Understanding Embryo Grading & How Embryologists Grade Embryos
Embryologists and fertility doctors need an objective assessment guide to help them decide on the best embryos, the ones most likely to result in a pregnancy and a healthy baby, to transfer during the process of in vitro fertilization (IVF).
The number and quality of embryos a fertility doctor transfers influence the procedure's success rate. Transferring low-quality embryos may cause uterine implantation failure and ultimately hinder pregnancy.
This article discusses embryo grading, its criteria, the various grading systems available, and the role of embryo grading in IVF success rates.
What is Embryo Grading?
Embryo grading is a scoring system used by embryologists or fertility doctors to determine the quality of embryos before their use in treatment. Embryo grading provides the clinic with a priority guide as to which embryos to transfer.
During IVF, eggs are artificially inseminated inside the laboratory. After successful fertilization, the fertilized egg divides and grows to become an embryo. Before the embryos are utilized, the embryologist conducts a quality assessment using an embryo grading system. This grading system allows the embryologist to determine which embryos should be used for treatment and which should not be.
Is Embryo Grading Beneficial?
A study published in the US National Library of Medicine revealed that embryos with a higher grade had better clinical pregnancy and live birth rates compared to those with a poor grade.
Apart from an embryo grade, factors such as the genetic makeup of the embryo, laboratory conditions, experience, and skill of the fertility expert can influence the overall success of an IVF treatment. Genetics is the gold standard for embryo choice and truly drives success.
Notwithstanding, embryo grading still plays a role. Selecting only good-quality embryos provides the best opportunity that an embryo will be able to endure various types of possible treatments (e.g., PGT biopsy, cryopreservation, and thawing).
"Preimplantation genetic testing (PGT) is a more objective test while embryo grading comes from an embryologist’s subjective opinion," according to an Advanced Fertility Care embryologist. In recent times, PGT has taken over because we know that it is far more important than my subjective opinion," the embryologist further explained.
Criteria for Embryo Grading
A few hours after fertilization, the fertilized egg or zygote starts dividing to form a mass of cells that develops gradually into an embryo. The embryo cell number progressively increases within the first few days.
The embryo cell number should be 2-4 cells after 48 hours and up to 7-10 cells by 72 hours. Embryos are most commonly cultured to the blastocyst stage, which occurs between the 5th and 7th day of culture.
There are different embryo grading systems, each focusing on specific characteristics of the dividing cells or blastocysts.
The IVF embryo grading system focuses on the following features:
- degree of fragmentation and symmetry
- the expansion rate and hatching of the blastocysts
- inner cell mass
- trophectoderm (a group of specialized tissues that differentiate and form the outer cell layer of a developing embryo.)
Generally, embryologists use the grading system based on the blastocyst expansion, inner cell mass, and trophectoderm for day five embryo grading. While day three embryo grading is typically based on the degree of fragmentation and symmetry.
Here are the common embryo grading systems most fertility clinics use to assess embryo quality before its transfer into the uterus for implantation.
Embryo Grading Based on Blastocyst Expansion and Hatching
Fertility specialists use the expansion rate of the dividing cells to score the embryo. It is also a numeric scoring system, and each embryo receives a score from 1-6.
The following is the numeric scoring system and its description using the blastocyst expansion and hatching feature:
- 1: Blastocyst development and stage status
- 2: Blastocoel cavity occupying more than half the volume of the embryo
- 3: Full blastocyst with cavity completely filling the embryo
- 4: Expanded blastocyst with cavity larger than the embryo and thinning of the zona pellucida
- 5: Hatching out of the zona pellucida
- 6: Hatched out of the zona pellucida
Embryo Grading Based on Inner Cell Mass
The inner cell mass is the group of cells in the developing embryo that transforms to produce the cellular structures that form a fetus.
Embryo grading using the inner cell mass is an alphabetical scoring system and includes the following:
- A: Many cells, tightly packed
- B: Several cells, loosely grouped
- C: Very few cells
In this system, the quality of the inner cell mass reflects the quality of the embryo.
Embryo Grading Based on the Trophectoderm
A trophectoderm is a group of cells that are the first to differentiate and form the outer cell layer of a developing embryo.
