Advice for making an informed decision on IUI vs IVF
by Isaac Glatstein, MD, MSc
As a fertility specialist, I know that the decision to pursue fertility treatment can be overwhelming. There are many factors to consider, including costs, timing and the type of treatment that may be best for you and your partner or for you. To help with that decision, let’s dive into the differences between two of the most common assisted reproductive technology treatment options: intrauterine insemination (IUI) and in vitro fertilization (IVF).
These are two fairly well-known treatments. Patients often ask me what the difference is between IUI and IVF and which one they should choose. The which to choose part of the question is more difficult to answer, as that depends on many factors discussed below that we won’t know until we perform a thorough evaluation on both partners.
In general, IUI is not as complex a treatment so it is less involved and considerably less expensive. The American Society for Reproductive Medicine notes that IUI, “is considerably less effective than IVF,” and can require multiple attempts for success. This can bring the cost up to around half of what one IVF cycle costs. It’s common for patients to try IUI then move on to IVF after lack of success. However, some patients may require IVF as the best chance treatment to begin with.
IUI and IVF are also treatments that many LGBTQIA+ individuals and couples will need to build their family. This will depend on the sexual makeup of the couple or individual and their preferences.
IUI vs IVF: understanding the different procedures
IUI and IVF are popular assisted reproductive technology fertility treatments, which are those treatments that involve handling eggs, sperm or embryos. Their popularity is due to their high success rates in treating various infertility issues. They go about it in different ways, namely:
IUI procedure
IUI is a procedure that reduces the barriers sperm may have in reaching the egg to achieve a pregnancy. It involves placing sperm directly into a woman’s uterus around the time of ovulation, eliminating the need for sperm to move through the cervix and getting it closer to enter the fallopian tube where fertilization occurs. It is a less invasive and less expensive option compared with IVF. It also requires minimal drugs to induce follicle development. Using no drugs is also an option.
IVF procedure
IVF involves stimulating a woman’s ovaries to produce multiple eggs, retrieving the eggs, fertilizing them with sperm in a laboratory and transferring the resulting embryo(s) back into the uterus. This involves several office visits for both monitoring and performing the steps involved. IVF requires a greater commitment of time and office visits than IUI.
Choosing between IUI vs IVF fertility treatments
Choosing a course of treatment can be daunting without a strong patient-doctor relationship. Prior to recommending any course of treatment, I will evaluate the prospective parent’s or parents’ medical history and perform an examination of both partners. Further testing and bloodwork may be needed.
I will also discuss preferences and lifestyle factors that can impede fertility and treatment success with the individual or couple to help them make an informed decision. We help patients understand all their options and why a particular treatment course may work best for them.
We base our recommendations between IUI or IVF on several factors, including the complexity of the infertility issue and the specific needs of a couple or individual. While there is no hard and fast rule, there are some general considerations for each procedure.
Is IUI right for me?
IUI is often the first step for couples facing ovulation issues, mild to moderate male factor infertility or unexplained infertility. We may recommend IUI more often for younger couples. Age plays a factor in fertility success, particularly for females, often making IVF a better treatment.
Other conditions or circumstances that may particularly benefit from IUI include:
- Endometriosis and polycystic ovary syndrome.
- Cervical or ovulation factor infertility.
- Men with poor sperm counts, low sperm movement or abnormal sperm shape (morphology).
- Men with ejaculation issues.
- Those with an unexplained infertility diagnosis.
- Those needing donor sperm.
Benefits of IUI include less medication, a quicker procedure, less invasive than IVF and lower costs compared to IVF.
Is IVF right for me?
On the other hand, IVF is typically recommended for couples facing more complex fertility issues, such as severe male infertility, blocked fallopian tubes, or those who have had multiple failed IUI cycles. IVF also has unique benefits for those with concerns about passing on genetic disorders, as preimplantation genetic testing (PGT) can identify abnormalities in embryos that can result in failed implantation, miscarriage and birth defects in a resulting child.
Comparing IUI to IVF is somewhat like comparing apples to oranges, in that they are similar but different. IVF meticulously manages every stage of conception, from selecting and fertilizing an egg to choosing the best embryo for implantation.
While more expensive, IVF offers higher success rates and is sometimes the only viable treatment option. For instance, we often recommend IVF for couples or individuals facing:
- Tubal factor infertility. This is when both fallopian tubes are blocked or damaged, preventing natural fertilization.
- Need for egg donors or gestational carriers. IVF is essential for those who cannot use their own eggs or carry a pregnancy themselves.
- Cancer treatment. Those undergoing treatments that affect fertility can use IVF to preserve eggs or embryos.
- Age-related fertility declines. Women experiencing reduced fertility due to advanced maternal age, which affects egg quality and quantity, can benefit from IVF’s higher success rates.
- Inherited disorders. IVF, combined with PGT, can help ensure that transferred embryos are free from specific genetic conditions.
Toward an affordable & effective fertility treatment plan
Ultimately, the best approach will depend on a person’s or couples’ unique situation as well as their insurance benefits and financial resources. While IUI and IVF are often treatments patients ask about, they are not the only treatments available. In fact, of those who have had fertility treatments, only 14% say they have used IUI and only 2% have used IVF.
There are a wealth of options to address problems conceiving, from lifestyle changes and natural cycle monitoring to ovulation medication and surgical procedures to correct anatomical issues or conditions. Couples or individuals might be candidates to try those treatments before opting for either IUI or IVF.
Knowing when to see a fertility specialist is the first, best step to developing a game plan together. Infertility is a common issue that many couples face, regardless of age, so seeking help sooner rather than later is important.