How to decide whether to try IVF

These are common question I hear from women and couples struggling with fertility. It’s a heavy decision, I get it. If you have unexplained infertility it can be especially mind-numbingly difficult to decide if intrauterine insemination (IUI) or unassisted or another option versus in vitro fertilization (IVF) is your next step. Absolutely, it’s a personal choice for you to make. There’s no right or wrong answer and above all else, ask advice from your fertility doctor and ask for all the options they recommend. If need be, get a second or third opinion. To also help gain some clarity or at least see if you can get even more informed, here’s a list of considerations for whether IVF is right for you to try next.

Before proceeding, I want to share a caveat. I use the term IVF – in vitro fertilization – but I use it in the term that people are familiar with, although it’s not always IVF. Here I’m using the term to talk about an egg retrieval plus fertilization of egg(s) with the woman/ person with the overies’ own egg(s), although I do refer to donor eggs below. Caveat ended.

How to decide whether to try IVF (or other options like an IUI)

Cost. This is a big one and can often the largest factor to do IVF or not. IVF is expensive. The high costs are especially a factor if you’re not in a province or territory where funding is available, and especially if you do get funding for IUI but not IVF. Even in Ontario where there may be a funded IVF cycle there are added costs such as sperm washing, embryo storage, testing, ICSI, and medication costs (among others) that may make IVF cost prohibitive. There are options for how to fund IVF (feel free to book a call with me to learn more) but it can be a headache and it can even be life altering. You’ve got this, I’m here with you.

Your specific case. It depends on the reason for your fertility struggles or anticipated fertility struggles. See below for more specifics.

Genetic concerns that PGT-A screening would be indicated. If you have had multiple miscarriages and especially if you know that chromosome abnormalities were the cause, then you might be choosing IVF since you could screen embryos through PGT-A or PGT-M. Perhaps you’re terrified of another miscarriage even if it’s not proven to be from chromosomal issues and PGT-A is an option to decrease those chances.

Statistical chances of pregnancy success with IVF vs IUI. IVF almost always is a higher pregnancy rate than IUI. There are statistics based on your specific age and case. There isn’t consensus among fertility doctors or clinics but with unexplained fertility, after 12 months of trying and no pregnancy, the chances of conception is 2 to 4% per month. Ask your doctor. Often the chances with IUI without injections isn’t much higher. With IVF the statistics usually jumps up much higher.

Access. If it’s easier to have an IUI in your town or city whereas it’s difficult to access a clinic that offers IVF, then this will be factor. When it comes to fertility treatment, logistics matter. There are options, but logistics do make a difference since fertility treatment can be like a part or full time job on top of your regular job (plus if it’s secondary infertility, on top of the parenting job).

Age. If you’re at an age where chances are decreasing beyond where you’re comfortable, together with your diagnosis (or lack of one), this will factor in. It’s a decision with medical input from your doctor. There are generally lower chances when you hit 30, 35, 37, 40, 42 and 45. This will factor in whether you’ll consider going straight to IVF.

Other lifestyle and environmental factors that could affect fertility. There are a few changes that can be made to increase fertility, so starting there will affect whether to do IUI or IVF or even neither.

IVF is diagnostic as well as treatment. IVF is almost always the most effective way to get pregnant and part of that is because you have the opportunity to learn more about your fertility case through IVF that you can’t with just bloodwork and ultrasounds and trying through IUI alone. Being able to put eggs and embryos under a microscope and also seeing how you respond to IVF medication are all part of what you learn with IVF. Having some answers or ruling out possibilities might be worth this option.

Diminished Ovarian Reserve. For women with DOR, fertility doctors usually recommend IVF from the start.

Severe tubal disease. If you or your partner has this, your doctor will probably tell you it’s time to go straight to IVF if you are wanting to use your own eggs.

Stage 3 or 4 endometriosis. Women with this confirmed advanced stage ion endometriosis may move rapidly to IVF.

Severe male factor. If you or your partner have around 15 million or lower, and/or severe motility issues then IVF (plus ICSI) is usually advised. That said, there may be options for trying to improve quantity with supplements and lifestyle changes.

You’re considering donor options. Some individuals or couples will bypass IVF with their own eggs and/or sperm (e.g. many LGBQT+ couples, medical reasons, and moms by choice) and go straight to donor conception such as donor sperm or donor egg or double donor conception which is both eggs and sperm (but different than donor embryo adoption!). It’s a choice with donor sperm whether to try IUI first because the cost and chances of success can be part of it. The number of tries with 1 vial of sperm is limited with IUI but can go farther and be more effective with egg retrieval. The latter you can still call IVF. This is getting detailed, but it’s an important part of this post.

After failed IUI(s). Usually fertility doctors recommend IVF after 3 or 4 failed attempts. Statistically, you’re more likely to find out if IUI will work for you within 4 cycles, usually by 3 IUI attempts. One study found that 88% of all  IUIs that lead to pregnancy happen within three cycles and 95% within four IUIs (Morshedi et al, 2003). Another study found that 90% of IUI pregnancies occur in the first three cycles of IUI (Soria et al, 2012). Keep in mind there are still people and couples who will conceive on their 5th IUI or additional IUI attempt such as the 7th IUI.

