Tuesday, December 15, 2015

IUI versus IVF for patients with unexplained infertility

 Patients with unexplained infertility are not sure whether to do IUI or IVF. Both options are applicable for them, but each of them has their pros and cons, and they're quite confused as to which one is the right one to select. Thus, IUI has a lower pregnancy rate, but is less expensive; with IVF, the pregnancy rate is much higher, but it's more expensive and more stressful because it involves more injections. Patients are often confused , and don't know how to decide.

Now, if they go to a gynecologist, the standard advice  is to do IUI , because gynecologists don't do IVF. If they go to an IVF specialist, often IVF clinics prefer doing an IVF because the pregnancy rate is better, and patients get pregnant more quickly ( and they make more money as well !)

However, this is not a decision which should be made by the doctor. It's a decision which should be made by the patient, and they need to weigh the pros and cons for themselves. Thus, for an older patient, it's perfectly sensible to take a shortcut and go to IVF directly, especially when finances are not a constraint.  However, for younger patients, IUI is a more sensible approach. However ,patients should design a treatment plan, and if they don't get pregnant in 3 IUI cycles, they should be willing to move on to doing IVF.

Sadly, gynecologists keeps on doing IUI after IUI, and refuse to refer the patient to an IVF specialist. Even when the patient changes doctors, the new gynecologist insists on repeating IUI cycles again, because he feels that the earlier doctor didn't do a good job. This kind of mindless repetition wastes a lot of time and money, and patients get fed up and frustrated. After 3 IUI cycles, they have reached the point of diminishing returns, and because the probability of a pregnancy has dropped, IVF is often a more cost effective option, as compared to doing another IUI cycle.

Conversely, we see IVF specialists who are extremely aggressive, and advice IVF straight away, without explaining the IUI option to patients . This is also not a balanced approach, which is why patients need to do their own homework, so they understand the doctor's biases, and can select the treatment which is right for them, given their personal preferences. This involves a lot of intangibles, and there is no easy right answer - one size never fits all in medicine !

IVF is often more cost-effective ( cost per baby)  than multiple IUI cycles, especially when you factor in emotional costs and the passage of time. It's true that some patients would get pregnant if they did more IUI cycles, but the truth is that every IUI cycle exacts an emotional toll , which is why IVF is a better option, because it has a higher success rate. It also allows couples to enjoy parenting more, because they are younger and have more energy to bring up their baby.

Our patients often say; "Maybe we would get pregnant if we tried more insemination cycles, but we're tired of this, and it is getting expensive. We just want a treatment with high success rates, which is why want to do IVF now."

So should all couples with unexplained infertility just do IVF directly ? Of course not. But some couples would benefit from doing IVF sooner rather than having more tests and more IUI cycles .

 As IVF success rates continue to improve over time, many couples are considering IVF treatment sooner than in the past.

You can check out the free IUI vs IVF comparison tool at http://www.ivf.com.au/fertility-treatment/iui-vs-ivf-comparison-tool

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

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