IUI vs IVF

Let’s talk about intrauterine insemination (IUI) versus in-vitro fertilization (IVF). 

I’m a double-board certified OBGYN and reproductive endocrinologist helping people build their families for over 15 years. A huge part of my work is deciding what fertility treatment is right for the patient in front of me. 

When I first started my career, the typical path was doing three or four rounds of IUI, and then moving on to IVF as a “last resort”. Nowadays, I’ve noticed that people are more comfortable with going straight to IVF without doing IUI beforehand. 

I get many questions about IUI and IVF (“Should I do IUI?” “Should I do IVF?” “Which one do I choose?” “How do I choose?”), so I hope that this blog post answers these questions. We’re going to go through the differences between IUI and IVF, and then I’ll share the pros and cons of each. I hope that this information helps you figure out the right path for you. 

Let’s get started.

What is intrauterine insemination (IUI)?

IUI is the process of washing and prepping sperm, then placing that sperm into the uterine cavity around ovulation. It essentially gets the best sperm past the cervix at an optimal time to conceive. It’s helpful because it works with your cycle, but once the sperm is placed, there will be a two-week wait to see if pregnancy has occurred. Compared to IVF, IUI is pretty simple. 

What is in-vitro fertilization (IVF)?

IVF is completely different from IUI. In-vitro fertilization is a multi-step process: 

• Medication is taken to stimulate the ovaries and recruit more than one or two eggs 

• You’ll undergo egg retrieval, which is a simple procedure of getting multiple eggs out of the body 

• The eggs will be taken to the lab and fertilized with sperm

• The embryo(s) (fertilized egg) is/are observed in the lab until reaching the blastocyst stage 

• When the embryo(s) is/are ready, it’s inserted into the uterus for implantation with a catheter that goes through the cervix 

What are the pros and cons of each fertility treatment?

IUI and IVF treatments have the goal of helping people conceive, but they are quite different from each other. 

Before deciding on a treatment, you should make sure you’ve had fertility testing, such as semen analysis and an HSG to make sure fallopian tubes are open. Diagnosis often dictates the treatment, and fertility testing may determine the best fit for you. For example, if fallopian tubes are blocked, IVF is a way to get pregnant by bypassing the fallopian tubes. 

The pros of IUI

• Usually, a simpler process that’s less complicated

• It works with the menstrual cycle

• Requires less medication 

• Lower cost

The cons of IUI

• Lower success rate than IVF (because there are fewer controlled variables), typically between 10-20%

The pros of IVF

• Higher success rate than IUI because we’re controlling for more variables 

• Ability to select the best embryos to transfer through genetic screening (which can identify chromosomally abnormal embryos that can lead to miscarriage) 

• Addresses more fertility issues like fallopian tube blockage

• Requires less sperm than IUI, so it offers a treatment option for patients with significant male factor infertility 

The cons of IVF

• More expensive than IUI

• Much more complicated than IUI, in terms of appointments, procedures, and medications

• It can be ethically challenging to decide what to do with frozen embryos that aren’t used 

Which treatment is best for you? 

Your fertility doctor can determine the best treatment for your unique situation. However, I can shed some light on what I’ve found in my 15 years of practicing. 

I’d recommend thinking about your family goals.

If you’re in your late 30s and you might want more than one child, IVF is often a good solution. This way you have embryos that you can utilize in the future for a sibling, which keeps your options open. 

If a patient is in their 40s, there’s no question that IVF will have a higher chance of success for that person because there can be a dramatic change in fertility over time. If the embryos are waiting for you, you will have a higher chance of building your desired family. 

If your fallopian tubes are blocked, IUI will not work because the egg and sperm will not be able to find each other. IVF helps bypass the fallopian tubes. 

If a patient is young with PCOS and has an irregular menstrual cycle, we might not need to go straight to IVF. If the fallopian tubes are open and age is on the patient’s side, we might want first to try to trigger ovulation through medication and then do IUI to see where that gets us. 

If your goal is one child, finances are challenging, and insurance isn’t going to cover much, IUI might make sense. 

IVF has other implications to consider if you’re worried about future costs. Thawing and implanting embryos in future cycles will also have additional fees. 

Talk about your goals with your doctor and see what feels right for you. Understanding each option (and its implications) is important before choosing for yourself. 

Let’s recap:

• IUI and IVF are two very different fertility treatments, but both share the same end goal of conceiving 

• IUI is less expensive and less complicated, but it controls for fewer variables

• IUI also has a lower chance of success

• IVF is more expensive and complicated, but it controls for more variables, which can lead to a higher success rate

• IVF can also be used as a fertility preservation option 

Above all else, speaking with your doctor about your goals, diagnosis, and options is important. 

I hope this is helpful. If you have questions, comment in my YouTube video. I’d also love to know what other topics you’d like covered.