Family planning beyond the next child. If you want another child or more after having the child you’re trying for now, then IVF might be the best option. This is partly to do with other factors such as age. With IVF you may be able to bank frozen embryos which preserves your eggs and sperm in time, whereas with time passing your fertility decreases. This an especially important factor if you’re in your mid to late 30s or in your 40s. Will you regret not trying IVF if you aren’t successful with the baby after this next one? It’s similar to why some women freeze their eggs to preserve their fertility. You also have the possibility to choose eggs to freeze and not just create embryos.

IVF is not a guarantee over IUI. Success rates are much higher for IVF than IUI (almost always) but IVF is not a guarantee. I’m sharing this as a consideration in terms of where to put your expectations. Most women will eventually have success with IVF but it’s not always after 1 or 2 cycles. Here’s an important caveat: There are options and services in clinics where you pay a (large) lump sum for either a few or unlimited guaranteed IVF cycles until success and pay the same amount no matter how many cycles it takes. Even then, it’s never guaranteed that you will have a child with your genetic make-up.

Time. IVF is usually the fastest option when it comes to the chance of fertility success sooner. If it’s been a long time with monitored cycle, with many IUIs, then it might be time to move on to IVF. If you’re just wanting to have a baby sooner and all else is equal, you might consider IVF.

Health concerns about fertility medication. Many of us are concerned about pumping unwanted medication into our bodies because of the side effects and potential longer term effects. I wasn’t ecstatics that I did. For some women or couples, that’s a reason to forgo IVF or IUI with injectables. Studies aren’t conclusive but so far there appears ‘there is no definitive relationship between the use of fertility drugs and cancer, and only some observational studies have pointed to this relationship’ (Momenimovahed et al., 2019) and especially when the result is a live birth.

Risks in IVF pregnancies. There is an increased risk of ectopic pregnancies, preeclampsia and other conditions in IVF pregnancies such as with the placenta (Gelbaya, 2010), although often it is due to the original reason for needing IVF such as advanced age than the IVF itself and with the placenta because of it being physically places instead of conception happening unassisted. There are known added complication risks with IVF pregnancies. I have personal experience with this and am open to share.

Health risks for children conceived through IVF. [Updated May 2022] A study indicated that there are increased health concerns for children conceived through IVF, including increased chances of asthma, allergy and eczema. I can speak from experience what that’s like because my IVF child has all three so feel free to ask me about this.

Religious reasons and values. You may be against or hesitant to try IVF because of your faith or values. This is so personal. What others in your faith around you say and how they will treat you can be a factor to consider. Will you be shunned by your community if you do IVF and does that matter to you (enough to forgo IVF)? There are also options when it comes to compassionate transfers and limiting the number of embryos fertilized.

You’re terrified and/ or a needle-phobic. Yes, that’s completely normal and understandable and everyone facing IVF has some sort of fear around it. Some can be more scared to the point where this isn’t an option. It’s such a personal experience. Book a call with me to discuss this because if having a baby is so important to you, let’s find a way to see if there are steps you can take (or not take) to address this. I was terrified too.

BMI is too high for egg retrieval. Let me start by saying that if you have a higher BMI, this is not your fault for why you have fertility struggles and for why choosing IVF is made more challenging. It’s not you. The reality is though, that many clinics have a limit in terms of what BMI their patients have before they say they will deny you IVF treatment. This is only SOME clinics and doctors. It’s usually cut off at a BMI of 40 or 41. This is because clinics don’t have the capacity to offer the sedation or pain management medication for your egg retrieval. Some clinics will let you decide whether you’re willing to go through it if you aren’t taking the medication. There are clinics in Canada who will serve you so please know there are options and, again, this is not your fault.

You don’t want to or you really want to. Both are reason enough if that’s what’s right for you.

That’s not the finite list but they are considerations. I know it’s a lot to take in and if you’re having trouble making the decision, feel free to book a free call with me to help sort it out – no strings attached. Good luck!

References:

Gelbaya TA. Short and long-term risks to women who conceive through in vitro fertilization. Hum Fertil (Camb). 2010 Mar;13(1):19-27. doi: 10.3109/14647270903437923. PMID: 19929571.

Momenimovahed Z, Taheri S, Tiznobaik A, Salehiniya H. Do the Fertility Drugs Increase the Risk of Cancer? A Review Study. Front Endocrinol (Lausanne). 2019;10:313. Published 2019 May 24. doi:10.3389/fendo.2019.00313

M. Morshedi, H.E. Duran, S. Taylor, S. Oehninger. Efficacy and pregnancy outcome of two methods of semen preparation for intrauterine insemination: a prospective randomized study. Fertil. Steril., 79 (Suppl. 3) (2003), pp. 1625-1632 https://www.sciencedirect.com/science/article/pii/S0015028203002504

Polinski KJ et al. Infertility treatment associated with childhood asthma and atopy. Human Reproduction. 2022. https://doi.org/10.1093/humrep/deac070

Soria M, Pradillo G, García J, Ramón P, Castillo A, Jordana C, Paricio P. Pregnancy predictors after intrauterine insemination: analysis of 3012 cycles in 1201 couples. J Reprod Infertil. 2012 Jul;13(3):158-66. PMID: 23926541; PMCID: PMC3719352. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719352/