While the process can seem easy, getting pregnant can be harder for some people than you might think. For many couples, conceiving needs medical intervention and reproductive technology (ART), like intrauterine insemination (IUI) and in-vitro fertilization (IVF).
IUI and IVF are two types of fertility treatments for couples who cannot conceive naturally. The critical difference between IVF and IUI is the number of eggs the female produces and the place of fertilization. In the IUI process, sperm is injected directly into the uterus. A woman is supposed to develop one or two eggs, and fertilization occurs internally. However, IVF is a multi-step procedure. It takes place outside the body and in the laboratory, during which a woman is given more medications to develop around 15 mature eggs. In this article, you can learn more about IUI vs. IVF, including what they are, who they are suitable for, their comparative success rates, pros and cons, and costs.
Table of Contents
What are IUI and IVF?
Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two of the most popular fertility treatments available today.
What is IUI Procedure?
The IUI procedure is done the day after ovulation and typically takes only five to 10 minutes. IUI can be coordinated with a normal ovulation cycle or with fertility medications.
During IUI, a semen sample is washed to separate sperm from the seminal fluid. The fertility doctor uses a speculum to view the cervix and then inserts a catheter (a small tube) into the uterus to place the final semen directly into the uterus. Since the sperm is put close to the egg in IUI, many couples’ chances of natural conception increase. Two weeks after IUI, the patients will give a pregnancy test to check if the procedure was successful. If the test is negative, the doctor advises a new treatment cycle or considers other treatment options. IUI is an inexpensive and non-invasive procedure. Therefore, it is often recommended as the first step for fertility treatment.
What is IVF Procedure?
IVF is the most effective type of ART that involves several stages. The ovaries normally produce just one follicle each month. However, during the IVF procedure, the patient will take a high dose of hormonal medications to produce multiple follicles, usually 10 to 15.
Once the eggs mature, the fertility doctor will remove them from the woman’s ovaries (oocyte retrieval). The eggs are then fertilized with sperm in a lab. After growing for a few days in the lab, an embryo is transferred back to the woman’s uterus to develop or is frozen for future use.
IVF is usually recommended after three or four unsuccessful cycles of IUI. It is also a primary treatment for infertility in women over 40 or couples with certain health conditions.
Which is More Painful: IUI or IVF?
Couples with infertility often start treatment with IUI, which is much less invasive and more natural than IVF. Pain during IUI is similar to a vaginal ultrasound appointment or a Pap smear. The procedure does not even require anesthesia or painkillers.
IUI or IVF: Which Fertility Treatment Is Best for You?
IVF and IUI can both be used successfully to achieve pregnancy. However, the ideal candidates may differ according to factors such as causes of infertility, patient’s age, known health conditions, personal health history, family health history, etc.
IUI can be helpful for:
- Couples under 35 who have had trouble conceiving a child after having unprotected sex for up to one year;
- Women with a lack of ovulation (anovulation);
- Couples with infertility due to medical conditions (e.g., oligospermia and endometriosis);
- Couples with unexplained infertility;
- Single women wish to start a family with donor sperm.
IVF can be a better option for:
- Women over 40 years old;
- Women with blocked fallopian tubes;
- Women with advanced endometriosis;
- Women with multiple miscarriages;
- Men dealing with severe infertility;
IUI vs. IVF Medications
Fertility drugs play a significant role in many different types of infertility treatment procedures, including IUI and IVF.
Medications used during IUI:
IUI is sometimes performed in a natural cycle without fertility medications. IUI can be combined with ovarian stimulation, including:
- Clomiphene citrate;
- Letrozole;
- hCG;
- Follicle-stimulating hormone;
- Prenatal vitamins (recommended for all pregnancies).
IVF common medications
Several fertility drugs are used in the IVF process, some taken orally and others injected. The common type of IVF medications are as below:
- Birth control pills;
- Prenatal vitamins;
- Lupron;
- Antagon (Ganirelix);
- Follicle-stimulating hormone;
- Novarel;
- Prednisone;
- Progesterone;
- Estrace (estrogen);
- Valium;
- Microdose Lupron.
IVF or Insemination in Early 40s?
Age 40 and above is a very sensitive time for fertility—the chance of a successful pregnancy drops significantly. IVF has higher success rates than IUI for women over 40 years old. However, that does not mean intrauterine insemination won’t work at all. Women over 40 with healthy reproductive organs can try IUI first. IUI can also help with conditions like PCOS, cervical mucus, or male-factor infertility. IVF can assist with severe reproductive concerns. It is better to consult with a reproductive specialist who can review a couple’s reproductive health in-depth. From there, both doctor and patient can make a decision about which technique is suitable.
Is IUI or IVF better for PCOS?
PCOS can limit ovulation and decrease fertility. Techniques like IUI and IVF help women with Polycystic ovary syndrome. The success rate of IVF in women with PCOS is about 70%, which is excellent. However, both techniques require added support with oral or injectable hormonal medications to stimulate ovulation. Getting pregnant with PCOS is possible combined with doctor-recommended lifestyle changes like having a healthy diet and exercising.
IUI vs. IVF – Success Rate
Chances of pregnancy with IUI are typically lower than those with IVF. . The success rate for IUI is 15% to 20% per cycle. Doctors recommend trying three to four IUI cycles, which have a success rate of 40% to 50%.
IVF candidates have odds in the 50-60% range. However, the IVF success rate varies depending on several factors, including the woman’s age, egg & sperm quality, reasons for infertility, and the fertility clinic.
IVF vs. IUI Pros and Cons
Below you compare the advantages and disadvantages of IUI and IVF procedures:
IUI Pros and Cons
Pros:
- It is non-invasive and requires little (or no) medications;
- The IUI process takes only a few minutes and is painless;
- It is a relatively cost-effective procedure.
Cons:
- The success rate is low, about 15-20% per cycle;
- The risk of multiples is higher because there is little control over the number of developed eggs.
IVF Pros and Cons
Pros:
- The success rate is higher, about 50-60%;
- It allows for Pre-implantation genetic diagnosis (PGD), reducing the risk of passing on inherited conditions.
Cons:
- The required medications to stimulate eggs production may have side effects;
- It is a relatively expensive procedure without insurance.
The Risks of IUI versus IVF
Both IUI and IVF procedures are safe and low risk. Proper monitoring, medication choice, and general care reduce the risks and side effects. IVF requires surgery under anesthesia, while an IUI does not.
Risks of IUI include:
- Infection;
- Spotting;
- Multiple pregnancies (if coordinated with ovulation-inducing medications).
Risks of IVF include:
- Multiple pregnancies;
- Premature delivery and low birth weight;
- Ovarian hyperstimulation syndrome;
- Miscarriage;
- Egg-retrieval procedure complications;
- Ectopic pregnancy;
- Birth defects;
Chance of Twins: IUI vs. IVF
Twins are more likely for patients performing IUI treatment. The main reason is that the procedure often involves fertility medications. These stimulation medications promote the production of multiple mature eggs. Furthermore, as sperm is put directly in the uterus in IUI, it is much easier for the sperm to reach the eggs and fertilize them.
Cost of IUI vs. IVF in Iran
The average cost of IVF in Iran is between $2,000 to $5,000, and the average cost of IUI ranges from $200 to $500 per cycle. Although, these costs depend on the doctor’s fee, facilities of the fertility hospital as well as its location, fertility drugs type, laboratory tests, number of ultrasounds, consultation charges, and whether to use donor sperm/egg, etc.