Embryo grading using the trophectoderm entails:
- A: Many cells forming a cohesive layer
- B: Few cells forming a loose epithelium
- C: Very few large cells
In this system, the embryologist uses the quality of the trophectoderm to assess the quality of the embryo.
Significance of Grades in Predicting IVF Success
Our embryologist also noted that: "just because an embryo looks good doesn't mean it's genetically normal, and just because it is a grade B doesn't mean it isn't normal. Today we use embryo grades as a way to demonstrate why an embryo was chosen to biopsy and/or freeze. The reason we do this is that poor quality embryos can't survive a biopsy and they also cannot survive the freeze and thaw process either."
Embryos with good grades have the potential to increase the chances of achieving pregnancy during an IVF treatment. In contrast, poor-quality embryos may fail to implant into the uterus, inevitably limiting IVF success.
Therefore, embryo grading provides fertility experts with the tool to make objective clinical decisions on the embryos to transfer.
Understanding Your Embryo Grade Results
Embryo grading will begin on day five. The embryos will be graded each day between day 5 and day 7. Any embryos deemed to be good quality will be utilized in treatment that day.
Any embryos that are not chosen are allowed to continue to develop until day 7. The IVF lab routinely expects that approximately 50% of the embryos in culture will make good-quality embryos for use.
Interpreting Your Embryo Grading Report
Embryologists typically assign alphanumeric scores, such as 1AA, 2BA,3BC, etc., to embryos to indicate the quality level.
The following are possible embryo grade scores according to their exhibited degree of blastocyst expansion, inner cell mass, and trophectoderm grades:
- High-quality embryos: ≥3AA
- Poor quality embryos : 1–6BC, 1–6CB, 1–6CC
Of note, these embryo grades alone do not indicate failed IVF treatment. Other factors, such as an embryo's genetic makeup, medical history, or age, among other things, also affect your chances of achieving IVF success and pregnancy.
Do You Need Help with IVF Treatment?
Embryo grading is one of many tools that provides crucial information to fertility doctors to enable them to select suitable embryos for transfer. Transferring poor-quality embryos can reduce the success rate of IVF treatment.
If you intend to go for IVF treatment, consult an experienced fertility doctor and learn more about their embryo grading process.
Our team at Advanced Fertility Care has proven experience with IVF, and we use standardized embryo grading methods to assess quality before embryo transfer.
If you want to learn more about our process and IVF treatment, contact us or schedule an appointment with our team today. We look forward to supporting you in starting or building your family using IVF.
Infertility Resources & Support
Why Male Infertility Evaluations Are So Important
All genders can contribute to infertility. Early evaluation of the male partner is a common starting point when investigating fertility struggles.
Why is Early Male Evaluation Important?
Male fertility evaluations are important for identifying potential fertility issues, ruling out medical conditions, planning appropriate treatment, and providing emotional support for couples struggling with infertility.
Early evaluation answers some crucial questions:
- Is the male a factor in the couple's infertility?
- Can the male benefit from treatment? (About 20% respond to treatment)
- Are assisted reproductive technologies (ART) indicated?
Male Fertility Testing
Male fertility testing includes a thorough review of your history, a physical exam, and a semen analysis. The most important lab indicator is the semen analysis. Because up to 15% of infertile men may have chromosome abnormalities or other genetic defects that can be transmitted to their offspring, the analysis may include genetic screening.
Guide for Treatment
A male fertility evaluation can help to determine the appropriate treatment for infertility. Treatment options may include lifestyle changes, medication, surgery, or assisted reproductive technologies such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intractyoplasmic sperm injection (ICSI). Understanding the underlying cause will help determine the best path forward and will guide your individual treatment plan.
Connect with our team today to start your journey to parenthood.
What is ICSI and Do I Need It?
What Is ICSI?
Intracytoplasmic sperm injection (ICSI) is a laboratory technique that offers a pathway to a successful pregnancy for couples with little hope of reproducing naturally or with IVF alone due to significant sperm issues. ICSI is the most used method that is a critical part of assisted reproductive technology. Its use accounts for 70% to 80% of the IVF procedures performed.
