What is the difference between artificial insemination and IVF? How to choose between them?

In the treatment of infertility, the most commonly terms heard are “Intrauterine Insemination (IUI)” and “test tube baby (IVF)”. What is the difference between the two?

The so-called IUI is one where processed high-quality sperm is injected directly into the woman's body on the ovulation day, so that the sperm can fertilize the egg promptly. Therefore, certain conditions must be met for artificial insemination to be conducted. The woman's fallopian tubes must be unobstructed, and the man's sperm count and mobility must meet a certain standard. What kind of couple is suitable for artificial insemination? For example, conditions such as weekend couples, living apart together couples, women having irregular menstrual cycle, men's sperm count and mobility not reaching the normal standard but not being too bad, and incompatible sperm and egg (anti-sperm antibodies) can all consider the treatment of artificial insemination. Due to the fact that artificial insemination still requires the sperm and egg to fertilize on their own, therefore the cost of artificial insemination is much cheaper than that of test-tube babies. However, the success rate is only 20%.

IVF is the so-called in vitro fertilization. The woman will need to receive ovulation injection, and frequently visits the hospital to check the size of the follicle. When the follicle matures, the trigger injection is taken and the egg retrieval operation will be arranged. After the egg retrieval, the egg and sperm are artificially fertilized in the laboratory and cultivated into an embryo, and the embryo is then implanted into the uterus.

Anyone is suitable for IVF treatment, as long as there are eggs and sperm. For couples with ovarian failure or azoospermia, their dream of pregnancy can be realized through donor eggs and sperms. The cost of the treatment varies greatly according to the type of treatment being taken. The treatment process includes second-generation test tubes, third-generation test tubes, fourth-generation test tubes, donor egg test tubes and so forth, and ranges from NT$120,000 to NT$500,000. Each person's physical condition may be suitable for different treatment courses, and the doctor will decide on the best treatment according to the examination result. Generally speaking, the success rate of IVF will be much higher than that of artificial insemination, where it can reach as high as more than 80%. For couples of advanced maternal age, doctors usually will also use IVF first up to achieve pregnancy.
 

• Difference between IUI and IVF

	IUI	IVF
Fertilization Method	Internal fertilization	External fertilization
Suitable patient	Male：poor sperm quality Female：poor egg quality, polycystic ovary…so forth	Male: poor sperm quality Female：chronic anovulation,、Fallopian tube obstruction…so forth
Treatment process	Receive ovulation injection or take ovulation medicine → Ultrasound examination → Take trigger injection → Sperm collection → Intrauterine Insemination → Take progesterone supplement → Pregnancy test	Pre-operation examination of the couple → Monitor follicles → Egg retrieval → Sperm collection → External fertilization → Embryo implant → Pregnancy test
Cost of treatment	Cheaper	Relatively expensive
Pregnancy rate	About 20%	Depending on the course of treatment chosen, about 20~80%

All in all, whether a patient is suitable for artificial insemination or IVF is based on the result of the infertility examination. Allow the doctors to make professional judgments and recommendations. That said, the main cause of infertility currently faced in Taiwan is that of late marriage and late birth. The average age of patients of Lee Women’s Hospital is 39 years old. Under such conditions, doctors will most likely recommend the use of test-tube babies.

According to research, the effect of using artificial insemination for advanced maternal aged couples is not good. In terms of the overall cost, directly implementing IVF to achieve pregnancy actually consumes less money and time. Furthermore, couples of advanced maternal age are prone to embryonic autosomal abnormalities, which can easily cause multiple IVF failures and miscarriages. In this case, using third or higher generation IVF can bring about a relatively higher pregnancy rate. Among the patients admitted to Lee Women’s Hospital, we’ve had many couples who are nearly 50 years old or had multiple experiences of failed IVF treatments in other hospitals for as many as 20 times. In the end, they were all successful in conceiving a baby. I hope these success stories can bring some confidence and hope to those couple seeking to conceive a baby.