IUI vs IVF for Sperm Problems: Which One is Right?
IUI and IVF are both treatments that can help you get pregnant when there is an abnormal semen analysis. How do you know when to pick one or the other? Let me explain 5 ways you can decide.
I get a lot of questions from patients who have low sperm counts or poor sperm motility, asking if they should use IUI or IVF to become pregnant. There are a couple of criteria you can use to help make that decision.
Less sperm reach the fallopian tubes in men with poor sperm
Couples who have low sperm counts or poor sperm movement have trouble becoming pregnant because there are less sperm that are able to reach the fallopian tubes where fertilization of the egg happens.
How do IUI and IVF help you get pregnant?
Both IUI and IVF can improve the chances for pregnancy in couples with sperm problems. IUI helps by increasing the number of sperm that reach the fallopian tubes. This increases the chance for fertilization.
The fertilized egg then moves down the fallopian tube into the uterus where it hopefully implants. IVF works by removing the eggs from the ovaries and fertilizing them outside of the body in the laboratory.
The embryos are left to grow in the laboratory. The doctor then places an embryo into the uterus where it hopefully implants.
With IUI, sperm are placed into the uterus. With IVF, eggs are removed and embryos are placed into the uterus. IUI is generally thought of as being easier to do and far less expensive than IVF.
What criteria can you use to decide between IUI and IVF?
How low are the sperm numbers? How poor is the sperm movement?
1. Severity. A normal sperm concentration is 20 million sperm per mL or higher. The closer you are to this number, the better your chances with IUI. If you have 12 or 15 million sperm, great!
If you have 12 or 15 thousand, then the chances with IUI are going to be very poor. Very poor does not mean impossible, however. We have seen success with IUI in couples with very low numbers. Just not very often. There isn’t a specific number that you can use as a cutoff but the lower the number of sperm, the lower the chances you’ll have with IUI and the better choice IVF becomes.
Severity is also important with sperm movement. Guys with normal fertility will usually have more than 50% of sperm showing any kind of movement and more than 25% with fast forward movement, which fertility experts call progressive motility.
The lower the number, the better IVF is going to be. If only 1% of the sperm have progressive motility, then IVF is going to be a much more efficient way to become pregnant.
Sperm source - ejaculated or aspirated?
2. Sperm source. If the sperm you are using to attempt pregnancy did not come from ejaculation, then you must do IVF. Sperm that are retrieved surgically or with a needle directly from the testicles have not yet developed the ability to fertilize eggs on their own. IVF is the only option in this case.
Are there other abnormal sperm tests?
3. Other abnormal sperm tests. Sperm counts and sperm motility tell you only about the ability of sperm to reach the egg in the fallopian tubes. If you have had additional testing that indicated the sperm have a reduced ability to fertilize, like a Cap Score Sperm Function Test, then IUI becomes a worse option and IVF becomes a better option.
Are there other female factors?
4. Other female problems. In the criteria I discussed above, we assumed that the female did not have any fertility issues of her own. If she does have problems, such as blocked fallopian tubes, scar tissue in her abdomen or endometriosis, then IUI pregnancies will be tougher to achieve or even impossible.
How aggressive do you want to be with treatment?
5. How aggressive? Pregnancy rates with IVF are generally going to be much higher than IUI. This means that the average time to pregnancy is going to be faster with IVF. If you are a couple that is looking to get the highest chance for pregnancy in the shortest amount of time, then IVF may be a better fit for you even if you meet all of the other criteria to consider IUI.
Whether you end up doing IUI or IVF, it is vitally important that you are treated by a physician who is a board certified fertility specialist.
You can also check out our fertility supplements to improve sperm quality.