Basic Treatment

Superovulation / IUI (insemination) versus IVF (in vitro fertilization)
for unexplained infertility

Fact Sheet / Superovulation vs. IVF stats page

Many couples come to this crossroads.  Their workup to this point does not pinpoint any obvious abnormality. Many things need to be considered when deciding which avenue to pursue. These include costs, success, and incidence of complications such as multiple births and high order multiples (i.e. > twins). Briefly IUI cycles cost between 1000 and 3000 dollars. Why the wide variation? Mainly the amount of insurance reimbursement and the amount of medicine, rFSH (Follistim, Gonal F, Bravelle, Menopur, and Antagon) used to stimulate the woman’s ovaries. Older women tend to use more meds, hence more expense. With insemination the chance of pregnancy is 20% per cycle at Carolina Conceptions. This will fall to 7 to 10% with even a mild to moderate male factor. The incidence of multiples is 25% and a 4% chance of triplets or more. The complications seen with super ovulation and IUI are usually mild but women may develop some symptoms related to hyper stimulation of their ovaries.
  If money is not an issue then IVF is the treatment of choice. Why? The pregnancy rates are higher, average is close to 50% in our program. See our website for current rates, lower incidence of triplets (<3%) and no quadruplets in our program. ICSI or sperm injection into the egg can be done to “ensure” fertilization. The costs are again dependent on amount of medication and insurance coverage, but run between 9,000 and 14,000 dollars. Various refund programs are also available. In addition most couples will have embryos to freeze in their cycles. These can be stored and thawed for later use. The cost of a thaw cycle is approximately that of a super ovulation and IUI cycle, with a higher chance of pregnancy.
IVF does require two days off work, an outpatient procedure, and is considered a less natural way than IUI to conceive. However techniques used in the lab such as assisted hatching, ICSI, and embryo biopsy may be useful in attaining conception and determining why the couple has failed to conceive in the past.

Other points to ponder:

If the woman is young, Drs. Meyer and Couchman will tend to suspect that there is a male factor. If the semen analysis is mildly abnormal then the couple may decide to order a DNA fragmentation test (see attached sheet). This will determine the amount of DNA fragmentation in the man’s sperm. With high levels of fragmentation the chances of the couple conceiving is less than 2% with super ovulation and IUI.

If ovarian dysfunction may be a problem (poor ovarian reserve) then Drs Couchman or Meyer may consider obtaining an AMH (antimullerian hormone level) on the woman. This can be done at any time during the cycle, even if she is on birth control pills. This may unmask a clandestine egg problem, and may assist in determining the dose of r FSH to use in stimulating the ovaries.