For sperm to fertilize an egg, the sperm's head must attach to the outside of the egg. It then must break through to the inside, where fertilization takes place. If the egg's outer layer has become hardened or thickened, or if the sperm is abnormal and cannot swim effectively, it will be difficult for the sperm to penetrate it.
Standard IVF vs. ICSI
In an IVF procedure, an egg is fertilized in a laboratory dish. Healthy sperm collected from the patient's partner or a selected donor is added to the dish to surround the egg. The sperm will naturally fertilize the egg by attaching itself to its outer membrane and breaking through into the egg. The fertilized egg (embryo) is transplanted into the uterus when it reaches a certain stage of development approximately five to six days after fertilization. If it implants into the lining of the uterus successfully, a pregnancy results.
There are times, however, when surrounding the egg with sperm in the dish may not result in fertilization. Based on the circumstances or results of a prior semen analysis, doctors may opt for ICSI to help improve fertilization success. This procedure can frequently solve the issue of male factor infertility or poor fertilization in IVF cycles. ICSI is essentially an extension of IVF that works to control some of the variables that affect fertilization and increases the chances of an embryo resulting in pregnancy.
How Is ICSI Performed?
ICSI is performed in conjunction with in vitro fertilization (IVF). Patients will undergo egg retrieval, and the egg will be injected with a single sperm in the lab through the process of ICSI with the hope of growing into a healthy embryo to be transferred to the carrying uterus.
Steps for Egg Retrieval
To prepare for egg retrieval, patients administer hormonal injections to stimulate the ovaries to produce multiple eggs for an average of 10 days, followed by an injection of human chorionic gonadotropin (hCG) or leuprolide acetate to assist in the eggs' final maturation.
When the eggs are ready for actual retrieval, a transvaginal ultrasound guides a thin needle through the vaginal wall into the ovary, then suction draws out and collects the eggs. This is performed under anesthesia and is a relatively short procedure lasting 10-20 minutes.
Unless frozen sperm is used, it is collected on the same day that egg retrieval occurs. The person supplying the sperm must collect ejaculate into a lab-provided container and deliver it to the lab within 30 minutes. The semen is analyzed for volume, mobility, and quality.
The ICSI Procedure
The ICSI procedure is performed with these steps:
1. The embryologist holds the mature egg in a lab dish using a small glass tube equipped with a suction bulb.
2. Using a thin needle, a single sperm is immobilized and picked up.
3. The needle is inserted into the egg.
4. The sperm is injected directly into the egg.
5. The needle is withdrawn.
Now the waiting begins.
After the ICSI Procedure
Following the completion of the procedure, the embryology team monitors the embryos' progress to look for signs of successful fertilization. Cell division should begin within one day if the fertilized embryo is healthy. In many cases, the embryos are grown for five to six days, and at this point, if the patient elects to have preimplantation genetic testing performed (PGT) this is when the surviving embryos are biopsied (cells removed and sent for additional testing) and then frozen.
If a fresh embryo transfer is performed, the developing embryo will need to grow appropriately for at least three to six days. When it is ready to transfer, a long, thin tube (catheter) is inserted through the vagina into the uterus under ultrasound guidance to inject the embryo into the uterus. The embryo must implant in the uterine lining for pregnancy to occur. If PGT testing is being performed, a frozen embryo transfer will be performed at a later date.
Who May Benefit from ICSI?
Male factor infertility is one of the causative factors in over one-third of male infertility cases. It usually results from complications in the sperm's production or delivery. In such a case, ICSI would be high on the list of options to overcome infertility. A man who has undergone a vasectomy reversal would also be a candidate for this procedure, even if the sperm is healthy otherwise. Other examples of infertility that may be helped through the ICSI procedure include:
• Abnormal sperm motility. This references the sperm's ability to move effectively.
• Low sperm count. The male partner doesn't produce enough sperm for a successful attempt using artificial insemination or IVF.
• Infertility that cannot be explained.
• The semen lacks sperm because of a blockage in the reproductive tract of the male.
• The sperm is unable to attach to an egg.
• Traditional IVF has been unsuccessful, even with fit sperm.
• The eggs used were matured in vitro.
• The eggs were frozen before use.
Even when it isn't specifically indicated, some physicians may choose to use ICSI when appropriate.
What Are the Risks of ICSI?
