Will You Need IVF Treatment?

What Are Your Options If You Don’t Want to Pursue IVF?

Many people assume that if you can’t get pregnant, IVF treatment is the go-to solution. This is a myth. A small percentage of couples with infertility—less than 5 percent, according to the American Society for Reproductive Medicine—will go onto to use IVF.

When it comes to those in need of IVF, people generally fit into one of two categories:

  • Those for whom IVF is their only option for a biological child
  • Those who have not had success with lower tech treatments

Will you need IVF? And what if you don’t want to do IVF?

When Is IVF the First Step?
There are some situations where IVF is your only option to have a biological child.

Severe tubal disease: If both fallopian tubes are blocked, IVF is your only option for a biological child.1 The fallopian tubes are the pathway that connects your ovaries to your uterus. If an egg ovulated from your ovaries can’t reach the uterus—and sperm can’t get to the egg—you can’t get pregnant.

In some situations, surgical repair of the fallopian tubes can avoid the need for IVF. However, success rates vary considerably, and it’s not a good option for most women with severe tubal disease.

Severe male infertility: In cases of severe male infertility, intrauterine insemination (IUI) with a sperm donor or IVF with ICSI may be your only option for biological children. ICSI stands for intracytoplasmic sperm injection. With basic IVF, sperm cells are placed in a petri dish with an egg. Eventually, one of the sperm cells will hopefully fertilize the egg.

With IVF-ICSI, one single sperm is injected directly into an egg. IVF-ICSI be necessary in cases of severe problems with sperm motility (movement) or morphology (sperm shape.) It may also be required if the sperm count is very low.

Azoospermia is when a male has a zero sperm count. Some of these men can still have a biological child thanks to IVF-ICSI. Immature sperm cells can be biopsied directly from the testes. The sperm cells are then allowed to mature in the lab. Sperm cells matured this way can’t fertilize an egg themselves, and IVF with ICSI is required for conception.

High risk of genetic disease: If you and your partner are at high risk of passing on a deadly genetic disease, IVF may be your best or only option.1 This may also be true for couples experiencing recurrent miscarriage due to genetic problems. In this case, you would need IVF with PGS or PGD.

PGD stands for preimplantation genetic diagnosis. This is when an embryo is tested for a particular disease. PGS stands for preimplantation genetic screening. This is when an embryo is generally checked for normal chromosomal counts. This test is not as reliable as PGD and is considered experimental.

Post-cancer fertility treatment: If you have frozen eggs, ovarian tissue, or embryos, you’ll need IVF to conceive with that cryopreserved tissue.

Frozen sperm cells can be used via an IUI procedure and may not require IVF. However, if there is a small amount of preserved sperm cells, IVF may be a better choice due to the increased success rates.

When cryopreserved eggs are used: Cancer is no longer the only reason why eggs may be frozen. While still uncommon, some women are freezing their eggs when they are young to reduce their risk of age-related infertility. If you freeze your eggs, and you want to use them to get pregnant in the future, you will need IVF treatment to conceive.

When a gestational carrier is required: If a woman is missing her uterus, either because she was born that way or it was removed for medical reasons, she won’t be able to conceive or carry a pregnancy. She may be able to have a child via a gestational carrier.

If the woman has her ovaries, or she has cryopreserved eggs or ovarian tissue, she may also be able to have a biological child with the help of a gestational carrier. If not, an egg donor may be used along with the biological father’s sperm cells. All of this requires IVF.

Finding a gestational carrier may also be required if there are severe uterine factor infertility issues that can’t be repaired surgically. A gay male couple that wants to have a biological child may also need a gestational carrier with IVF treatment.

(Technically, IVF could be avoided by using the gestational carrier’s eggs and using artificial insemination with the biological father’s sperm or a sperm donor. However, this can cause legal problems and may be more psychologically difficult for the gestational carrier. This is why it’s more commonly done with IVF and an egg donor, the biological mother’s eggs, or an embryo donor.)


