fertility treatments

How to Tell Your Fertility Treatments Apart—and Which Ones Work Best

IVF, IUI, surrogacy, sperm donors, and the list goes on.

Rachel Pickus

In the middle of a pandemic, it can be hard enough to tie your shoes in the morning (wait, what are shoes?) or put yourself to bed at night. But if you’re dealing with fertility issues, you can’t exactly command yourself to just stop thinking about it.

Whether you’re trying to get pregnant right now, or you’re just educating yourself for the future, there is a bit of good news: With the help of a specialist, there’s a lot of great information out there.

For starters, we wanted to find out exactly what IVF and IUI are and how they might help a woman get pregnant. We were also curious about cost, alternative medicine, sperm donors, surrogates, and oh, well, actually, a lot of other things.

For answers to our burning questions, we turned to Rachel A. McConnell, MD, a fertility specialist at Columbia University Fertility Center, who kindly answered all of them—and we do mean all of them.

Quick note: Throughout the interview, McConnell used the word “couple” to describe two people trying to get pregnant together, and in some places “partner” to describe a man who’s half of a unit trying to get pregnant, but those terms don’t apply to everyone who’s trying to get pregnant. We left her wording in, but please note that we support women getting pregnant in any form—alone, together, in a throuple, as best friends, as business partners, as neighbors, and anything in between.

First and foremost, let’s get our terms straight. What is IVF, and how does that work in terms of fertility?

“IVF, an abbreviation for in-vitro fertilization, was first introduced in 1978,” says McConnell. “It involves removing a woman’s eggs from her ovaries and fertilizing them in a tightly controlled laboratory environment with the previously collected sperm.”

What are the pros of IVF?

If you have had trouble getting pregnant, IVF can be a road toward conception. “IVF, a type of assisted reproductive treatment, has afforded many couples the opportunity to create a family, or add to their families, who may not have been able to conceive naturally,” McConnell says.

“This procedure is very beneficial to women who may have blocked or absent fallopian tubes and for men who have low sperm parameters,” she adds.

What about the cons of IVF?

You might have already guessed, but IVF isn’t exactly cheap. “Without insurance support, this can be a very expensive procedure,” McConnell says. “And this process involves the use of injections and a time commitment of several visits to the doctor for monitoring.”

It’s not just physically and financially taxing—IVF can also take a toll on your mental health. “The process can also create anxiety and fear for some candidates,” McConnell adds.

Moving on—what’s artificial insemination, and how does that work in terms of fertility?

“Artificial insemination—same as IUI, or intrauterine insemination—is another assisted reproductive treatment procedure,” McConnell says. First step: a little sperm bath. “This process involves the partner collecting a sperm sample, which is then washed in the laboratory, to remove sperm from the seminal fluid,” she says.

Capping the process off, “a high concentration of sperm is placed high into the uterine cavity, which bypasses the cervix, releasing the sperm closer to the fallopian tubes,” McConnell says.

What are the pros of artificial insemination?

First off, IUI is a bit more within reach pricewise. “This procedure is not as costly as IVF, and it allows fertilization to still take place inside the body,” McConnell says.

What are the cons of artificial insemination?

IUI is less complicated—and less costly—but it’s also less effective. “Pregnancy rates are not as high compared to IVF,” McConnell says. “There’s also a time commitment for office visits, but not as frequent” as IVF.

What about a sperm donor? Can you talk about how that factors into all this?

“A sperm donor is a male who provides sperm samples that will be used in the process of IVF or IUI to help a woman conceive a baby,” McConnell says. “The use of donor sperm is beneficial to women who do not have a male partner or a couple who is not able to conceive due to male-factor infertility,” she says.

This can be a good solution to these situations, but it doesn’t necessarily come without strife. “The decision to use a sperm donor, due to an inability to provide one’s own sperm, can initially create emotional and psychological stress in some cases,” McConnell says.

What about alternative medicine methods? Do you recommend, for example, acupuncture?

In a word, yes. “Alternative medicine, such as acupuncture, can be beneficial in combination with assisted reproductive treatments such as IUI and IVF,” McConnell says. “Acupuncture could help normalize the menstrual cycle as well as hormone levels.”

Acupuncture may also play an important part in upping one’s pregnancy chances: “It may increase blood flow to the uterus and ovaries, which can help with implantation,” McConnell adds.

Are there other options other than IVF and AI that are a good idea for women to explore if they’re having fertility issues?

You could start small, McConnell says. “Other treatment options may include the use of only fertility medication, which would be beneficial to couples that are noted to have ovulation dysfunction or anovulation—no ovulation,” she says.

Others might go with an egg or an embryo donation. “Some couples may need oocyte—egg—donation, or choose embryo donation,” McConnell says. “Some couples will need a gestational carrier to help them create their families.”

If you decide to go with egg donation, here’s what it looks like: “Egg donation involves a recipient, a male partner, and a third party, an egg donor, who is usually less than 30 years of age,” she says. “The egg donor will undergo testing to evaluate their overall health and egg reserve.”

A donor will “use fertility medication to recruit eggs for in-vitro fertilization,” McConnell says. Her eggs are then “fertilized with the partner’s sperm to create embryos. The recipient will carry the pregnancy.”

If you’re not able to get pregnant, a surrogate—or gestational carrier—can be called in. “In some cases, a couple will be able to create their own embryo with in-vitro fertilization, but the female may not be able to carry the pregnancy, therefore a gestational carrier is needed,” McConnell says. “A gestational carrier is someone who carries a pregnancy and gives birth to a baby for another couple or individual.”

Does insurance ever cover IVF, AI, or sperm donors?

“Some insurance companies cover cycles of artificial insemination or IVF, but won’t cover the purchase of donor sperm or the subsequent treatment cycles of oocyte donation,” McConnell says.

What if you have specialty insurance, are there some that are better than others in terms of coverage?

“Some specialty insurance companies are better than others,” McConnell says. “Many insurance companies may allow testing to determine the cause of the couple’s infertility, but not cover the fertility treatments.”

If you have exceptionally good insurance, it may cover even more. “There are companies that may cover between three to six cycles of IUI or IVF,” she says.

If you’re paying out of pocket, can you compare the financial burden of the three options?

Of course, the answer to this question varies depending on exactly what’s needed. “When paying out of pocket, the financial burden could vary significantly, depending on the type of assisted reproductive method employed,” McConnell says.

“For example, IUI is $500 to $700 for only the procedure, but if you include medication with office visits for monitoring the cycle, the cost could be $2,500 to $3,000,” she says. “IVF is $12,000 to $18,000 without medication; add around $5,000 to $7,000 for medications.”

To top things off, “an egg donor cycle can be around $30,000 to $36,000,” she adds.

If a woman is told she won’t be able to conceive naturally, how should she choose which method to go with—IVF, AI, or something else? How would a sperm donor factor in here? Is there one option she should start with first?

It all depends on what kind of infertility she’s dealing with. “The treatment option will be recommended according to the patient’s infertility findings,” McConnell says. “If a woman’s fallopian tubes were blocked, she would need IVF,” she says.

“If the patient’s diagnosis is anovulation, only fertility medication for ovulation induction, such as Clomiphene Citrate or Letrozole, may be needed,” she says. “In many cases, the diagnosis is unexplained infertility, cause unknown, and sometimes starting with IUI and fertility medications may be used for a few cycles, and if unsuccessful, the next step could be IVF.”

In other words, this is not a one-answer-fits-all scenario. But with the help of a knowledgeable, trustworthy doctor, there are ways to get pregnant apart from, you know, the one we’re all aware of. 

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