Compared to conventional IVF, some studies of the ICSI procedure suggest a possible connection between ICSI and an increased risk for intellectual delays, autism, chromosomal abnormalities, and birth defects such as Beckwith-Wiedemann syndrome, hypospadias, Angelman syndrome, and sex chromosome abnormalities. These are rare, occurring in less than 1% of babies conceived through ICSI with IVF. Other possible risks include:
• Ovarian hyperstimulation syndrome in response to excessive fertility drugs
• Multiple births, either twins or triplets
• Increased risk of premature labor and low birth weight
• Slight increase in risk compared with IVF
• The need for a cesarean section for delivery is slightly increased
On average, fertilization occurs through ICSI in 70% to 85% of cases. The rate of live births reflects the number of healthy children born following an IVF/ICSI cycle. These success rates are classified based on maternal age and will often vary due to additional factors affecting the eggs and sperm.
Take the First Step
If you'd like to learn more about IVF, ICSI, or other fertility treatments that may be a solution for you, contact the infertility specialists at Advanced Fertility Care to set up a consultation.
Can I Use My Own Eggs for IVF After 40 Years Old?
Deciding to start a family is an exciting yet highly personal decision. Many people delay trying to get pregnant until later in life. You may have decided to wait because of your career, life goals, relationship status, or simply because you weren't ready.
If you're over age 40 and want to get pregnant, you likely have questions about your chances of pregnancy. Fertility treatments, like in vitro fertilization (IVF), can help couples and individuals finally become parents. However, how do you know if you should use your own eggs or when to consider donor eggs?
In this article, we'll look at some challenges of getting pregnant after 40 and when to consider an egg donor.
The Challenges of Getting Pregnant After 40
Being over 40 doesn't mean you can't build the family you desire. However, fertility does decline with age. So, if you're struggling with infertility, you're not alone.
Statistics show that the odds of getting pregnant decrease significantly as time goes on. The chances of getting pregnant naturally each month for women over 40 are only about 5%. About 22% of all women struggle with infertility after age 35, and up to 29% by 40. Over 40, the likelihood of a successful pregnancy decreases every year, so it would make sense not to delay any attempts at conception and to pursue a fertility evaluation and treatment early on.
So why, exactly, does fertility decrease as time goes on? There are several reasons this occurs.
Uterine, Hormone, and Menstrual Changes
Issues like endometrial polyps and fibroids can increase with age, potentially contributing to infertility. Decreased ovarian sensitivity to certain hormones can also play a role, as well as changing hormone secretion levels.
Diminished Ovarian Reserve
However, the main reason women struggle more over age 40 with fertility is the natural decline in both egg number and egg quality. Every woman is born with a limited supply of oocytes (immature eggs), which she will have for her lifetime. Women typically have 1-2 million oocytes at birth. The amount of eggs decreases with age, falling from 500,000 by puberty to 25,000 around age 37.
Some women may experience a low egg count, also known as diminished ovarian reserve. While all women have some decline in fertility with age, for some, it happens sooner than for others. If there are a lower number of eggs in your ovarian reserve, it could decrease your odds of conceiving. However, your egg count is not the only factor in fertility.
How do you know if you have a low ovarian reserve? Usually, there are no symptoms other than having difficulty getting pregnant after trying for months or even years. Some people can experience irregular menstruation, hot flashes, and vaginal dryness. Low egg count can be caused mainly by aging but also by some cancer treatments or autoimmune disorders.
The quality of your eggs also contributes to infertility. As a person ages, the eggs that are ovulated are more likely to be genetically abnormal, which of course, means that it will be more difficult to achieve pregnancy. Since the quality of your eggs is closely tied to how genetically normal they are, having a high number of abnormal eggs makes it harder, on average, to end up with a normal egg that can fertilize and end with the successful birth of a child. This is also why we see higher miscarriage rates as women age.
Despite these challenges, there are also effective ways to treat infertility and achieve pregnancy after 40.
Paths To Getting Pregnant After Age 40
At Advanced Fertility Care, we offer several fertility treatments to help you start a family.
