IVF vs. IUI: What are the Differences
If it feels like more and more people are struggling with infertility, that’s because they are. In the United States, about 11% of women and 9% of men of childbearing age have infertility. The World Health Organization reports that roughly 60 to 80 million couples worldwide experience infertility. Fortunately, assisted fertility technology, like in vitro fertilization (IVF), and intrauterine insemination (IUI) have proven track records in helping couples all around the world have babies.
IVF and IUI: what do they have in common?
IVF and IUI are distinctly different infertility treatments, but they do share a few common factors. With each, the goal is the same – a successful embryo implantation that leads to a full-term, healthy birth.
Before fertilization or insemination, IVF and IUI may include a regimen of fertility drugs to increase rates of fertilization, or in the case of IVF, to assist in ovulation and help with egg retrieval.
When male infertility is a factor, both treatments can include processes to isolate the highest quality sperm for fertilization.
What is in vitro fertilization?
IVF treatment involves harvesting viable eggs that are fertilized outside the body and then implanted in the lining of the uterus. In broad strokes, IVF happens in these five steps:
- Pre-cycle fertility testing for women
- Stimulation of the ovaries to produce several eggs during one menstrual cycle
- Retrieval of the eggs from each ovary
- Fertilization of the eggs in a laboratory by either conventional fertilization or ICSI
- Embryo implantation into the uterus
The process
To start, a course of injectable ovary-stimulating medications is used to help you produce multiple eggs in one cycle. These medications are taken for 8 to 12 days, with blood work and ultrasounds to monitor that the medications are working.
Once the eggs are mature, there is an outpatient surgical procedure to extract them. At this point, the male partner or donor provides a semen sample, which will be combined with the harvested eggs and watched by an embryologist for about five days.
The developed embryos are then transferred into the uterus. Or the embryos can be safely frozen if now is not the right time to start having kids.
ICSI with IVF
Intracytoplasmic sperm injection is a process where a single sperm is injected directly into an egg. ICSI with IVF is used to overcome severe male infertility.
IVF with genetic testing
If you are worried about passing on a genetic disorder or the possibility of birth defects, preimplantation genetic testing can check for general genetic health and single-gene disorders before the embryo implantation process.
What are the pros and cons of IVF?
As with any medical procedure, there are upsides and downsides to IVF treatment.
The biggest upsides are that IVF offers the best success rates, often more than double those of IUI for most age groups. ICSI with IVF and preimplantation genetic testing also greatly increase your chances of successfully getting pregnant.
The downside is that a cycle of IVF is more expensive than IUI. Furthermore, the drug regimen and egg extraction are harder on the body, with up to a third of patients experiencing side effects.
Why parents choose IVF
Fertility testing can reveal a variety of issues. The following are common reasons parents choose IVF:
- Unexplained infertility: One in three couples experience infertility with no obvious cause. In these cases, IVF treatment provides the best outcomes.
- Blocked fallopian tubes: Also known as hydrosalpinx, a blockage prevents the eggs from reaching the uterus for fertilization.
- Lack of success using IUI: Many couples turn to IVF after unsuccessful rounds of IUI because it offers better success rates.
- Not passing on specific genetic disorders: Preimplantation genetic testing allows parents to screen for genetic disorders known to run in their family.
- Severe male infertility: The ICSI procedure provides the best chance at successful fertilization and conception for parents experiencing male infertility.
When to start IVF
Given the much higher success rates with IVF treatments, many couples are choosing to forego IUI entirely. If fertility testing reveals conditions like severe male factor infertility or blocked fallopian tubes, or if you have suffered multiple miscarriages, your fertility expert will likely recommend starting with IVF.
Success rates with IVF
While an IVF cycle is more expensive, it offers significantly higher chances of getting pregnant.
| Female age group | IVF success rate |
| Under 35 | 54% |
| 35-37 | 40% |
| 38-40 | 26% |
| Over 40 | 8% |
What is intrauterine insemination?
Commonly referred to as artificial insemination, IUI is a non-surgical procedure where a doctor inserts sperm from a male partner or donor directly into the uterus, which increases the chances of pregnancy.
The Process
An IUI cycle starts on the first day of your period. For the next 12 to 14 days, your doctor will use blood work and ultrasounds to ensure that an egg is maturing properly for ovulation. Frequently, this stage includes taking oral medications to prompt ovulation.
The actual IUI takes place on the day of ovulation. Before insemination occurs, the semen sample is “washed,” meaning healthy sperm is separated from seminal fluid to increase chances of fertilization. Finally, the sperm sample is inserted into the uterus using a thin catheter, allowing fertilization to happen naturally.
The pros and cons of IUI
The biggest upside to IUI versus IVF is that it isn’t nearly as expensive. The process is also less intensive and can even be done without medication, which reduces the chances and severity of side effects.
Unfortunately, success rates with IUI are fairly low. Additionally, there are a number of conditions that prevent any success with IUI. Genetic testing and the ICSI procedure are also not options.
Why parents choose IUI
Depending on what fertility testing reveals, IUI is often the first step in infertility treatment. The following are common reasons parents choose IUI:
- Polycystic Ovary Syndrome (PCOS): PCOS is a hormone disorder that causes irregular or no ovulation.
- Cervical Mucus Problems: Problems with the consistency of cervical mucus at the time of ovulation can prevent sperm from reaching the egg.
- Sperm Health: Issues with low sperm count or low mobility can prevent fertilization.
- Same-sex couples: For same-sex couples, IUI is the first option for conceiving biological children.
- Single mothers by choice: For women who choose to be single parents, IUI allows them to become pregnant using a sperm donor.
- Insurance reasons: Many insurance providers will only cover IVF treatments after several rounds of IUI have been attempted.
When to start IUI
Most frequently, IUI is where infertility treatment starts. Unless fertility testing reveals an issue that makes IUI a no-go, most fertility specialists recommend starting with IUI.
Success rates with IUI
| Female age group | IUI success rate |
| Under 35 | 13% |
| 35-37 | 10% |
| 38-40 | 7% |
| Over 40 | 4% |
IVF vs. IUI: what are the differences?
The main difference between IVF and IUI fertility treatments is that IVF involves removing eggs from your body and fertilizing them in a lab setting, whereas IUI injects sperm into the uterus to decrease the sperm’s travel time to the egg.
To put it simply, IVF is a more involved treatment that helps you create the ideal conditions to get pregnant and have a healthy baby. By contrast, IUI focuses on reducing obstacles preventing sperm from reaching the egg on their own.
Risks of IVF and IUI
Most of the risks with IVF and IUI are from the medications you have to take.
If you need medication with IUI, it’s usually in the form of oral medications that have fewer and milder side effects. The most common side effects are hot flashes, headaches, and breast tenderness.
A regimen of injectable medication is unavoidable with IVF, and that means a bigger chance of side effects. About a third of women experience headaches, mood swings, insomnia, hot or cold flashes, breast tenderness, bloating, or mild fluid retention.
The good news is that these side effects are temporary and should go away on their own once the cycle is over.
How to choose between IVF and IUI
The first step in deciding which infertility treatment option is best for you is to undergo fertility testing. Each course of treatment has ideal conditions for success. Your fertility specialist will work with you to determine which is ideal for your specific needs.
Insurance coverage and fertility
Since more parents are turning to infertility treatments, more insurance companies are rethinking their coverage of assisted reproduction technology. Before you make any decisions about financing your fertility journey, be sure to check your insurance policy.
Infertility is never an easy diagnosis, but you have plenty of treatment options available to you, now. Consult with an infertility specialist about whether IVF or IUI are right for you.