When Is IVF the Next Step?
No treatment map fits every couple perfectly. Therefore, it’s not possible to say what your personal path to IVF may look like. Some couples may require surgery before they try any fertility treatments. Some may first need to treat an underlying medical condition. Some may never need fertility treatments.

That said, here are some more common treatment trajectories. The treatment pathways listed below are simplified and don’t represent all treatment possibilities.

This is the most common treatment path for women with mild to moderate ovulatory problems:

  • Clomid for three to six cycles (may or may not also include treatment with metformin, if the woman has PCOS or is insulin resistant)
  • If Clomid doesn’t trigger ovulation, letrozole for three cycles
  • Gonadotropins with timed sexual intercourse for two to six cycles (some doctors skip this step and go straight to IUI with fertility drugs)
  • IUI with Clomid or gonadotropins for three to six cycles (fewer cycles if the woman is 35 or older)
  • IVF treatment

Most common treatment path when mild to moderate male infertility is the primary problem:

  • (When applicable) fertility drug treatment to boost sperm production
  • (Sometimes) removal of a varicocele, if that’s the problem
  • IUI without fertility drugs (unless the woman also has ovulation problems) for three to six cycles
  • IUI with sperm donor (more common for those who don’t want to do IVF)
  • IVF treatment

For a couple with unexplained infertility, a common trajectory may look like this:

  • (Possibly) limited time continuing to try on your own
  • IUI with Clomid, Letrozole, or gonadotropins for up to six cycles
  • IVF treatment

What determines whether your doctor suggests trying for one, three, or six cycles of a particular treatment? Or whether they skip one of these steps? Or suggest a fertility treatment not listed above?

Your doctor will take into consideration your cause of infertility, the research on your particular situation, your ages, your personal desire to keep trying before moving onto the next level, your feelings towards or against IVF, your insurance coverage, and your financial situation.

If you’re wondering when IVF may become the next step in your personal circumstances, speak to your doctor. If you disagree that IVF should be the next step, or you are curious if you have alternative options, don’t be afraid to get a second opinion before making a decision. Deciding to pursue IVF is a big decision.

What If You Don’t Want to Do IVF?
You always have the option not to pursue IVF. This is true whether IVF is the first treatment recommended by your doctor, or you only are facing IVF after several attempts of non-assisted reproductive technologies.

There are many reasons why a couple may decide not to do IVF. Some of the most common reasons are…

  • Financial inability to pay for it
  • Wish to avoid risks and invasiveness of the procedure
  • Decision not to pursue treatment based on low estimated success rate (will vary for every situation)
  • Religious objections
  • Desire to pursue adoption (because they only have enough cash to do either IVF or adoption, or they simply prefer adoption to IVF)

Sometimes, you will have no chance of having a biological child without IVF. In other cases, your odds of conception may be low—possibly less than 1 percent in some cases—but not impossible.

For example, women with primary ovarian insufficiency (POI) may be unlikely to conceive on their own. But it does happen in a very small percentage of cases. You shouldn’t count on being in that rare group. At the same time, you shouldn’t assume your infertility diagnosis will keep you from conceiving on your own naturally.

What are your options if you don’t want IVF? This is something to discuss with your fertility doctor and a counselor.

Some possible options besides IVF may include:

  • Further pursuing low-tech treatments (more IUI cycles, for example)
  • Alternative therapies (like acupuncture)
  • Continuing to try on your own
  • Surgical procedures (when applicable)
  • Pursuing adoption
  • Choosing a child-free life

If you decide to pursue further lower tech cycles, or try alternative treatments, discuss with your doctor the actual odds of treatment success. For example, some research has found that after six to nine cycles of IUI, the odds of conception drop significantly. You don’t want to throw away money and waste emotional energy on treatments that are unlikely to work.

While it can be hard to stop trying, sometimes it is the best thing to do for your body and your emotional well-being. If you’re having difficulty deciding when to stop treatment, see a professional counselor who can help you work through the grieving process.

by Rachel Gurevich


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