity suits. An example is the case of a woman in California who received the embryo of another couple and was notified of this mistake after the birth of her son.[94] This has led to many authorities and individual clinics implementing procedures to minimise the risk of such mix-ups. The HFEA, for example, requires clinics to use a double witnessing system, the identity of specimens is checked by two people at each point at which specimens are transferred. Alternatively, technological solutions are gaining favour, to reduce the manpower cost of manual double witnessing, and to further reduce risks with uniquely numbered RFID tags which can be identified by readers connected to a computer. The computer tracks specimens throughout the process and alerts the embryologist if non-matching specimens are identified. Although the use of RFID tracking has expanded in the US,[95] it is still not widely adopted.[96]
3-6 months of treatment with Clomid pills (clomiphene citrate) might improve fertility by as much as 2 times as compared to no treatment. This is a very low level infertility treatment. Infertility specialists do not usually recommend Clomid treatment( without insemination) for unexplained infertility for women over the age of about 35. Most fertility specialists do not use it (without IUI) on any couples with unexplained infertility. If a woman is already having regular periods and ovulating one egg every month, giving Clomid, which will probably stimulate the ovaries to release 2 or 3 eggs per month (instead of one) is not really fixing anything that is broken - and is not likely to be successful.
IUI: An IUI can be done with no medications or a number of different medications to help develop and ovulate one or two eggs. Around day 14 of a woman’s cycle, the insemination takes place which deposits sperm inside the uterus. This greatly increases the number of sperm at the junction of the uterus and fallopian tubes, the distance they have to swim to meet the egg, and thus increases the chances of natural conception for many people.
^ Hozyasz, K (March 2001). "Coeliac disease and problems associated with reproduction". Ginekol Pol. 72 (3): 173–9. PMID 11398587. Coeliac men may have reversible infertility, and as in women, if gastrointestinal symptoms are mild or absent the diagnosis may be missed. It is important to make diagnosis because the giving of gluten free diet may result in conception and favourable outcome of pregnancy.
PCOS: Polycystic ovarian syndrome (PCOS) is an ovarian issue that can cause irregular menstrual cycles and make it difficult for women to ovulate — a crucial part of the conception and pregnancy process. Women with PCOS do not release eggs regularly, and their ovaries often have many small cysts within. IVF is a strong option for women with PCOS, since it can help their bodies ovulate to achieve pregnancy.
During the selection and transfer phases, many embryos may be discarded in favour of others. This selection may be based on criteria such as genetic disorders or the sex.[125] One of the earliest cases of special gene selection through IVF was the case of the Collins family in the 1990s, who selected the sex of their child.[126] The ethic issues remain unresolved as no consensus exists in science, religion, and philosophy on when a human embryo should be recognised as a person. For those who believe that this is at the moment of conception, IVF becomes a moral question when multiple eggs are fertilised, begin development, and only a few are chosen for implantation.[citation needed]

Advanced technologies add to your IVF bill but may also make a huge difference to your success rate. Pre-implantation genetic screening (PGS) can improve implantation rate by selectively transferring genetically normal embryos. For couples with male factor infertility, Intracytoplasmic sperm injection (ICSI) can help deliver a sperm directly into the egg. Nevertheless, ICSI only improves success rate in couples with severe male infertility.
During the selection and transfer phases, many embryos may be discarded in favour of others. This selection may be based on criteria such as genetic disorders or the sex.[125] One of the earliest cases of special gene selection through IVF was the case of the Collins family in the 1990s, who selected the sex of their child.[126] The ethic issues remain unresolved as no consensus exists in science, religion, and philosophy on when a human embryo should be recognised as a person. For those who believe that this is at the moment of conception, IVF becomes a moral question when multiple eggs are fertilised, begin development, and only a few are chosen for implantation.[citation needed]
When weighing the options, the pros and cons of intrauterine insemination (IUI) and in vitro fertilization (IVF) will, of course, be explored fully in discussion with your physician. In general terms, you can expect IUI to be a simpler process, less invasive, and lower cost. Some fertility specialists recommend attempting one or more cycles of artificial insemination before moving to IVF but this does not apply to everyone. For example, for an older woman, to try artificial insemination first may take up valuable time and the recommendation could well be to move straight to IVF. But before you can compare the two treatments, you need to know what exactly you could expect from IVF.
