In this episode, we delve into the complex world of fertility treatments, exploring the key differences between Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF). "What's good for the goose isn't always good for the gander," as they say, and the same holds true for fertility methods. While one couple's journey may align with the straightforward approach of IUI, waiting for the natural menstrual cycle to commence, others may find their path in the more intricate dance of IVF, with birth control for priming and medications to prevent ovulation. Join us as we break down the protocols, the processes, and the purposes of each treatment, providing you with a clear comparison to understand which option could be the right one for you. Whether you're deep into fertility research or just starting to explore your options, this episode is your guide through the nuances of conception strategies in the modern age.
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Today we talk about why is what's good for the goose is not good for the gander. When comparing IUI and IVF. I'm Dr. Mark Amels. And this is Taco about Fertility tuesday. I get asked a lot why we're not doing things in IUIs that we would do in IVF, or vice versa. Why are we not doing things in IVF that we did in IUIs? That's a great question. So today I want to talk about why we don't do always the same things and when sometimes those same things are necessary. Let's first start with IUIs. So one of the things I get asked a lot with IUIs is why we don't use ganorillex or cetertide to block ovulation because we do it in IVF. And one of the reasons we don't is because what causes ovulation isn't just the size of the follicle, it has to do with the estrogen level. And so when you're doing IUIs, you're not trying to make a lot of eggs grow, you're trying to maybe make three or four. So the estrogen level never gets high enough to cause ovulation too early. But with IVF, you're making multiple eggs, sometimes 1012 20. And so very early on, the estrogen level will rise and will initiate the process of ovulation. So you have to give a medicine to block the process so you can let the follicles get big enough so that way they'll be mature. Otherwise they would ovulate too soon and would have a lot of immature eggs. So one of the worries that comes up is, well, then do I need to be worried about, a post mature egg in IUI? What if it's too big? Well, that will actually not happen because in IUIs, it's naturally ovulating, so you don't have to worry about holding it back like you would in IVF. In IVF, you could be preventing ovulation, and so the egg could eventually become post mature. But in an IUI, it will ovulate at some point. And so, you know, it will never be in that post mature state. Now, that doesn't mean you can't use things to block ovulation in IUIs. Matter of fact, I do it all the time. There are sometimes patients who I realize we need to pick up another egg. I want to give them more time, but I have to tell them, listen, based off your estrogen level, you're probably going to ovulate. The only way I'm going to be able to capture those other eggs is we're going to have to take an antagonist to block ovulation. And that's exactly what they'll do. They'll take that antagonist, they'll buy us another day or two, and we're able to get more eggs for the artificial insemination cycle. The next area that comes up is, why do a lot of clinics use Avidril for IUIs, but use HCG, such as Navarro Pregnal for IVF? And there's the simple answer, which is a lot of people believe that Avidril may not be strong enough to induce maturity in all of the follicles in the IVF cycle, but with IUIs, you're only making a few follicles, so it's not a big deal. Now, this has actually been shown to not be true. There are many clinics that only use albadrill, but there is no question it is a lower dose than, let's say, a 10,000 unit, pregnil. And so you do have clinics who use avidril, but most will usually use avidril for IUIs and then for IVF. There are some that use avidril for IVF, but most use HCG. The one thing you definitely will not see is using lupron in an IUI cycle. And the reason why is because you're rarely going to make enough eggs in an IUI cycle that you're worried about variant hyperstimulation, that you would give a lupron trigger versus a CG trigger. So that's really an IVF thing. And honestly, if someone probably did make that many eggs in an IUI, they would either be canceled or get converted over to IVF. The other area I get asked is how come we use clomid or Femara in IUI cycles, but we really don't use them in IVF cycles? And that's because clomid and Femara themselves do not make your follicles grow. All they do is trick the body into thinking the estrogen lower, or they actually lower your estrogen levels that then cause your pituitary gland to make more hormones that make the eggs grow. But there's a limit because your Pituitary only has so much hormone. At some point it says, that's all I got, doesn't matter if you go up on the dosage, I can't give anymore. And so in IVF, instead, we give injectables because we can go to whatever number we want, and we don't have to depend on the pituitary, we get to control everything. Now, you can make the argument, well then why not use injectables only in artificial inseminations? And the answer, M, is you can. Matter of fact, we used to do that. But the problem is your response could be too great and you can end up having multiples or even having your cycle canceled. And so, a lot of times we'll use Femara, and clomate because we'll get a decent response without the risk of high order multiples. Now, the other reason why we don't like to use injections in IUIs is because of the cost. Using injections for IUIs could cost you thousands of dollars, yet using Femara and maybe an injection or two might cost you$300. And since IUIs aren't that high of a chance to begin with, it doesn't make sense to put thousands and thousands of dollars into an IUI. Now, it's reasonable to put that type of money into an IVF, because the rates are much better at getting pregnant with IUIs. They're not. And so it doesn't make as much sense. And that's why most people will use