Choosing Your First Fertility Treatment: Timed Intercourse, IUI, or IVF
Asking yourself, “should I do an IUI or IVF as my first fertility treatment?” What about starting with a more natural timed intercourse? One of the most common questions people ask when they first begin doing their research on infertility treatment is, “what fertility treatment should I start with?” While many presume it’s always best to start with the least intervention possible, that’s not always the case.
It’s a great question and while every situation is unique and you should consult with your own personal fertility specialist, we’ve asked one of our Board Certified Reproductive Endocrinologists, Dr. Edward Ditkoff, to answer a few questions and help get you started.
Timed Intercourse as First Fertility Treatment?
Q: What is one situation in which you recommend pursuing timed intercourse as an initial treatment option, and why?
A: “As long as the female has a normal ovulatory cycle, her anatomy is normal, the sperm count is normal, and they have not been trying to get pregnant for a long time, I think it’s a suitable way to start fertility treatment. Typically, the older the patient, the less time you would recommend pursuing timed intercourse. But if they’re younger, under 30 years of age, everything seems to be normal, and they haven’t really tried to get pregnant yet, I think that’s a good first option. “
Q: What is one situation in which you recommend AGAINST timed intercourse as an initial treatment option, and why?
A: “I would not recommend timed intercourse in an older patient who should be more aggressive. I would not recommend timed intercourse for a woman 37 years of age or older attempting to conceive on their own for a year or so unsuccessfully. Otherwise, I don’t really think we are helping these patients conceive as efficiently as they should, which I would think they’re interested in since they’re seeing a fertility specialist.”
IUI as First Fertility Treatment?
Q: What is one situation in which you recommend pursuing IUI as an initial treatment option, and why?
A: “One situation in which I would recommend pursuing IUI as an initial treatment during initial fertility treatment attempts, is if the female pelvis is anatomically normal with or without an ovulation issue. Insemination can be used with women who ovulate normally as well women who don’t. As long as there’s adequate sperm from their partner or from a donor. Typically, I would not recommend IUI if the patient, upon initial consultation, has been attempting to conceive for a long time with a male partner who has a normal semen analysis.”
Q: What is one situation in which you recommend AGAINST IUI as an initial treatment option, and why?
A: “If a patient has tubal disease, that’s one situation in which I would recommend against IUI. The reason would be, if the fallopian tubes are blocked, the insemination would be ineffective and conception would not occur. If the tubes are partially blocked or open and diseased, that would increase the risk of an ectopic pregnancy. Obviously, I would not recommend IUI if the male factor is severe enough that there is not sufficient sperm. Specifically, if the total motile sperm count is less than 10 million sperm. In the past, we used 2 million motile sperm as the cut-off, but these days, we generally use 10 million.”
IVF as First Fertility Treatment?
Q: What is one situation in which you recommend pursuing IVF as an initial treatment option and why?
A: “There are two situations in which we recommend pursuing IVF as an initial treatment option: (1) if the fallopian tubes are blocked and the patient is otherwise fertile in terms of age, good ovarian reserve, etc. she is an ideal patient to undergo IVF; (2) if the male partner has a very low sperm count (less than 10 million total motile sperm) with an otherwise normal, fertile female, that couple is also an ideal patient to begin IVF as an initial treatment. Obviously if the fallopian tubes are blocked then the sperm and egg cannot get together. Similarly, if the sperm count is below 10 million total motile sperm, then the probability of the sperm finding the egg on its own is low as well, even with other fertility treatments such as IUI. IVF is the ideal solution in these cases.”
Q: What is one situation in which you recommend against IVF as an initial treatment option and why?
A: “Even though I am an IVF doctor and I think IVF has a potential benefit for almost any type of patient if not every patient, there are situations where it is not warranted. For example, for a 23-year old otherwise normal male and female couple who only have an ovulation factor to be concerned about, letrozole or Clomid IUI is a very reasonable initial treatment option to consider. Why? Because they are very fertile and unless they want to preserve their fertility, there is no reason they need to do IVF. All they need to do is induce ovulation, correct the underlying problem, and pregnancy should occur hopefully within a 3-month trial period. Regarding cost and invasiveness of treatments, couples most often prefer to be more conservative. This would be one situation in which I would recommend against IVF as an initial treatment option.”