Unexplained Infertility: Do I Need IVF or IUI?
From Dr. Paul Gindoff of Chelsea Fertility NYC
After completing a standard workup and evaluation, approximately one-third of women carry a diagnosis of unexplained infertility, also referred to as idiopathic infertility. Essentially this means that a clear-cut cause, such as a blocked fallopian tube, cannot be identified for the conception delay. However, unexplained infertility does not mean that there is no actual reason why a patient is unable to conceive.
This may seem confusing, but imagine that the male partner’s sperm count is normal upon testing (i.e. complete sperm analysis), but the sperm don’t function normally. That is, the test results are normal, but there still is a problem that needs to be discovered and treated.
Using IUI with unexplained infertility
IUI (intra uterine insemination) requires open and fallopian tube, occurring in an ovulatory setting (either natural or with medications). IUI uses sperm that falls within normal parameters, or can be reconstituted by swim up lab techniques to approach acceptable parameters. In this situation, there are some assumptions: functioning fallopian tubes and functioning sperm.
Unfortunately less than half of all women with this diagnosis under optimum circumstances including age under 35 years, will ultimately conceive with IUI as such.
Using IVF with unexplained infertility
The next step in treatment would be IVF (in vitro fertilization), where close to 90% of remaining women can conceive. For many women with the diagnosis of unexplained infertility, IVF can also be diagnostic as well as therapeutic. Discovery of fertilization issues as well as embryo quality issues can be discovered during this course of treatment. In fact, for many women, especially those over 38 years of age, the risk of failure at the IUI stage can be avoided by triaging directly to IVF.
How do I decide if IUI or IVF is right for me?
Personal choice with consideration to urgency, psychological impact of the struggle with conception delay at this juncture, avoidance of burn-out, in addition to insurance and financial resources all play into the decision by the patient as to which option to exercise first.
The best prognostic signs are younger age and prior fertility in helping to select the right treatment option. The best philosophy is to encourage access to the stronger treatment option especially for the weaker prognostic cases in order to lead to more successes. Ultimately, this is a more cost effective approach as well.