oral medications to keep the cost down and then potentially add injectables if needed. Another question that gets asked is, why do I get monitored more in IVF and not as much in IUIs? A lot of people think, well, because you don't pay as much. That's really not the reason. It's because you don't need to look as much. It'd be like the difference of saying, hey, why do you pay so much attention to your little toddler? But you don't pay as much attention to your 16 year old? Well, because your six year old is a little mature. You know, you have to watch them very closely. Well, when you do an IUI, there are really only two points in time that matter. The first is in the beginning to make sure there's no cyst. And then the next is to know when to give the trigger shot. You're not starting any other medications, but in IVF, it's a little bit different. We're shooting for more eggs. We're trying to make sure there's the best quality, so we're adjusting. So we have to watch them more. We have to know when to start an antagonist medication to prevent Ovulation. So in an IVF cycle, in the very beginning, you're trying to make adjustments, so you have to watch closely. Then you have to see if those adjustments are working or are too much. Then the next thing you have to look for is to make sure, do you need to start an antagonist? And then later you're looking for maturity. Because now we are preventing ovulation. We don't want to get the post maturity, so we have to watch things closer. So the reason you do more ultrasounds and there's more monitoring is not because you pay more, but because you actually have to do more to be able to have a good cycle. You rarely hear me say that other clinics do things wrong because I do believe there's a lot of ways to do things. But truly, if you are doing the IVF cycle with another clinic and you're only being seen twice, then that probably isn't a good clinic because you do need to be seen more when it comes to IVF. So why do we take antibiotics in IVF, but we don't take them in IUIs? And the reason why is because the antibiotics are not just for the retrieval, but even when you go to do a transfer, the thought is that there is a potential risk that you are carrying some bacteria. And so when you go to do the transfer, we are theoretically treating any bacteria to reduce that for the transfer. Now, in the IUI, because you're not doing a procedure where you have a needle going through the back of the vagina, the antibiotics aren't needed. But like I said, the other benefit of antibiotics, especially in a fresh transfer, is also clearing the system of any possible bacteria that could be interfering with implantation. Another question comes up is why do we take birth control for IVF, but not IUIs. Now, if you heard last week's episode, you would know that the reason birth control is in IVF is to synchronize the eggs. And that's because we're making a whole bunch of them in IUIs. We're not trying to make a ton of eggs, we're maybe making two, three, four at the max. And so if they spread a little bit, meaning the measurement of the follicles might be, let's say 1517, 1920, it's not that big of a deal because they're not going to ovulate anyways till they're around the appropriate size. So most of them will be in that mature zone. But in IVF, if they spread out a whole bunch, the problem is that they'll be tons below 15, tons above 20. And now you have a bunch of immature and post mature eggs. And so what we do is by putting on the birth control, it can synchronize those eggs. And then there are other benefits too. Now, that being said, there are times I do put people on birth control for IUI cycles. The couple of reasons I put them on is, one, sometimes they're going to be gone during treatment time and they want to absolutely do treatment when they get back. So I tell them, listen, go on birth control, manipulate your cycle and we can just start it when you get back, when you stop the birth control. The other benefit is people have high FSH levels who want to try IUIs. Just like I talked about in the last episode, I'll put them on birth control for a period of time, suppress their FSH for a period of time until it's a normal range, then stop it and hit them with high dose medications. And usually can get these women to ovulate who normally don't ovulate because their ovarian reserve is so severely low. The last question I want to go over is why, when a man ends up having sperm extracted from the epidymus called a pasa, can you do IVF but can't do IUI? And the reason for this is because there's just too few sperm to be able to do IVF. You really don't need a lot of sperm. I mean, technically you only need one sperm per egg. But to do IUIs, you really do need a lot of sperm. And that's because a lot of it's even gone by the time you get washing it. So when you do a pesa, which is where you extract the sperm from the epidymus, this would be common in someone, let's say, who had a vasectomy, and once they have another kid, they can extract the sperm from it. You can't do an IUI because there's not enough sperm, not even one IUI, because usually you're going to have in like a couple million sperm. And so the only option at that point is to do IVF, because now you can take the sperm and inject it into the egg and have fewer sperm to work with. Hopefully this was helpful for some of you who, are going through IUIs, are going through IVF, or have even asked these questions yourself, thinking, do I need to be worried about something? As you can see, IUIs and IVF are different, but there's a lot of similarities. And so if this question has come up, hopefully this answered it for you. If you have friends who are going through it, let them know about this podcast. It may help them with some of their worries, thinking that maybe things aren't being done right, when in reality, they're just different. Some things done with IUIs are done with IVF, and some things are not done vice versa. As always, I greatly appreciate everyone listens to our podcast. If you enjoy it, give us a five star review on your favorite medium and let your friends know about us. I look forward to talking to you again next week on, Taco Belt Fertility Tuesday.