How to Decide Between IUI and IVF

Millions of Americans are impacted by fertility challenges each year. The National Institutes of Health (NIH) estimates that roughly 9 percent of men and 11 percent of women have had fertility problems of varying severity. These fertility struggles may get in the way of people’s dreams, and they can have a devastating impact, if left unaddressed, on both individuals’ and couples’ mental and emotional health. Fertility challenges may not be the only reason people consider fertility treatments. For example, many people who are single by choice, as well as LGBTQ+ couples, may see fertility treatments as their best road to building their family.

Fertility Treatments Are Available To You

If you’re struggling to conceive, the good news is that there are treatment options available that could help you realize your dreams of parenthood. Two of the most common treatment choices are intrauterine insemination and in vitro fertilization. In this article, we discuss these two fertility treatment options in greater detail and compare the pros and cons of each one while recognizing that patients’ ultimate decisions are highly personal.  

What is IUI?

Intrauterine insemination, also referred to as IUI, is an increasingly popular fertility treatment that can be used as an initial intervention when people have trouble trying to conceive. One of the selling points of IUI is that it is dramatically less expensive than a treatment like IVF. Even though IUI treatments often include medications, like Clomid, to encourage ovulation, many see it as a less intensive or invasive treatment than IVF. You may find yourself wondering what happens in IUI. The answer is quite simple. Washed sperm from a partner or a donor will be inserted directly into the uterus. This means that the sperm will have less distance to travel to meet a released egg, and hopefully, it means that the likelihood of a pregnancy increases. IUI is a common first step for many couples struggling to get pregnant, single parents by choice, or others using donor sperm.

Although you may not need a highly qualified reproductive specialist for a successful IUI, there are many reasons why you might consider working with one. This way, you will have an established relationship with a fertility physician if you need to consider other interventions down the road. A reproductive specialist can also provide any necessary testing to help you determine why you may be experiencing challenges on your fertility journey. Many find that an initial evaluation from a fertility specialist can provide a fuller picture of their fertility status and better understand their best options to move forward.

What is IVF?

IVF, or in vitro fertilization, is a well-known type of assisted reproductive technology (ART) that’s helped thousands of people worldwide have the family of their dreams. IVF involves fertilizing eggs in the laboratory and transferring created embryos to a uterus. The process involves extracting eggs, retrieving a sperm sample, and combining an egg and sperm in the laboratory to help fertilization and embryo creation.The first step in an IVF cycle is ovarian stimulation, which is where synthetic hormones are injected to stimulate the ovaries so that they can produce multiple eggs. Once the eggs mature, it’s time for follicular aspiration, also known as egg retrieval, when a needle is inserted into one or both ovaries to retrieve the eggs. After that, the egg is fertilized with sperm provided by a partner or donor. Once this has happened, medications are administered to the person planning to carry the pregnancy to prime the environment for a healthy pregnancy. The embryo is then transferred into the uterus. If any other embryos were created, they may be frozen and kept in storage for future use.

What Are the Main Differences between IVF and IUI?

There are multiple differences between in vitro fertilization and intrauterine insemination. A few of the  most significant differences are highlighted below:

#1 The Extensiveness of the Process

IVF is considered more involved and has more stages in the process than IUI. This includes egg retrieval, which can be uncomfortable or painful for the patient. Many of these steps happen in a laboratory before the embryo is transplanted back into the uterus.

#2 What Is Treated  

As we will explore in more detail below, there are some situations in which IUI may be appropriate, and there are others where providers may recommend IVF. Remember, everyone’s fertility journey looks different, depending on numerous factors, and there is no single perfect answer for everyone.

#3 How Much It Costs

The price of IVF and IUI may vary depending on where you live and various factors. IVF is usually costlier than IUI. Depending on the clinic you are using and the accompanying treatments you may need, IUI may cost less than $1,000 per attempt, and IVF is estimated to cost between $15,000 and $30,000 per attempt. This price differential explains, at least in part, why some doctors recommend starting with intrauterine insemination as an initial fertility treatment.

#4 The Length of the Process

There is no easy or perfect answer for how long it will take someone to get pregnant. Some medical experts suggest that your success rate with IUI will be about 15 to 20 percent per try. However, your odds jump significantly if you decide to go the IVF route. In this case, your likelihood of a successful overall outcome is between 30 and 60%, depending on the woman's age. The chance of a successful pregnancy from one round of IVF can vary depending on the underlying source of infertility. For example, advanced maternal age, which describes people over the age of 35 during pregnancy, may be one factor that significantly lowers the success rate. Although these factors impact many people's decisions when discussing their treatment options and plan, there is also a psychological and emotional toll to every cycle without a successful pregnancy to be carefully considered.

When Is IUI a Better Choice than IVF?

As stated above, IUI is less expensive than IVF treatment. However, there are two caveats here. First, the budget should never be the sole determinant of your reproductive health. It is important to talk to skilled fertility practitioners and see what they recommend for your unique circumstances. Second, the attractive prices quoted above were for a single round of IUI. However, given the relatively low success rate per cycle, many patients need to undergo multiple treatment rounds, and the cost can accumulate cycle after cycle.In addition to very valid cost considerations, some other factors could nudge you to consider IUI. If, after testing, doctors are still unsure about the source of your infertility, then this treatment option could be a good starting point. If it does not work, you can always move to another option, like IVF. It may be a good idea to discuss how many cycles you are willing to try before changing your approach with your provider ahead of time. This can help with future decision-making when in the midst of fertility treatment. Also, IUI can be a great option if the fertility challenges you're experiencing have been determined to be caused by sperm motility issues. The IUI process puts the sperm and the egg in much greater proximity, upping the likelihood of success. However, this may only be effective if the motility reduction is mild or moderate. More severe cases of sperm motility issues may require a greater amount of intervention, such as IVF or ICSI.

When Is IVF a Better Choice than IUI?

Even though IUI is an excellent choice for many people, especially those with unexplained infertility, it may not help everyone achieve the family of their dreams. In these cases, it might be time to consider IVF. For instance, if fertility testing shows that the source of infertility is fallopian tube scarring, IVF might be a better choice. This creates an issue because the egg cannot make it to the uterus for fertilization. IVF treatment bypasses this issue by uniting the sperm and egg in the controlled environment of a laboratory dish. IVF treatment also allows for the opportunity to utilize genetic testing. With Preimplantation genetic testing (PGT), medical professionals can test embryos for a wide range of genetic and chromosomal conditions and only implant the healthy embryos. In many cases, undergoing IVF with PGT can significantly increase the chance of having a healthy baby. Another reason why IVF may be a better choice is if sperm quality and/or motility are very low. The controlled environment of a lab with IVF may be the only way to achieve fertilization. However, even placing the sperm closer to the egg, like with IUI, may not be enough to achieve fertilization. In some cases, it may be recommended to utilize intracytoplasmic sperm injection or ICSI. During ICSI, a single sperm is directly injected into the egg, which can greatly improve the fertilization rate. IVF may also be recommended for someone dealing with endometriosis or if the patient has experienced multiple miscarriages at any stage of pregnancy.  

Reach Out to Advanced Fertility Care

At Advanced Fertility Care, our highly qualified team of medical specialists prides itself on being the best at helping people realize their dreams of parenthood. Set up your initial consultation today to learn how our team can guide you in this journey. We understand that everyone’s fertility journey is unique, and we will work with you to set up a treatment plan that transforms your dreams into reality.