This document discusses and compares intrauterine insemination (IUI) and in vitro fertilization (IVF) as assisted reproductive technologies. IUI is described as a simpler, less expensive initial treatment option compared to IVF, which has higher success rates but also more risks and costs. The document provides guidelines on when each procedure is most suitable based on factors like infertility diagnosis, age, ovarian reserve, and prior treatment failures. It emphasizes shared decision-making between physicians and patients based on individual prognoses and preferences.

2. THE MOST WIDELY
USED ART’S
IUI &
IVF / ICSI

3. WHICH ONE WOULD YOU
CHOOSE
 Slow - track  Fast - track

4. MAIN INDICATIONS FOR
ART
IUI
 Oligospermia
 Cervical or
Immunological
factors
 Unexplained
Infertility
IVF
 Tubal Infertility
 Male Infertility
 Advanced Endometriosis
 Ovulatory disorders
 Unexplained Infertility
 Immunological Infertility
 Failed IUI Treatments
 Donation of eggs and
embryos
 Surrogacy

5. MAJOR DIFFERENCES
IUI
 Simple
 In expensive
 Usually started as
initial treatment
 Requires
comparatively
minimal drugs
 Usually uncontrolled
cycles
IVF
 Complex
 Expensive
 Usually considered as
final treatment
 Requires more drugs
 Mostly controlled
cycles

6. MAJOR DIFFERENCES (cont.)
 Risk of premature LH
surges
 Risk of OHSS
comparatively less
 Multiple preg risk higher
with multiple follicles
 Smaller follicles become
atretic & of no future
use
 Success rates
 10 – 15 % per cycle
 CPR – 40 % by 6 cycles
 Less emotional / financial
burden
 Risk of premature surge
eliminated
 Risk of OHSS 1 – 10 %
 20 % risk of multiple preg
Can be reduced by
 Set
 Blastocyst transfer
 Cryopreservation of
supernumerary embryos
 Future use possible
 Success rates
 40 % per cycle
 CPR – 80 % by 4 cycles
 More emotional / financial
commitment

8. WHAT TO DO WHEN
IN SITUATIONS OF
 Tubal factor
 Severe male infertility
 Advanced maternal age
 Young women with low ov.reserve
 Women keen to avoid
multiple pregnancy
 Unexplained infertility
 High response IUI cycles

9. IN CASES OF TUBAL
FACTOR
 IVF best option
 With unilateral healthy tube – few
cycles of IUI, when ovulates from
side of normal tube

11. SEVERE MALE INFERTILITY
 IVF / ICSI in severe oligoasthenospermia
 Minimal requirement
 For IUI : 10 – 15 million / ml (AM)
 PR 10 % per cycle
 For IVF : 2 – 3 million / ml (AM)
 For ICSI : few sperms

13. ADVANCED MATERNAL AGE
 Every intervention less likely to work in
elderly age > 35 yrs.
 IUI / IVF success rates decline with
age & halved down from 38
 To shorten time with less effective
IUI’s & to plan IVF at earliest

14. YOUNG WOMEN WITH
LOW OV. RESERVE
 Predictors of ovarian reserve
 FSH
 AMH
 AFC – less in no.
 Counsel & speed up treatments
 Plan for IVF early

16. PREVENTION OF MULTIPLE
PREGNANCY
 IUI with out drugs or with low stimulation
 IUI with classical doses of FSH
 High multiple PR &
 High order multiple births
 In IVF / ICSI
 1 – 2 ET safer

18. UNEXPLAINED INFERTILITY
 Majority do not conceive after initial specific
treatment
 Eligible for empiric treatment in form of IUI or IVF
The decision to be made by these couples
 When to start treatment
 What order more sensible ?
 When should they shift to more sophisticated &
costly treatment

19. DECISION PROCESS
(early or late)
 Should be in partnership with couple &
physician
 Proceeding for IVF may take longer if
IVF is not done in the same clinic
 A trend towards IVF may be sooner in
an IVF center

20. TREATMENT TIME - TABLE
 Expert can recommend time table according to
couple’s choice
 Treatment time table to slow-down or speed-up
according to patient’s needs
 Frequent traveller
 Couple staying at separate places
 Couple shifting to places where
 Treatment not available or
 More expensive

21. DECISION MAKING PROCESS SHOULD
NOT DEPART FROM EVIDENCE
BEST EVIDENCE SUMMARIZED
1. Unstimulated IUI : Does not significantly PR
2. CC / IUI : 5 – 7 % PR per cycle upto 7 cycles
3. IUI / Ovarian Stimulation : 15 – 17 % per cycle
 Risk of OHSS
 Multiple pregnancy
4. IVF : 7 – fold higher likely hood of pregnancy
(ESHRE capri work shop group, 08)
5. ICSI : better than IVF in couples with male infertility

22. PROGNOSIS
 couples should consider their chances of
spontaneous pregnancy
 Chances of spontaneous conception with out
treatment greater with shorter duration
of infertility
 The association of duration of infertility &
chances of conception - proportional

23. TREATMENT PLAN
 Controversies regarding :
 Order of treatment
 Effectiveness of stimulated IUI cycles in relation to
IVF / ICSI
 Management trials needed to evaluate :
 Success rates
 Availability of methods
 Adverse effects
 Satisfaction
 Cost, invasiveness of techniques &
 Likelihood of couple compliance

24. TRIAL COMPARING
IVF / IUI
1. Standard protocol
3 cycles of CC / IUI
3 cycles of IUI with FSH
& upto 6 cycles of IVF
 Clinical pregnancy – 64 %
2. Accelerated protocol
3 cycles of CC / IUI (no FSH / IUI)
& upto 6 cycles IVF
 Clinical pregnancy rate - 65 %

26. HYPERSTIMULATED OVARY

27. HIGH RESPONSE
IUI CYCLES
 Hyper response seen more often in
severe & resistant PCO
 High risk of OHSS & multiple pregnancy

28. HIGH RESPONSE
IUI CYCLES
OPTIONS
 Cancel cycle
 Aspirate few follicles & continue with
IUI
 Rescue cycle & plan for IVF

29. HIGH RESPONSE
IUI CYCLES
WHEN CONVERTED TO IVF
1. OR – 1-2 ET or
2. Cryopreserve all embryos & measures to
reduce risk of OHSS
 Avoids complete cancellation of cycle &
 Comparable PRS with standard IVF
protocols

31. COUNSELLING COUPLES
couples need information about
 Prognosis
 Success rates &
 Order of treatment

32. POINTS TO REMEMBER
 Where IVF is affordable, IUI is unnecessary
 Potentially IVF a premature choice
 In younger women &
 With unexplained infertility of < 3 yrs
duration
 Success rates in IVF much higher than before
 Success rates with stimulated IUI have not
changed much

33. COST EFFECTIVENESS
 Starting treatment with IUI rather
than IVF
 More cost effective in unexplained &
persistent infertility
 Primary offer of IVF
 In male infertility &
advanced maternal age

34. CONCLUSIONS
 In good prognosis couples, PR s better with
out treatment
 IUI widely used except in
 Bil. Tubal blocks
 Severe male infertility &
 Severe Ov. defects
 Although IUI treatment cheaper & less
demanding, IVF most effective
treatment

35. BE – AWARE OF CHANGE
 Attitude of patients
 Low patience
 Apprehensive
 Worried about side effects, future
 Waiting time
 For conception &
 Wait in clinics
 Don’t drag until
 Ovarian
 Physical
 Emotional &
 Financial exhaustion