In vitro fertilization (IVF) and intrauterine insemination (IUI) are two of the most common fertility treatments available to couples and individuals who are struggling to conceive. Both treatments can support couples facing male factor infertility, female factor infertility, and unexplained infertility, as well as enable single and LGBT intended parents to have a baby.
When comparing IVF vs IUI, it’s helpful to understand the differences in cost, invasiveness, and success rates that can help determine your best treatment route.
IVF vs IUI
What’s the Difference Between IUI and IVF?
One of the most notable distinctions you will see when first comparing IVF vs IUI is that IUI is a simpler, less involved procedure, while IVF is more extensive. Because of this, IUI is often the first choice for couples with mild or unexplained fertility issues, and IVF is often recommended for couples with more severe fertility issues or who have not had success with other less aggressive treatments.
What Is IUI?
Intrauterine insemination involves washing, concentrating, and inserting the sperm directly into the uterus. Through natural intercourse, very few of the sperm make it to the upper reproductive tract because they are hindered by the cervical mucus. By placing them directly into the uterus, a greater number of sperm have a chance of fertilizing an egg—not only do they bypass many of the natural barriers in the cervix, but they have a shorter distance to swim.
What Is IVF?
In vitro fertilization is a multi-stage process that begins with hormone injections to promote ovarian follicle growth and the maturation of several eggs. Next a procedure is performed to remove the eggs from the ovaries, and the sperm is collected from the parent or sperm donor. While the eggs and sperm are fertilized and cultured in an embryology lab, the parent or gestational carrier takes hormone injections to prepare the uterus to receive the embryo. Finally, the embryo is transferred from the lab into the uterus.
When to Try IUI First?
As the less aggressive option when comparing IVF vs IUI, intrauterine insemination is often recommended before IVF as the first-line treatment for couples experiencing mild cases of:
- Male factor infertility, such as decreased sperm concentrations or limited sperm motility
- Age-related infertility
- Fallopian tubal factor infertility, particularly if only one tube is affected
- Unexplained infertility or infertility caused by PCOS, endometriosis, or other irregular ovulation
In many of these cases—in which infertility is tied to egg count or ovulation, or in which the cause of infertility is unclear—IUI is combined with controlled ovarian hyperstimulation (COH) to increase the number of mature eggs and further increase chances of fertilization.
When to Try IVF First?
For patients who are unsuccessful after 3–6 cycles of IUI with COH, in vitro fertilization is often recommended as the next treatment attempt. IVF may also be recommended as the first-line treatment in some cases, such as:
- When sperm counts are too low for IUI to mitigate the barriers to fertilization
- When both fallopian tubes are blocked, making fertilization with IUI and COH alone unlikely
- When parents are carriers of genetic disorders, like cystic fibrosis, and wish to use pre-implantation genetic testing of the embryo to prevent the transmission of disease
- When time is limited: some patients—especially those in their late 30s or 40s who don’t have as many fertile years, and patients who must create and freeze embryos prior to chemotherapy—choose to skip IUI and go straight to IVF to speed up the process.
In addition to couples who are facing moderate to severe fertility issues, IVF is commonly used in conjunction with egg donors and/or gestational carriers to enable single parents and same-sex couples to have a baby.
The Process: IVF vs IUI
What Is the Process for IVF?
The IVF process begins with a 10–14-day treatment of gonadotropin injections to stimulate the growth of multiple follicles and the maturation of as many eggs as possible. Once the optimal number of eggs have matured, a trigger injection is administered to induce ovulation.
About 36 hours from this trigger shot, the egg retrieval procedure is performed, and the mature eggs are moved to an embryology lab where they are fertilized with the sperm collection and cultured for 5–7 days until they reach the blastocyst stage. The most viable of these embryos is selected for transfer to the uterus.
Before the transfer, progesterone injections are administered to enhance uterine receptivity, and on the sixth day of progesterone treatment, the embryo is transferred to the uterus for the remainder of the pregnancy.
Is IVF Painful?
Egg retrieval is performed under anesthesia—primarily because movement will interfere with the retrieval process—however, most women report minimal discomfort following the procedure. Many patients report symptoms similar to painful menstrual cramps, and most report that they can return to work the following day.
Both the administration of progesterone injections and the speculum exam, which is used to ensure a full bladder during embryo implantation, are generally considered uncomfortable or mildly painful. However, the catheter used for the embryo transfer itself is soft and flexible, and the procedure as a whole is usually well tolerated.
What Is the Process for IUI?
The IUI process often begins with ovulation induction, during which medication is used to stimulate the ovaries to produce one or more mature eggs. Once the eggs are mature, a semen sample is collected from the parent or sperm donor, and the sperm is washed and concentrated before being placed directly into the uterus with a thin catheter. A pregnancy test is performed approximately two weeks later to determine if insemination was successful.
