The number of sperm, their shape and their ability to swim can all impact a couple's ability to get pregnant naturally. Certain medications or lifestyle factors may cause a drop in sperm count or other negative effects. These side effect can often be reversed, but there are more serious conditions that impact sperm permanently. Read our last blog post to learn more.
When sperm problems persist, there are treatments to overcome most of them. Intrauterine insemination (IUI) is one option that involves placing the sperm directly into the uterus, giving weak swimmers a better chance of reaching the egg. In vitro fertilization (IVF) is another, where the egg and sperm are fertilized in a laboratory dish, and the resulting embryo is transferred into the uterus. Intracytoplasmic sperm injection, also called ICSI, involves injecting a sperm directly into the egg, so even men with the poorest swimmers can father a baby.
Let's discuss each option further.
If your partner’s semen sample is sufficient in count and quality, your doctor may suggest intrauterine insemination (IUI).
On the day of your IUI, your partner will be asked to produce a sperm sample. His sample would be processed and “washed” in the lab to select and concentrate sperm that look normal and swim well. Your fertility doctor can deliver this selected sperm directly into your uterus with a sterile catheter, timing the procedure with your natural ovulation or medication-induced ovulation to make sure your egg is there to meet the sperm.
In vitro fertilization (IVF) and ICSI
In the past, a combination of oral medications and IUI was often recommended before IVF because it is simpler and less expensive. Doctors may now recommend IVF as the first-line treatment because it is a much more effective treatment. It is counterproductive to delay IVF in favor of multiple rounds of less effective treatments as it may actually cause the overall cost to be higher while further compromising your chance of succesfful treatment because of ovarian aging.
For healthy women who are just not ovulating regularly on their own, oral medication may be enough. However, if pregnancy is not achieved within a few IUI cycles or if ovarian aging is a concern, switching to IVF may be the best option. It’s important to discuss these tradeoffs with your doctor.
Since the birth of the first IVF baby in 1978, treatment for infertility using IVF has improved dramatically. Patients today have more success with IVF than with simpler treatments, because it bypasses multiple fertility issues (follicle development, ovulation, fallopian tube obstruction, and poor sperm quality) all at the same time.
To fertilize an egg successfully through intercourse or intrauterine insemination (IUI), a relatively large number of sperm (tens of millions) with strong swimming ability are needed to make it to the fallopian tube and still have sufficient energy to fertilize the egg. Fewer sperm with less stellar swimming ability are enough for IVF, because they are placed in close proximity to the egg in the same dish.
For a procedure called intracytoplasmic sperm injection (ICSI), the man needs to have only one normal sperm per egg because a single sperm is injected into a single egg by the lab technician. Sperm that swim weakly, or not at all, are able to fertilize an egg when ICSI is used. Semen analysis results can help guide the doctor’s recommendation for your treatment.
When treating infertility, sometimes it makes sense to make a beeline for more aggressive treatments to save time, money and emotional frustration. Although IVF success rates exceed 60% per cycle in the top US clinics, IVF is currently used by as few as 2% of patients. Some of this underutilization is due to the high cost of IVF. Insurance providers are responding to pressure from patients to include IVF as a benefit, and providers are seeking ways to make IVF more affordable for their uninsured patients.