Intrauterine insemination (IUI) is a treatment where sperm are collected from either a donor or a partner, then isolated, washed, and concentrated. Then, they're placed into the uterus around the time of ovulation. Typically, our patients undergo treatment with fertility drugs in combination with IUI. This is meant to help bodies ovulate more than one egg each cycle, giving you more chances that month of getting pregnant. While IUIs have a lower success rate than in vitro fertilization, that does not mean IUI won't work for you even if you're over 40. For those at 40, IUI is considered to have about an 8-10% success rate compared to 15-20% success found with IVF.
In Vitro Fertilization
In vitro fertilization (IVF) is another method that involves fertilizing eggs with sperm in a laboratory, then transferring the best resultant embryo into the uterus using a thin tube. First, eggs are extracted from the ovaries, typically after taking fertility medications. The eggs are then isolated and fertilized in a laboratory, becoming embryos.
One of the real advantages of IVF is what is known as preimplantation genetic testing or PGT.
• With PGT, a few cells from the part of the embryo that eventually becomes the placenta are removed and sent for genetic (chromosome) testing.
• With PGT, we can identify which embryos have the right number of chromosomes and which ones have an abnormal number of chromosomes. If an embryo has an abnormal number of chromosomes, it won't result in a pregnancy, or if it does, it would be very likely to miscarry.
• PGT also helps us identify embryos with an abnormal number of chromosomes that can result in a live birth. The one everyone is aware of is Down Syndrome. This type of thing is seen more often in women over 40.
Suppose we can identify an embryo that is chromosomally normal with PGT. In that case, your success rates can be as high as 70% when you have your embryo transfer, and you have to worry less about things like Down Syndrome during pregnancy. Success rates aren't 70% for everyone with IVF because many patients will do the IVF but won't end up with any normal embryos.
IVF can have excellent success rates. However, the success of IVF often depends on factors such as egg quality and your response to ovarian stimulating medications. So how do you know when to consider using donor eggs instead of your own?
When Should You Consider Donor Eggs?
It's entirely possible to get pregnant using your own eggs over 40. Yet, for some people, there seems to be an egg quality or quantity issue that we can't overcome. This is especially true for women over age 43 or 44. Donor eggs in this situation could greatly increase the chances of getting pregnant through IVF.
It may be worth considering using an egg donor, especially if you have a diminished ovarian reserve or demonstrated poor egg quality. Ovarian reserve testing is one way to estimate whether your ovaries match your age which would give us a good indication of how you might respond to fertility treatment. Some testing results might indicate that it is unlikely that fertility treatment will increase the chances of you getting pregnant using your own eggs.
At Advanced Fertility Care, we offer an in-house Donor Egg program which provides those in need of an egg donor a variety of high-quality egg donors available for matching. Preview our available egg donors here.
Ovarian Reserve Testing
Ovarian reserve testing can help determine how many eggs you may have left. Screening for diminished ovarian reserve can tell you whether the ovarian stimulation medications used in IVF treatments might work for you. A low egg count could mean your ovaries won't respond as well to these treatments, decreasing your chances of pregnancy.
Ovarian reserve testing can also help guide your decision to undergo fertility treatments, as it may suggest how likely you'd be to get pregnant without some kind of fertility treatment.
To test your ovarian reserve, your provider performs blood tests to assess your levels of certain hormones. Your provider may also perform a vaginal ultrasound to look at your ovaries and count the number of follicles you have. The number of follicles you have in your ovaries at the beginning of a menstrual cycle represents the number of eggs that are available to your body for fertility treatments. The higher the follicle count, the more eggs we have to work with.
While ovarian reserve testing doesn't definitively say whether or not you'll be able to conceive, it can help you decide if using an egg donor may be a better option than pursuing an IVF cycle with your own eggs. If the tests reveal a diminished ovarian reserve, you may consider using a donor to increase your chances of getting pregnant through IVF.
Advanced Fertility Care is Here to Support Your Fertility Journey
No matter your situation, our caring and professional team at Advanced Fertility Care is here to support you in getting pregnant. We offer IUI, IVF, a donor egg program, and more. Building a family is within reach, even if you're over 40.
To learn more or to schedule a consultation, contact us today.
