IVF, IUI, ICI

If you are having difficulty getting or staying pregnant, rest assured you are not alone, and much can be done to assist you.

Reproductive problems whether known or unexplained in men and women under age 42 may often be circumvented using various assisted conception methods.

The methods IVF IUI ICI, referred to collectively as Assisted Reproductive Technology (A.R.T.), are described and cross compared in the table below.

What does the acronym stand for?
IVI	Intra-Vaginal Insemination
ICI	Intra-Cervical Insemination
IUI	Intra-Uterine Insemination
IVF	In-Vitro Fertilization
What Is It?
IVI	IVI involves placing the sperm into the vagina near the cervix and is done at home using a syringe. IVI is the most similar method to intercourse.
ICI	ICI is done by a professional at a facility. ICI is much like a regular gynocological visit. A speculum is insterted into the vagina in order to open the vagina and expose the cervix. A catheter is then inserted into the cervix. A syringe containing the sperm is then attached to the catheter and is used to push the sperm into the cervical canal. The catheter is removed. A sponge is then placed over the cervix to prevent cervical mucus that may have been loosened by the catheter, from leaking out. The speculum is removed. The sponge may be removed a couple of hours after the procedure.
IUI	IUI involves depositing sperm into a woman's uterus. This procedure must be done by a professional at a facility. IUI is very similar to ICI and is therefore also much like a regular gynocological visit. A speculum is insterted into the vagina in order to open the vagina and expose the cervix. A catheter is then inserted through the cervix. A syringe containing the sperm is then attached to the catheter and is used to inject washed sperm directly into the uterus. The catheter is removed. A sponge is then placed over the cervix to prevent cervical mucus that may have been loosened by the catheter, from leaking out. The speculum is removed. The sponge may be removed a couple of hours after the procedure.
IVF	IVF involves mixing the sperm and the egg at a facility, watching the egg initially split and implanting it in the woman. In IVF treatment, eggs from a woman's ovary are surgically removed and placed in a Petri dish, where they are mixed with a sperm sample. IVF treatment consists of several stages, including ovulation induction, egg harvesting, insemination and fertilization, and embryo transfer. Pre-implantation genetic diagnosis or PGD may also be done to screen for any embryonic chromosomal abnormalities.

Who would benefit from this procedure?
IVI	IVI is a good method for surrogacy, using donor sperm or if your partner has difficulty ejaculating during sex.
ICI	ICI is a good method for surrogacy, using donor sperm or if your partner has difficulty ejaculating during sex.
IUI	IUI is a good method for surrogacy, using donor sperm, lack of sufficient fertile cervical mucus, or unexplained infertility.
IVF	IVF is a good method for using an egg donor, or unexplained infertility.
How long and invasive is the procedure?
IVI	IVI takes about 5 minutes, is painless and has no side effects. It is minimally invasive.
ICI	ICI takes about 5 minutes, is painless and has no side effects. It is minimally invasive.
IUI	IUI takes about 5 minutes, is painless and generally has no side effects although some women experience mild cramping. It is minimally invasive.
IVF	IVF involves a surgical procedure. It is invasive.
What kind of sperm is used?
IVI	IVI uses non-washed or washed fresh or frozen donor sperm.
ICI	ICI uses non-washed or washed fresh or frozen donor sperm.
IUI	IUI uses WASHED fresh or frozen donor sperm. Raw semen cannot be inserted directly into the uterus because it contains chemicals called prostaglandins which may induce muscular contractions causing cramping and the possibility of collapsing the uterus. Sperm washing is a process by which the sperm is separated from the seminal fluid which makes up 95% of the ejaculate. At this time more motile sperm may also be separated out in order to produce a better sample.
IVF	IVF uses non-washed or washed fresh or frozen donor sperm.
Does it require medication?
IVI	IVI may be natural or medicated e.g. clomid.
ICI	ICI may be natural or medicated e.g. clomid.
IUI	IUI may be natural or medicated e.g. clomid, hCG injectable ovulation trigger.
IVF	IVF is medicated (hormonal treatment) only.

When should the procedure be done?
IVI	Using fresh sperm, optimal timing for IVI would be the same as for natural intercourse. Fresh sperm that is inseminated vaginally lives for up to 72 hours. Using frozen sperm, timing needs to be more exact, as frozen sperm has a shorter lifespan than fresh. The lifespan for thawed frozen sperm that is inseminated vaginally is about 24-36 hours.
ICI	Same as IVI above.
IUI	With IUI, EXCELLENT timing is imperative as washed sperm has a shorter lifespan than non-washed. Washed fresh sperm that is inseminated directly into the uterus has about a 24-36 hour lifespan. Washed thawed frozen sperm inseminated directly into the uterus has a 12-24 hour lifespan. IUI is generally done the day after the first positive OPK result. Ideally an IUI should be performed within 6 hours either side of ovulation. If you know you tend to ovulate earlier or later than 24 hours passed a positive OPK (based on your temps or a number of previously done sonograms) then you must account for this when timing your insemination.
IVF	Timing in this sense is not an issue for IVF as the egg and sperm are mixed together in a lab. Timing of IVF cycles is controlled by the hormone therapy whether using your own eggs or synchronizing to the egg donor. Using fresh sperm has no greater success rates than thawed frozen sperm.
What is the cost?
IVI	IVI at home is a few dollars, the cost of a syringe or kit. Other possible expenses include: Donor sperm vials range in price from $250-$650 plus shipping and storage costs. Medication costs will vary based on medication and dosage.
ICI	ICI is approximately $250. Other possible expenses include: Donor sperm vials range in price from $250-$650 plus shipping and storage costs. Medication costs will vary based on medication and dosage.
IUI	IUI is approximately $250. Other possible expenses include: Blood tests which are about $40-$80 per hormone tested and sonograms which are about $150. Donor sperm vials (WASHED sperm only) which range in price from $550-$650 plus shipping and storage costs. Medication costs will vary based on medication and dosage. Medicated cycles are generally monitored more so imply some blood test and sonogram costs
IVF	IVF is expensive. It is approximately $12,000 per cycle but there are many variations. Some clinics have a reduced rate for multiple cycles and various plans to recoup money if there is no success or remaining cycles are not needed. Some clinics have a set rate if both IVF and donor egg services are needed. You will need to investigate the facilities in your area to get all of the information required to make an informed decision.
What is the success rate?
IVI	If there are no underlying fertility problems, success rates for IVI and ICI should be the same as for natural intercourse, whose success rates are age dependent. Some studies have shown that doing two IVIs within a cycle may double your chances of conception. Under the age of 38, the use of fertility drugs will slightly increase the rate.
ICI	Same as IVI above.
IUI	IUI success rates vary from about 6-26% per cycle. It is however difficult to determine the true success rate of IUI procedures as most couples will also have natural intercourse around the woman's fertile period. Although semen is implanted directly into the uterus, if there are no underlying fertility problems, IUI will not be much more successful then IVI or ICI and may even be less as the washed sperm necessary for this procedure have a shorter lifespan. If the woman has fertile cervical mucus problems or the man has problems with his sperm this method may improve their chances for success. If the woman in under the age of 38, the use of fertility drugs will also slightly increase the rate.
IVF	Success rates for IVF vary from facility to facility. Some clinics will purposely turn away older patients in order to keep their success rate statistics elevated. Top clinics have pregnancy rates of 50% per month, stratisfied to age. Generally IVF is two to three times more successful then IUI.