IUI vs. IVF: Deciding Which Is Right for You

Intrauterine insemination (IUI) and in vitro fertilization (IVF) are medical techniques that help someone get pregnant. They are types of assisted reproductive technology (ART) or fertility treatment. Intrauterine insemination is when the sperm fertilizes the eggs inside the uterus, whereas in vitro fertilization occurs in a petri dish or lab.

This article compares types of IUI and IVF, their procedures, cost-effectiveness, success rates, and possible side effects. 

What Is IUI?

IUI is ART that involves placing sperm inside the uterus. People may refer to it as artificial insemination, alternative insemination, or donor insemination.

Conception (pregnancy) occurs when the sperm joins the egg. Sperm must swim from the vagina, through the cervix, and into the uterus. IUI aids pregnancy by decreasing the distance the sperm travels to fertilize the egg.

Types

Providers differentiate IUI based on the use of fertility drugs. Both types have a higher success rate than trying to conceive without fertility drugs, procedures, or other forms of assistance.

• Natural cycle IUI: Sperm is placed in the uterus after the body’s hormones induce ovulation.
• Stimulated cycle IUI: Stimulated cycle IUI uses fertility drugs to stimulate ovulation or increase the number of eggs with ovulation. 

Procedure

With IUI, artificial insemination occurs the day after ovulation. Before the procedure, your healthcare provider will prepare and “wash” the sperm sample. 

If your partner provides the sperm sample, they will do so on the day of IUI. For those using donor sperm, your provider will thaw and prepare the sample before beginning the procedure. 

The artificial insemination procedure is similar to a Pap smear or pelvic exam. It may be slightly uncomfortable, but it should not be painful and doesn’t require sedation. It is performed as follows:

• Step 1: Lie on the exam table and place your feet in the stirrups. 
• Step 2: The healthcare provider uses a speculum (the same tool they use during a Pap smear) to open the vagina and visualize the cervix. 
• Step 3: The provider inserts a long thin tube past the cervix and into the uterus. They inject the sperm into the uterus through the tube.
• Step 4: Lie still for 15 to 30 minutes before cleaning up and dressing. You may have mild cramping or bleeding for a few hours after the procedure. 

Your provider may prescribe progesterone, a hormone that prepares the lining of the uterus and helps implanted embryos grow. Typically, you will take a pregnancy test two weeks after IUI.

What Is IVF?

IVF is fertilizing an egg outside the uterus in the lab. "Fertilize" means combining the sperm with the egg. The fertilized egg matures into an embryo that the provider puts back in the uterus to become a fetus.

You can choose to use your eggs or donor eggs for this procedure. This decision will depend on your fertility challenges and personal preferences. 

Types

The following is a review of the different types of IVF:

• Traditional IVF: The provider places thousands of sperm in a petri dish with a mature egg. The need for fertility drugs vary based on fertility challenges.
• Natural IVF: The provider retrieves eggs during ovulation; no fertility drugs are necessary.
• Minimal stimulation: The gestational carrier takes low amounts of fertility drugs over a short time frame.
• Frozen embryo transfer (FET): The provider freezes and stores the embryos for later use.
• Single-embryo transfer (eSET): The provider places one of several embryos in the uterus. 
• Donor IVF: This is when another person donates their eggs or sperm.
• Intracytoplasmic sperm injection (ICSI): ICSI is when a provider injects a single sperm directly into the egg under microscopic guidance. This procedure is helpful with low sperm count or when sperm are not strong enough to push through the egg. 
• In vitro maturation (IVM): IVM is the retrieval of immature eggs. It differs from traditional IVF because the eggs mature in a petri dish outside the body rather than in the ovaries. It’s only done with ICSI and can help those who cannot take fertility medications.

Procedure

Typically stages of successful IVF progress as follows:

• Stimulation: Fertility drugs stimulate ovulation.
• Egg retrieval: Your healthcare team gives you mild sedation while the provider retrieves eggs from your uterus during an in-office procedure. They insert a thin needle through the vagina into the ovaries with ultrasound guidance. 
• Insemination and fertilization: The healthcare provider places the eggs and sperm together. 
• Embryo growth: A few days after fertilization, the egg starts dividing, becoming an embryo. 
• Embryo transfer: The provider transfers embryos to the uterus or freezes them for future use. 
• Implantation: When embryos stick to the uterus lining, implantation occurs.