Infertility Resources & Support
Top Frequently Asked Questions About PCOS
Polycystic Ovarian Syndrome, or PCOS, is a common disorder that can contribute to infertility and long-term health risks. If you think you may be dealing with symptoms of the disorder, you're certainly not alone. In fact, as many as 12% of women of reproductive age in the U.S. live with PCOS.
If you have PCOS, you may have many questions about the condition, its treatment, and what it might mean for your chances of getting pregnant. In this article, we'll answer some common questions about PCOS.
What Is PCOS?
PCOS is a multi-system disorder affecting many women of reproductive age. The cause of the disorder is unknown, but people with PCOS commonly exhibit imbalances in certain reproductive hormones, such as androgens. As the name implies, people with PCOS often have large numbers of follicles which are the small egg-containing cysts found in the ovaries. During a normal menstrual cycle, your ovaries mature and release an egg every month. Due to the effects of PCOS, your ovaries may be unable to make or release an egg regularly. This can result in infertility issues.
What Are the Symptoms of PCOS?
PCOS symptoms vary between individuals and can range from mild to severe. Many people may experience irregular periods, erratic ovulation, infertility, oily skin, extra hair on the face or body, hair loss on the scalp, and weight gain. More recently, PCOS has been linked with depression or mood disorders. Some people with PCOS are overweight, although people who are not overweight can have it also. Being overweight can make the signs and symptoms of PCOS worse.
A common problem in people with PCOS is insulin resistance (more on this below). People with insulin resistance can often find darkening of the skin along creased areas like the groin or neck can occur, as well as the development of skin tags.
Who is at Risk for PCOS?
The condition affects women of all ethnicities and can develop at any time during reproductive years or any time after puberty. The precise cause of PCOS is unknown. However, you may be at higher risk if you have a family history of the disorder.
As noted above, people with PCOS often have insulin resistance. People with insulin resistance can make insulin, but their cells don't respond to insulin as they should. As a result, insulin levels in the body may increase. This can cause the ovaries to produce higher levels of a group of hormones known as androgens which causes some of the symptoms of PCOS like unwanted hair growth.
In addition to PCOS, other factors can contribute to insulin resistance such as being overweight, having an unhealthy diet, or a family history of diabetes. These people can see a worsening of their symptoms of PCOS. It's important to take action if you have high insulin or blood sugar levels since this may increase your risk of developing diabetes.
How Is PCOS Diagnosed?
Since PCOS is a syndrome with many different signs and symptoms, not all experts agree on the criteria to diagnose PCOS. The three most commonly used criteria are seen here.
As you can see, some criteria rely on blood tests, others rely on ultrasound, and still, others emphasize signs and symptoms. Therefore, your doctor may perform an exam and discuss your medical history to diagnose PCOS. They may perform a pelvic ultrasound to examine your ovaries and do blood tests to determine your hormone levels. These exams and tests will help rule out any other possible causes of your symptoms.
How Is PCOS Treated?
There is no total cure for PCOS. But fortunately, you can take steps to manage or improve your symptoms. Getting adequate exercise, managing your weight, and eating a healthy diet can all help. You may also be able to take medication to lessen physical symptoms, like hair growth and acne. Making lifestyle changes can lower your long-term risks like type 2 diabetes.
It's not easy to hear that you may have PCOS, but you can talk to your doctor about how to lessen your symptoms. Some simple lifestyle changes may improve things.
Can You Get Pregnant if You Have PCOS?
It's possible to get pregnant if you have PCOS. While PCOS can cause infertility struggles, there are a few things you can do to increase your chances of pregnancy.
Having irregular ovulation will make it harder to track the fertile phase of your menstrual cycle. Even so, you could still be able to get pregnant naturally. If this doesn't happen, there are fertility treatment options available.
Can Fertility Treatments Help You Get Pregnant With PCOS?
Absolutely! If you're having trouble getting pregnant, one possible option is in vitro fertilization (IVF). During this advanced fertility treatment, a doctor extracts your eggs, fertilizes them in a laboratory with collected sperm, and transfers the fertilized egg into your uterus. IVF bypasses the fallopian tubes, enabling a fertilized egg to be placed directly into your uterus, where it can implant. IVF can be an effective choice for many people, including those with PCOS, endometriosis, or damaged fallopian tubes.
