First thing to know: if you have the ability to produce a fresh semen sample with normal sperm counts when you’re ready to have children, your doctor probably won’t recommend that you use your stored sperm for a fertility procedure. This article will focus on what your options are to create a baby if you are advised to use your stored sperm.
To attempt to create a baby from stored sperm, your fertility doctor will typically recommend one of two procedures: IUI, or IVF. Depending on many factors, including how much sperm you have stored, your reproductive partner’s fertility and age, and more, you and your doctor will discuss and decide if IUI or IVF is right for you. Keep in mind that neither procedure is guaranteed to result in a baby.
👉 Note: this article refers often to your “female reproductive partner” or FRP which may or may not be your significant other or spouse. We’re not trying to make the females roles feel transactional; we’re trying to be inclusive to anyone who chooses to use egg donors, surrogates, or other female counterparts to achieve a pregnancy.
Now, there’s a TON of information out there on this subject, but we wanted to give you the high level details of each each option:
IUI (intrauterine insemination) or commonly known as the “turkey baster” approach, is when sperm is transferred directly in a woman’s uterus via a small catheter while she is ovulating.
Your fertility doctor will schedule the procedure to align with when your female reproductive partner (FRP) is ovulating. Your doctor may also recommend that your FRP take certain fertility medications to increase her number of mature eggs that could be released in her next ovulation cycle (otherwise, women usually just release one egg). The more eggs that can be released, the more likely one will get fertilized and result in a pregnancy.
If you can produce a normal semen sample, your doctor will request you produce one within one hour of the procedure. Either way, when it's time for the procedure, your semen is loaded into a catheter and transferred into your FRP’s uterus. You may be thinking, “how is this different from regular sexual intercourse?” and that’s a fair question! The main difference is that sperm are released much closer to the egg. In sexual intercourse, sperm is released in the vagina, and they must swim through the small channel of the cervix to reach the uterus. With IUI, the small catheter is led through the vagina and the cervix, allowing the sperm cells to be released directly into the uterus. Another benefit to the IUI process is having a fertility expert help identify when your FRP is most fertile, and potentially enable her to release more than one egg during one cycle.
There’s a few factors that determine if this approach is right for you and your FRP. First, your doctor will typically only recommend this approach if you have over 5 million viable sperm in either a fresh sample, or a stored vial. Also, since you must use an entire vial for one IUI attempt, your doctor will want to make sure you have either a few extra vials stored to try to conceive again in the future, or ensure that you are physically able to create more vials or samples if this attempt is unsuccessful. This is especially true if you want to have more than one child. Now, these are only the male considerations. Doctors will also typically only recommend IUI for younger women who have a normal number of eggs left (blood work and ultrasounds can be used to determine this), and who are clear of other fertility issues that may interfere with the success of attempting a pregnancy with IUI.
IUI is generally a cheaper option compared to IVF. One attempt of IUI is usually around $1,000, but of course the cost will depend on your insurance, your company benefits, and the specific clinic you choose. We recommend calling your insurance company to understand what your plan covers.
On average, each IUI attempt typically results in a 10-20% pregnancy rate. However, age of your FRP, number of sperm in your sample, and other fertility factors can greatly impact the success of IUI.
If you’re curious about how your expected total motile sperm count (per stored vial or per ejaculate) is correlated with your chances of conceiving through IUI, check out the table below. This data is from a peer-reviewed study published inFertility and Sterility.Spoiler alert: the more motile sperm, the higher the likelihood of conceiving through IUI.
The younger the woman going through IUI, the more likely she will conceive. Check out the table below to see how a woman’s age affects her chance of conceiving through IUI. Data is generated from a peer reviewed paper in 2013.
Now, let’s talk about…
IVF (in vitro fertilization), is a common fertility treatment that involves retrieving eggs from a woman’s ovaries, fertilizing them in a lab with sperm, and then placing one or more embryos into a woman’s uterus.
After you meet with your fertility clinic and decide IVF is right for you and your female reproductive partner (FRP), your FRP will begin medication. Everyday, she will self-administer shots (in usually the abdomen or butt) to stimulate her ovaries to produce mature eggs. After 8-14 days, the eggs will be ready to be retrieved, and she’ll go to the clinic for the egg retrieval surgery. During the procedure, a doctor will use a small hollow needle to retrieve the mature eggs from her ovaries. Most women are either under local or full anesthesia for this. Next, your fertility clinic will examine these eggs under a microscope to determine which are mature (or viable) to be fertilized. Once they determine which eggs are candidates for fertilization, they will use a process called ICSI (intracytoplasmic sperm injection), where they will take one of your viable sperm cells and directly inject it into one of her mature eggs. Depending on your circumstances and the plan you have created with your doctor, your clinic may fertilize as many mature eggs as there are available using ICSI. If the fertilized eggs grow into healthy embryos (sometimes chromosomal testing is performed to confirm), one or more eggs can be transferred into your FRP’s uterus, and the others can be cryogenically frozen for future pregnancy attempts. To increase the chances of pregnancy, most IVF experts recommend transferring up to three embryos at a time. However, this means your partner could have a multiple pregnancy, which can increase the health risks for both you and the babies.
There are many considerations in determining if IVF is right for you and your FRP. For one thing, if you have a limited amount of sperm available (perhaps you only have a few vials stored and you’re unable to create more), IVF is your best bet at achieving a pregnancy. Remember, with IUI, an entire vial is needed for one attempt at fertilizing one egg. However, with IVF and ICSI, only one healthy sperm is needed per egg--meaning each of your vials can be used to fertilize as many mature eggs that are available at that time.
Deciding to pursue IVF will come down to both your circumstances and your FRP. Considering the female side of the equation, doctors will typically recommend IVF for women who are in their older child bearing years, have fewer eggs in their ovarian reserve (doctors can estimate this from blood work and ultrasounds), or have other issues that are causing infertility.
IVF is the more expensive option compared to IUI. One round of IVF (which includes medications, egg retrieval, fertilization, and embryo transfer) is usually around $13,000-$17,000. This of course depends on your insurance, your company benefits, and the specific clinic you choose. Some states require insurance companies to cover infertility procedures, so check out this list or call your insurance provider to better understand your options. Also, some non profits and other organizations have money set aside for couples struggling with infertility, so it may be a good idea to do some investigating if these costs feel like a non-starter. One additional cost to consider is if you choose to pursue IVF and want to freeze embryos, the cost of storing them can be $350-$1000 per year.
The success rate of IVF can be higher than the success rate of IUI, but the most influential factor in determining your likelihood of success is your FRP’s age. According to the Society for Assisted Reproductive Technology (SART) Clinic Report, the average live birth rate from IVF is 55% with women under 35. For women over 42, the rate is 4%.
Many fertility clinics report on their IVF success rates, so we highly recommend researching at least a few clinics and inquiring about their success rate before choosing your clinic, after all, this is a very big financial, physical, and emotional investment. Here’s a list of clinics in the U.S.
There’s a lot of variables at play here in figuring out which procedure could be right for you. The best thing you can do is talk to your doctor about your family goals so they can start working with you on a game plan. They may recommend that you store more samples to give you more flexibility when the time comes that you may need your sample.
It would be nigh impossible to find a bunch more passionate about fertility than the Fellow Team. We are a group of colleagues who loves to author articles in our free time (that is, when we aren't challenging each other to games of Code Names). You can reach us at firstname.lastname@example.org.