Your provider may prescribe progesterone after the transfer to help the embryos grow.

IUI vs. IVF

When deciding between these options, you and your fertility specialist should consider the gestational carrier's age, fertility concerns, overall health, cost, and family history. 

Common Reasons for IUI

People with the following fertility concerns might opt to try IUI first:

• Unexplained infertility
• The need for donor sperm
• Problems with sperm concentration, movement, size, or shape
• Ejaculatory disorders
• Immunological infertility
• Mild endometriosis (a condition where cells similar to those found in the uterine lining grow outside of the uterus)
• Cervical factor infertility  
• Ovulation problems
• Allergy to semen
• Other causes of implantation failure
  

Common Reasons for IVF 

IVF may be the best option if your or your partner’s condition involves the following:

• Severe male infertility
• Blocked fallopian tubes that surgery cannot correct
• Absent fallopian tubes
• Lack of success with IUI
• Multiple miscarriages
• Severe endometriosis
• Polycystic ovary syndrome (PCOS)
• Advanced age
• Concern about passing on genetic disorders

Cost

IVF is more expensive than IUI. The average cost of an IUI cycle in the United States is $300 to $1,000. IVF cycles cost between $10,000 and $20,000. 

Insurance coverage for IVF varies by state. It’s always a good idea to contact your insurance provider in advance.  

Risks

The egg retrieval portion of IVF is riskier than IUI. However, both IUI and IVF involve artificial insemination. IUI risks include:

• Infection
• Multiple babies (twins, triplets, etc.)
• Ectopic pregnancy (occurs when a fertilized egg implants outside of the uterus)
• Ovarian hyperstimulation syndrome

Risks with egg retrieval for IVF also include:

• Anesthesia (sedation medication) reaction
• Bleeding
• Infection
• Damage to structures around the ovaries

Side Effects

Side effects vary based on artificial insemination, egg retrieval, and fertility drugs.

• Artificial insemination: Both IUI and IVF involve artificial insemination. Common side effects include mild cramping or bleeding for a few hours. 
• Egg retrieval: When IVF includes egg retrieval, it has more side effects. Egg retrieval is not necessary with egg donor IVF. These side effects can last around a week and involve abdominal bloating and discomfort, vaginal soreness, and cramping or spotting.
• Fertility drugs: IUI and IVF may require fertility drugs to stimulate egg production or increase the number of eggs you produce. These medications carry potential side effects, including abdominal bloating and discomfort, mood swings, nausea and vomiting, and headaches.

Success Rate

IUI success rates range from 5% to 25% as opposed to 25% to 87% with IVF. These extensive gaps in the ranges are due to the following variables:

• Age 
• Height and weight
• Type of fertility issues
• Prior pregnancies
• Egg retrieval versus donor eggs
• Number of egg retrievals 
• Number of embryo transfers 

When considering IVF, the following success estimators may be helpful.

• Society for Assisted Reproductive Technology (SART) tool 
• Centers for Disease Control and Prevention (CDC) IVF success estimator

Which Is Better: IUI or IVF?

While IUI is less invasive, carries less risk and fewer side effects, and is less expensive, it has a lower success rates. The choice comes down to age, fertility challenges, treatment history, and financial resources.

For example, IUI may be a good starting point for people under 35 with specific fertility concerns such as unexplained infertility or sperm problems. 

If IUI doesn’t work within a few cycles, people often opt to move on to IVF. In some cases, IVF may be the best or only option for some fertility challenges involving severe male infertility, severe fallopian tube blockage, advanced age (over 35), or concerns about genetic disorders.

Summary

IUI and IVF are both assistive reproductive treatments. With IUI, the healthcare provider places sperm in the uterus. IVF occurs when the provider fertilizes an egg outside the uterus (in a lab). IUI is less invasive, carries less risk, and is less expensive.

However, it has lower success rates than IVF. You and your fertility specialist should consider age, fertility concerns, overall health, financial resources, and family history when deciding between these options.