However, many patients don't require IVF to get pregnant.
Reducing insulin resistance by lifestyle changes or medication can often result in more regular ovulation and pregnancy. Another alternative is ovulation induction with intercourse or intrauterine insemination (IUI). For this procedure, you take fertility drugs to induce ovulation before having intercourse or undergoing artificial insemination so that your eggs can become fertilized.
Does Having PCOS Increase Your Risk of Pregnancy Complications?
If you have PCOS, there can be some increased risk of certain complications like gestational diabetes and preeclampsia during pregnancy. However, this does not always happen, and you can reduce your risks by maintaining a healthy weight and making sure your blood sugar levels are normal before trying to become pregnant.
No matter your situation, the team of caring professionals is here to support you on your fertility journey. We would be glad to answer any questions you may have about PCOS, infertility, and fertility treatment options. Explore our website or schedule a consultation with our experts today if you'd like more information.
How to Decide Between IUI and IVF
Millions of Americans are impacted by fertility challenges each year. The National Institutes of Health (NIH) estimates that roughly 9 percent of men and 11 percent of women have had fertility problems of varying severity. These fertility struggles may get in the way of people’s dreams, and they can have a devastating impact, if left unaddressed, on both individuals’ and couples’ mental and emotional health. Fertility challenges may not be the only reason people consider fertility treatments. For example, many people who are single by choice, as well as LGBTQ+ couples, may see fertility treatments as their best road to building their family.
Fertility Treatments Are Available To You
If you’re struggling to conceive, the good news is that there are treatment options available that could help you realize your dreams of parenthood. Two of the most common treatment choices are intrauterine insemination and in vitro fertilization. In this article, we discuss these two fertility treatment options in greater detail and compare the pros and cons of each one while recognizing that patients’ ultimate decisions are highly personal.
What is IUI?
Intrauterine insemination, also referred to as IUI, is an increasingly popular fertility treatment that can be used as an initial intervention when people have trouble trying to conceive. One of the selling points of IUI is that it is dramatically less expensive than a treatment like IVF. Even though IUI treatments often include medications, like Clomid, to encourage ovulation, many see it as a less intensive or invasive treatment than IVF. You may find yourself wondering what happens in IUI. The answer is quite simple. Washed sperm from a partner or a donor will be inserted directly into the uterus. This means that the sperm will have less distance to travel to meet a released egg, and hopefully, it means that the likelihood of a pregnancy increases. IUI is a common first step for many couples struggling to get pregnant, single parents by choice, or others using donor sperm.
Although you may not need a highly qualified reproductive specialist for a successful IUI, there are many reasons why you might consider working with one. This way, you will have an established relationship with a fertility physician if you need to consider other interventions down the road. A reproductive specialist can also provide any necessary testing to help you determine why you may be experiencing challenges on your fertility journey. Many find that an initial evaluation from a fertility specialist can provide a fuller picture of their fertility status and better understand their best options to move forward.
What is IVF?
IVF, or in vitro fertilization, is a well-known type of assisted reproductive technology (ART) that’s helped thousands of people worldwide have the family of their dreams. IVF involves fertilizing eggs in the laboratory and transferring created embryos to a uterus. The process involves extracting eggs, retrieving a sperm sample, and combining an egg and sperm in the laboratory to help fertilization and embryo creation.The first step in an IVF cycle is ovarian stimulation, which is where synthetic hormones are injected to stimulate the ovaries so that they can produce multiple eggs. Once the eggs mature, it’s time for follicular aspiration, also known as egg retrieval, when a needle is inserted into one or both ovaries to retrieve the eggs. After that, the egg is fertilized with sperm provided by a partner or donor. Once this has happened, medications are administered to the person planning to carry the pregnancy to prime the environment for a healthy pregnancy. The embryo is then transferred into the uterus. If any other embryos were created, they may be frozen and kept in storage for future use.
What Are the Main Differences between IVF and IUI?
There are multiple differences between in vitro fertilization and intrauterine insemination. A few of the most significant differences are highlighted below:
#1 The Extensiveness of the Process
IVF is considered more involved and has more stages in the process than IUI. This includes egg retrieval, which can be uncomfortable or painful for the patient. Many of these steps happen in a laboratory before the embryo is transplanted back into the uterus.