Is IUI Painful?
IUI involves only minimal discomfort for most patients and is often compared to a pap smear in terms of patient experience. There are generally no major side effects associated with IUI, but occasionally women experience minimal cramping or spotting following the procedure.
Which Takes Longer: IVF vs IUI?
Depending on the unique patient and which supporting treatments are being used, like controlled ovarian hyperstimulation or endometrial receptivity assay, the process of IVF vs IUI from start to finish can vary. Typically, IUI can be completed within a few weeks, and a cycle of IVF within a couple of months. For both IUI and IVF, the procedures themselves are usually fairly quick.
Sperm Sample Collection: This can be done in the office or at home and can be done within a few minutes.
Insemination Appointment: The insemination procedure itself typically takes just over an hour, however the appointment, including the washing of the sperm and speculum exam, will take a bit longer.
Egg Retrieval: Not including preparation time, the retrieval procedure itself generally takes about 20–30 minutes.
Sperm Sample Collection: This can be done in the office or at home and can be done within a few minutes.
Embryo Implantation: This appointment involves a transdermal speculum exam, but the transfer of the embryo itself generally takes about 10 minutes, though it can take longer if there are challenges with the cervix. Once you know the date of your embryo transfer, you can estimate your due date with an IVF due date calculator.
Which Is More Effective: IVF vs IUI?
When comparing IVF vs IUI, it is important to consider that the effectiveness of treatment depends on your particular infertility diagnosis and other unique health factors. Beyond the effectiveness of treatment itself, some factors that can influence the outcome of pregnancy include the age and related quality of eggs and the additional treatments that are used in conjunction with IVF or IUI.
That said, IUI success rates generally range from 10–20%—with higher rates associated with isolated male factor infertility and lower rates associated with unexplained infertility—and IVF success rates range from 55–80%—with higher rates reflecting cases in which the embryo’s chromosomal normalcy was confirmed through genetic testing.
When comparing success rates of IVF vs IUI, it is also important to consider cumulative success rates that can be attained through multiple cycles of treatment. IUI in particular, as a less involved treatment, can be adjusted and performed multiple times for a significantly higher cumulative chance of success. This is why it is often recommended that a patient try 3–6 rounds of IUI prior to attempting IVF or other more aggressive treatments.
Which Is Cheaper: IVF vs IUI?
When comparing IVF vs IUI, cost is a major factor for most patients—especially considering the significant difference between the two. Typically, without supplemental fertility services, treatment costs range from:
- $800–$1200 per cycle of IUI (including just the insemination process) and
- $14,000–$18,000 per cycle of IVF (Including ovulation induction, egg retrieval, uterine preparation, & embryo implantation).
IUI is clearly a much cheaper treatment, however the cost effectiveness of IVF vs IUI is less straightforward.
While the cost of one IUI cycle is comparatively quite low, the cumulative cost can add up if multiple attempts are needed. Even still, if these attempts will increase a patient’s odds of success, the cost will still be significantly lower than that of IVF, making IUI a good place to start.
Additionally, though more costly, IVF can and often does result in multiple embryos which can be frozen for later use, potentially making IVF more cost-effective for patients hoping to have multiple children. ICRM’s Dr. Maas shares, for example, that one of his patients recently became pregnant with their third child from the same round of ovarian stimulation and egg preservation.
What If IVF and IUI Don’t Work?
If couples are unsuccessful after 3–6 cycles of IUI combined with COH, a consultation is recommended to review the causes and develop a new treatment plan. This often involves IVF, and sometimes several cycles of IVF, depending on the outcome of the first IVF cycle.
For patients who achieve a limited number of embryos through IVF or for whom an embryo transfer does not work the first time, an endometrial receptivity assay (ERA) can be performed to inform more successful transfer attempts.
For patients who are unsuccessful after IUI, COH, and several adjusted cycles of IVF, there are still several alternative options for building your family, like IVF with an egg donor.
Failed fertility attempts can take a significant emotional toll, which is why Dr. Maas encourages patients, “Don’t burn yourself out on something if it’s not working. Talk to your physician and see what the options are rather than just throwing in the towel if it’s not working out.” Because almost always, there are other options.
The most important thing to consider when comparing IVF vs IUI is that both treatments can be the superior option depending on your specific fertility issues, family-building goals, and where you are in your fertility journey.
If you are ready to begin or continue your path to pregnancy and you’re not sure where to begin, we can help. At Idaho Center for Reproductive Medicine, we are known for helping patients overcome some of the most complex infertility issues and finding a way for every intended parent to build their family.
Reach out to our clinic to discuss the benefits of IVF vs IUI for you specifically—and to learn more about all the options available for growing your family.