If a man and woman 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without getting pregnant, they should suspect secondary infertility. This especially applies to women older than 30 who have experienced pelvic inflammatory disease, painful periods, irregular menstrual cycles or miscarriages, and to men with low sperm counts.
Laboratories have developed grading methods to judge ovocyte and embryo quality. In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos.[72] Since 2009 where the first time-lapse microscopy system for IVF was approved for clinical use,[73] morphokinetic scoring systems has shown to improve to pregnancy rates further.[74] However, when all different types of time-lapse embryo imaging devices, with or without morphokinetic scoring systems, are compared against conventional embryo assessment for IVF, there is insufficient evidence of a difference in live-birth, pregnancy, stillbirth or miscarriage to choose between them.[75] Active efforts to develop a more accurate embryo selection analysis based on Artificial Intelligence and Deep Learning are underway. Embryo Ranking Intelligent Classification Assistant (ERICA),[76] is a clear example. This Deep Learning software substitutes manual classifications with a ranking system based on an individual embryo's predicted genetic status in a non-invasive fashion.[77] Studies on this area are still pending and current feasibility studies support its potential.[78]
It is possible that a significant contributor to unexplained infertility can be attributed to changes in sperm epigenetics. Methylation patterns in sperm DNA which affect the expression of various genes may be the missing link for this unique patient population. By employing epigenetic analysis, we may be able to identify more causes of infertility and suggest the optimal course of therapy. Preliminary evidence even suggests that these epigenetic signatures influence the probability of conception, embryogenesis, and successful carrying of pregnancy to term. Future research on sperm epigenetics holds the promise of revolutionizing reproductive medicine and empowering patients in the process.
Men will need to have sperm testing. This involves giving a semen sample, which a lab will analyze for the number, size, and shape of the sperm. If the sperm are weak or damaged, a procedure called intracytoplasmic sperm injection (ICSI) may be necessary. During ICSI, a technician injects sperm directly into the egg. ICSI can be part of the IVF process.
Infertility is a medical condition, and a fertility specialist can help with thorough, focused examinations directed at discovering the underlying cause. For every couple that begins an evaluation, about 35% discover that there is an issue with the man which is contributing to the couple’s infertility. 50% is related to female factor while 5% is due to rare causes. The remaining 10% (1 in 5 couples) is due to unexplained infertility despite completing a full infertility work-up.(2)
Psychological factors: Studies on infertile groups of men and women have produced contradictory findings of the importance of psychological factors in causing infertility. Emotional disturbances undoubtedly appear to have some significance. This is only reasonable if you realize that the whole hormonal cycle, with its delicate adjustments, is controlled from the brain. This is an area which needs further investigation.

For example, a deaf British couple, Tom and Paula Lichy, have petitioned to create a deaf baby using IVF.[99] Some medical ethicists have been very critical of this approach. Jacob M. Appel wrote that "intentionally culling out blind or deaf embryos might prevent considerable future suffering, while a policy that allowed deaf or blind parents to select for such traits intentionally would be far more troublesome."[100]
A surge in LH triggers your ovaries to release an egg. The surge usually happens 36 hours before the egg is released. Ovulation kits check LH levels in your urine to help you pinpoint the day of ovulation. These kits, which you can buy at the drugstore, are convenient and highly accurate. You may want to test 1-2 days before you expect the surge so you can note the rise in LH.
In general, the cost of IVF is higher than for IUI, but IVF confers the highest pregnancy rates per cycle. It is impossible to put a precise figure on the two treatments for comparison as much will depend on your personal treatment program. You can see some ballpark figures on the website of the Society for Assisted Reproductive Technology. It also contains an overview of the differences between IUI and IVF.
I had a wonderful experience at CHA Fertility Clinic and got pregnant on my first cycle.  My son will turn two this year and I immediately contacted them when we were thinking of having a second child.  The doctors and staff are so kind, informative, and helpful, and they really put my mind at ease.  We had looked at other fertility clinics … Read More
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