Fertility treatments can be broadly categorized in different ways. Some
treatments like Clomid and IUI are non invasive and relatively inexpensive. Others, like IVF,
are more invasive and very expensive. In general. The pregnancy success rates with Clomid and IUI
are a lot lower than the success rates with IVF. If you are looking to start fertility treatment,
should you start with easy and inexpensive knowing that the chance for success is lower? Or should
you go straight to IVF and take advantage of the much higher success rate? Stay tuned
There are many reasons why people who are trying to conceive may need to go directly
to IVF. For example, if infertility is due to persistent tubal blockage,
IVF is the only way to become pregnant. When sperm are retrieved directly from the testicles,
they are unable to fertilize eggs on their own so IVF in this case is also mandatory.
What if there weren't any identifiable problems, what fertility doctors refer to as unexplained
infertility? These patients don’t have to do IVF to conceive; but IVF is an option along
with other options. The most commonly used “other” option for couples with unexplained
infertility is the use of the oral fertility medication clomiphene or Clomid. Clomid is
used in an attempt to mature multiple eggs at the same time. Close monitoring is performed
in order to determine the exact day of ovulation. On that day, instead of having intercourse alone,
sperm can be placed directly into the uterus. This is known as intrauterine insemination or
IUI. Clomid is a relatively inexpensive medication and because it is a pill,
it is easy to take. IUI is an inexpensive treatment that is no more uncomfortable than a PAP
smear. The advantages of this approach are ease and lower expense. The biggest downside to this
approach is that it only increases the chance for pregnancy by a small amount. Each month, Clomid
with IUI may give you a chance for pregnancy between 8 and 15%. The average is about 10%.
Let’s say 100 couples with unexplained infertility decided to try Clomid and IUI
four times. After 1 month, 10% of couples will have conceived, leaving 90 couples.
If all 90 attempt to use Clomid and IUI again, 10% of 90 means that 9 couples conceive in the
2nd month. After 4 months of treatment, about 35 out of the original 100 couples will have
conceived. The cumulative chance for pregnancy over 4 months is therefore 35%. In the USA,
the cost for a clomid IUI can range from a few hundred dollars to over
1000 dollars depending on where you live and what type of monitoring you use for ovulation.
With IVF, injections of fertility medications are used to mature a large number of eggs. The
eggs are aspirated from the ovaries and a single sperm is injected into each egg. Any resulting
embryos are kept in the laboratory for several days and if they grow and develop normally,
then they are frozen. After the following period, the uterus is prepared, an embryo
is thawed and placed into the uterus. For an average couple with unexplained infertility,
the chance for pregnancy on that single embryo transfer could be in the 40 to 50% range or more.
In other words, on average, more people become pregnant
from a single attempt at IVF than with four attempts with Clomid IUI.
This is great in theory but is there any real life data? Actually, there is! Several years
ago doctors in Boston conducted a study called the FASST trial. In this study,
doctors randomly allocated infertility patients to one of two groups . Group
1 did a traditional treatment where they started more conservatively with Clomid
and IUI . Group two went directly to IVF. They found that the IVF group was
able to get more people pregnant sooner than in the traditional treatment group.
Our infertility TV bottom line is this comma if you have unexplained infertility then there
are options to start more conservatively or more aggressively each option has its pros
and cons but the direct to IVF method will get more people pregnant sooner.