What We've Learned So Far

As I mentioned in the introduction, our urologist recommended IUI, while the nurse practitioner at my ob/gyn has recommended IVF. Here is what we've learned about these two different techniques - please keep in mind that I am not a doctor and a lot of the information I have is still kind of sketchy. In other words, it may be somewhat inaccurate or it may be completely wrong. Please don't rely on it for your own purposes!

My understanding is that IUI is a process by which sperm are collected, washed, and then injected into the woman's uterus. I think it's primarily used when the sperm are having a tough time making it all the way to the egg. The urologist recommended this method, and I think he did so because it's a less expensive and less invasive method than IVF. It does still involve the woman going through injections and Clomid medication in order to make sure she is ovulating at the time when the insemination of the sperm through a catheter will be made.

IVF is a more invasive and much more expensive method. In IVF, the woman first takes a series of medications (oral and injection) to stimulate the growth of extra follicles in order to try to harvest numerous eggs. After she starts taking the medications, she goes in for ultrasounds and blood tests to see if the medications are working and to track potential ovulation. The hope is to get a lot of eggs, so the woman's ovaries may grow from the size of a walnut to the size of a human fist with the medications. When it is determined that it is the right time, the woman goes in to the doctor and has the eggs extracted. At that point, the eggs are either placed in a petri dish with a bunch of the sperm to allow fertilization or the eggs are individually fertilized by a specialist in a process called ICSI. The eggs are then monitored for several days to determine which ones successfully were fertilized and which ones are growing into blastocysts or embryos. Once the successful embryos are identified, they may be tested for genetic disorders (this is optional) and then the woman will return to the doctor to have between 1 and 3 embryos implanted. Two weeks after the embryo(s) are implanted, the woman returns to the doctor for a pregnancy test.

We think we're going to end up doing IVF plus ICSI because the problem for us is that our sperm don't have good morphology. Morphology describes whether the sperm are shaped properly for fertilization. When the sperm have the wrong shape, it may be difficult for them to fertilize an egg. Our sperm count is at 15 million sperm per milliliter. In order to be considered to be officially fertile, you need to be at about 20 million per milliliter, so we are low but not terribly low. Similarly, our motility (the movement of the sperm) shows that 30% are moving fast enough. Again, low, but not terrible. The bigger problem for us is that our morphology is only 2%. That means that only 2% of our sperm are shaped properly for fertilization. To be considered fertile, you need to have at least 14% shaped properly. Therefore, our best chance at a successful fertilization may involve locating the healthiest sperm and injecting them straight into the egg via ICSI.

Tomorrow (or maybe later tonight if I'm motivated), I'll talk about the financial differences and challenges and the other options we have.