When people found out that we were about to try IVF we were asked many times if we were going to have multiple children, with more than one reference to us as Larry and Sheila plus 8. After my twins were born and a friend asked how we were doing, we honestly said that although we were loving every minute of it, two newborns were hard. She said, “well you did IVF, you knew you were going to have twins or more.” In response to both of these statements I tried to really explain the IVF procedure and the chances of multiple births. Granted, my explanation was more plausible before IVF rather than after, when I knew that I had been blessed with two little miracles. Nevertheless, I often felt it was/is my duty to educate people about the IVF procedure and how it is different than IUI and the real chances of conceiving multiples.
Most people have heard of, if not seen, the Jon and Kate plus 8 show on TLC. In one of their tell-all episodes they talked about doing an IUI procedure to conceive the sextuplets. I usually use them as an example (I figure with a television show about their family they probably aren’t too concerned with privacy) of the fundamental differences between IUI and IVF. Sextuplets would be virtually impossible to conceive at most IVF clinics where the most embryos they will transfer are 3 and in a very few instances 4. Getting pregnant with six in an IVF where three embryos were transferred would mean that all three embryos would split – highly unlikely. With a natural IUI cycle it would also be difficult, but is more likely (still very rare) with an IUI cycle using ovulation induction, or injectibles. In an IUI (Intrauterine Insemination) procedure using clomiphene or injectibles there is the possibility that more eggs are produced than in a natural cycle and therefore the possibility is there that multiple eggs are fertilized.
IUI is a procedure where sperm are washed and then the patient is inseminated. A typical IUI patient has poor cervical mucous, antisperm antibodies present in the female or male partner, or the male has excessively high or low sperm counts or low sperm motility. In contrast, the typical IVF patient is one with absent, blocked or abnormal fallopian tubes, a couple with one of the aforementioned issues who has had unsuccessful IUI treatment, women with endometriosis who have been unable to achieve pregnancy through other treatments, and couples with unexplained infertility. The success of IUI depends on many factors but in general the chance of conceiving during one unstimulated or clomid cycle is about 10% and about 20% for ovulation induction cycles. In an IVF procedure a woman’s ovaries are hyperstimulated, eggs are retrieved from the ovaries at the appropriate time and fertilized outside the body, and then a select number of embryos are transferred back into the patient. IVF success rates vary drastically by clinic but the general success expectation of an IVF cycle is about 40%. The success rates for either treatment depend so much on individual factors that it really is best to talk to your doctor about realistic expectations for your individual case.
So, with that very basic description of the differences between the two treatments, it may not be initially apparent why people don’t just try IVF as it is the one with the higher success rate and less chance of higher order multiples. The answer is that IVF is a lot more expensive, more physically and emotionally taxing, and really the treatment option for more advanced infertility issues. We were initially upset that our doctor advised that we not even attempt IUI, but after researching the differences in treatments and learning more about each procedure I think we (together with our doctor) made the best decision for us financially, and in light of our myriad of fertility issues. I am by no means saying that people who attempt IUI are destined for higher order multiples or that it isn’t the perfect treatment for a lot of people, but rather that for us IVF was the way to go and that in general IUI has more of a chance to lead to twins, triplet or more than a regulated IVF cycle at a clinic that limits the number of embryos transferred.