#2 What Is Treated
As we will explore in more detail below, there are some situations in which IUI may be appropriate, and there are others where providers may recommend IVF. Remember, everyone’s fertility journey looks different, depending on numerous factors, and there is no single perfect answer for everyone.
#3 How Much It Costs
The price of IVF and IUI may vary depending on where you live and various factors. IVF is usually costlier than IUI. Depending on the clinic you are using and the accompanying treatments you may need, IUI may cost less than $1,000 per attempt, and IVF is estimated to cost between $15,000 and $30,000 per attempt. This price differential explains, at least in part, why some doctors recommend starting with intrauterine insemination as an initial fertility treatment.
#4 The Length of the Process
There is no easy or perfect answer for how long it will take someone to get pregnant. Some medical experts suggest that your success rate with IUI will be about 15 to 20 percent per try. However, your odds jump significantly if you decide to go the IVF route. In this case, your likelihood of a successful overall outcome is between 30 and 60%, depending on the woman's age. The chance of a successful pregnancy from one round of IVF can vary depending on the underlying source of infertility. For example, advanced maternal age, which describes people over the age of 35 during pregnancy, may be one factor that significantly lowers the success rate. Although these factors impact many people's decisions when discussing their treatment options and plan, there is also a psychological and emotional toll to every cycle without a successful pregnancy to be carefully considered.
When Is IUI a Better Choice than IVF?
As stated above, IUI is less expensive than IVF treatment. However, there are two caveats here. First, the budget should never be the sole determinant of your reproductive health. It is important to talk to skilled fertility practitioners and see what they recommend for your unique circumstances. Second, the attractive prices quoted above were for a single round of IUI. However, given the relatively low success rate per cycle, many patients need to undergo multiple treatment rounds, and the cost can accumulate cycle after cycle.In addition to very valid cost considerations, some other factors could nudge you to consider IUI. If, after testing, doctors are still unsure about the source of your infertility, then this treatment option could be a good starting point. If it does not work, you can always move to another option, like IVF. It may be a good idea to discuss how many cycles you are willing to try before changing your approach with your provider ahead of time. This can help with future decision-making when in the midst of fertility treatment. Also, IUI can be a great option if the fertility challenges you're experiencing have been determined to be caused by sperm motility issues. The IUI process puts the sperm and the egg in much greater proximity, upping the likelihood of success. However, this may only be effective if the motility reduction is mild or moderate. More severe cases of sperm motility issues may require a greater amount of intervention, such as IVF or ICSI.
When Is IVF a Better Choice than IUI?
Even though IUI is an excellent choice for many people, especially those with unexplained infertility, it may not help everyone achieve the family of their dreams. In these cases, it might be time to consider IVF. For instance, if fertility testing shows that the source of infertility is fallopian tube scarring, IVF might be a better choice. This creates an issue because the egg cannot make it to the uterus for fertilization. IVF treatment bypasses this issue by uniting the sperm and egg in the controlled environment of a laboratory dish. IVF treatment also allows for the opportunity to utilize genetic testing. With Preimplantation genetic testing (PGT), medical professionals can test embryos for a wide range of genetic and chromosomal conditions and only implant the healthy embryos. In many cases, undergoing IVF with PGT can significantly increase the chance of having a healthy baby. Another reason why IVF may be a better choice is if sperm quality and/or motility are very low. The controlled environment of a lab with IVF may be the only way to achieve fertilization. However, even placing the sperm closer to the egg, like with IUI, may not be enough to achieve fertilization. In some cases, it may be recommended to utilize intracytoplasmic sperm injection or ICSI. During ICSI, a single sperm is directly injected into the egg, which can greatly improve the fertilization rate. IVF may also be recommended for someone dealing with endometriosis or if the patient has experienced multiple miscarriages at any stage of pregnancy.
Reach Out to Advanced Fertility Care
At Advanced Fertility Care, our highly qualified team of medical specialists prides itself on being the best at helping people realize their dreams of parenthood. Set up your initial consultation today to learn how our team can guide you in this journey. We understand that everyone’s fertility journey is unique, and we will work with you to set up a treatment plan that transforms your dreams into reality.