Where to Start: IUI or IVF?

1. What Is IVF and Who Benefits?

Definition

In Vitro Fertilization (IVF) is an assisted reproductive technique (ART) in which mature eggs are retrieved from the ovaries, fertilized with sperm in a laboratory, and resulting embryos are cultured and later transferred into the uterus.

Who Benefits Most

While IVF was originally designed to overcome blocked fallopian tubes, it now benefits a broad range of reproductive situations, including:

Clinical Rationale in Lesbian or Female Couples

• IVF allows biological connection between both partners through Reciprocal IVF: one partner provides eggs while the other carries the pregnancy.

• It enables genetic testing of embryos (PGT-A) and selection of healthy embryos prior to transfer.

• IVF offers higher control, higher success rates, and reduced risk of multiple pregnancies compared to multi-cycle IUI approaches.

2. IVF Success Rates

Overall IVF Success (National Benchmarks)

According to the latest CDC and SART data (U.S. national ART registry):

• Women under 35 years: ~50–55% live birth rate per embryo transfer

• Ages 35–37: ~40–45%

• Ages 38–40: ~25–30%

• Above 40: 10–20%, depending on egg quality and ovarian reserve

(Data may vary based on clinic protocols, embryo stage, and use of donor eggs or sperm.)

Factors That Influence IVF Success

Comparative Insight

For lesbian couples using donor sperm and healthy gametes, IVF outcomes are often excellent, similar to age-matched heterosexual patients without infertility, since no male factor or ovulatory disorder is typically present.

3. The Process of IVF

The IVF process consists of five key clinical stages, each optimized for safety, efficiency, and embryo quality.

Stage 1: Ovarian Stimulation

• Injectable gonadotropins (FSH, LH analogues) stimulate the ovaries to produce multiple mature eggs.

• Monitoring includes ultrasound scans and estradiol testing.

• When follicles reach maturity, ovulation is triggered with hCG or GnRH agonist.

Stage 2: Egg Retrieval (Oocyte Aspiration)

• A minor surgical procedure (under sedation) retrieves eggs from ovarian follicles using ultrasound-guided aspiration.

• Eggs are immediately assessed for maturity (MII stage) by embryologists.

Stage 3: Fertilization & Embryo Culture

• Fertilization Methods:

  • Conventional IVF (co-incubation of sperm and egg)

  • ICSI (Intracytoplasmic Sperm Injection) if donor sperm concentration is limited

• Embryos are cultured in specialized incubators to the blastocyst stage (day 5–6).

• Optional: Preimplantation Genetic Testing (PGT-A) to screen for chromosomal normality.

Stage 4: Embryo Transfer

• The best quality embryo(s) are selected for transfer into the uterine cavity using a soft catheter under ultrasound guidance.

• Single Embryo Transfer (SET) is recommended to minimize twin risk.

Stage 5: Luteal Phase & Pregnancy Confirmation

• Progesterone support continues for 10–14 days post-transfer.

• Serum beta-hCG confirms pregnancy; follow-up ultrasound ensures intrauterine gestation and heartbeat confirmation.

Optional: Embryo Cryopreservation

• Surplus viable embryos are vitrified for future transfers, enabling additional pregnancy attempts without repeated stimulation cycles.

4. Reciprocal IVF (Co-Maternity)

Definition

Reciprocal IVF, also known as Co-Maternity, allows two partners in a female couple to share biological roles in conception:

• Partner A: Provides eggs (genetic connection)

• Partner B: Carries the pregnancy (gestational connection)

Clinical Steps

1. Partner A’s ovarian stimulation & egg retrieval

   • Standard IVF stimulation performed.

2. Fertilization with donor sperm

   • Embryos are created using Partner A’s eggs and donor sperm.

3. Embryo transfer to Partner B’s uterus

   • Partner B undergoes endometrial preparation with estrogen and progesterone to synchronize her uterus for transfer.

Advantages

• Both partners share a biological and emotional connection with the child.

• Enables inclusion of both individuals in the conception process.

• Success rates are equivalent to standard IVF, depending on egg source age.

Clinical Considerations

• Both partners must undergo complete pre-treatment testing: infectious disease screening, ovarian reserve testing, uterine evaluation.

• Legal documentation and consent are essential to define genetic and gestational roles.

• Psychological counseling is recommended to discuss long-term implications.

• The same model can be adapted for trans couples or gestational carrier arrangements where one partner’s gametes are used with another’s uterus or a surrogate’s.