From the Guidelines
The most effective method for achieving a live birth is IVF, with success rates ranging from 40-50% per cycle for women under 35, followed by IUI with success rates of 5-20% per cycle, and natural conception with a 15-25% chance of pregnancy per month. When considering the best approach for couples with unexplained infertility, IUI with ovarian stimulation (OS) is recommended as the first treatment option for those with a poor prognosis of becoming pregnant through normal coitus, as it has been shown to be non-inferior to IVF in terms of live birth rates and is more cost-effective 1. For couples with a good prognosis of becoming pregnant naturally, expectant management for at least 6 months is recommended before pursuing IUI or IVF 1. The success rates of these methods decline with maternal age, particularly after 35, and the choice of treatment should be based on the specific fertility diagnosis, age, financial considerations, and the couple's desire to pursue treatment.
Some key factors to consider when choosing between IUI and IVF include the presence of mild male factor infertility, cervical issues, or unexplained infertility, as well as the woman's age and ovarian reserve. IVF is generally recommended for couples with severe male factor infertility, tubal issues, or advanced maternal age. In contrast, IUI is often preferred for couples with mild male factor infertility, cervical issues, or unexplained infertility, as it is less invasive and expensive. Ultimately, the decision between IUI and IVF should be made on a case-by-case basis, taking into account the individual circumstances and priorities of the couple.
In terms of specific success rates, a study by Bensdorp et al. (2015) found that IUI-OS resulted in a live birth rate of 47%, compared to 52% for IVF with single embryo transfer (SET) and 43% for IVF in a modified natural cycle (MNC) 1. Another study by Reindollar et al. (2010) found that clomiphene citrate-IUI was the most cost-effective first-line therapy for couples with unexplained infertility, with a live birth rate of 23.6% per cycle 1. These studies highlight the importance of considering both the effectiveness and cost-effectiveness of different treatment options when making decisions about fertility treatment.
Overall, the choice between IUI, IVF, and natural conception should be based on a careful consideration of the individual circumstances and priorities of the couple, as well as the latest evidence on the effectiveness and cost-effectiveness of each approach. By taking a personalized and evidence-based approach to fertility treatment, couples can maximize their chances of achieving a successful pregnancy and live birth.
From the Research
Successful Pregnancy Rates
- The successful pregnancy rate, defined as the rate of live births, varies among different fertility treatments, including Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), and natural conception.
- According to a study published in 2017 2, the 5-year live birth rates for women undergoing fertility treatments were strongly influenced by female age, ranging from 80% in women under 35 to 26% in women over 40.
IUI vs IVF
- A study published in 2017 3 found that the use of clomiphene citrate or letrozole with or without gonadotropins in IVF cycles did not result in a significant difference in live birth rates compared to gonadotropins alone.
- However, the study found that the use of clomiphene citrate or letrozole was associated with a reduction in the incidence of ovarian hyperstimulation syndrome (OHSS) and a decrease in the mean number of ampoules used.
IUI Success Rates
- A study published in 2010 4 found that the use of letrozole or clomiphene citrate combined with gonadotropins for ovarian stimulation prior to IUI resulted in similar pregnancy rates, with 23.7% and 26.2% of patients becoming pregnant, respectively.
- Another study published in 2013 5 found that the use of letrozole plus FSH for controlled ovarian stimulation in IUI cycles resulted in a similar pregnancy rate compared to the use of FSH alone, but with a significantly lower total dose of FSH used.
Natural Conception
- According to the study published in 2017 2, 14% of couples conceived naturally within 5 years of starting fertility treatments.
- The study also found that the likelihood of natural conception decreased with increasing female age, with 16% of women under 35 conceiving naturally compared to 10% of women over 40.
Comparison of Success Rates
- The study published in 2017 2 found that the 5-year live birth rates for women starting treatments with IUI were 35% for IUI, 24% for subsequent IVF treatments, and 17% for natural conception.
- In contrast, women starting treatments with IVF had a 5-year live birth rate of 53% for IVF, 11% for natural conception, and 0.6% for subsequent IUI.