- Start with IUI if: You're under 38, have unexplained infertility, mild male factor, or need donor sperm with no other issues
- Go directly to IVF if: You're over 40, have blocked tubes, severe male factor, endometriosis, or low ovarian reserve
- Consider IVF after: 3-4 unsuccessful IUI cycles
When fertility treatment becomes necessary, IUI and IVF are the two most common options. Understanding the differences between these treatments—and knowing when each makes sense—helps you make informed decisions and avoid wasting time and money on treatments unlikely to work for your situation.
IUI and IVF at a Glance
| Factor | IUI | IVF |
|---|---|---|
| What It Is | Washed sperm placed directly in uterus | Eggs retrieved, fertilized in lab, embryo transferred |
| Success Rate (per cycle) | 10-20% (varies by diagnosis) | 40-50% under 35; varies by age |
| Cost Per Cycle | $500-$2,000 | $15,000-$25,000 |
| Time Commitment | 2-4 monitoring appointments | 8-12 appointments + procedures |
| Medications | Often oral (Clomid/Letrozole) or low-dose injectables | Injectable hormones (intensive) |
| Invasiveness | Minimal (simple procedure) | Moderate (egg retrieval under sedation) |
| Genetic Testing Option | No | Yes (PGT-A/PGT-M) |
| Fertility Preservation | No | Yes (freeze embryos/eggs) |
How IUI Works
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Ovarian Stimulation (Optional)Many IUI cycles include medications like Clomid or Letrozole to stimulate 1-3 eggs. Some cycles use injectables for stronger stimulation. Natural cycle IUI (no medications) is also possible.
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Monitoring2-4 ultrasounds and/or blood tests track follicle development. When follicles reach mature size (18-22mm), a trigger shot (hCG) initiates ovulation.
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Sperm PreparationPartner produces sample (or donor sperm is thawed) on procedure day. Lab "washes" sperm to concentrate healthy, motile sperm and remove seminal fluid.
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InseminationUsing a thin catheter, washed sperm is placed directly into the uterus. Procedure takes 5-10 minutes, feels similar to a Pap smear. No anesthesia needed.
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Two-Week WaitRest briefly after procedure, then resume normal activities. Pregnancy test approximately 14 days later.
How IVF Works
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Ovarian Stimulation10-14 days of daily injectable hormones stimulate multiple eggs (goal: 10-15+). Requires frequent monitoring with ultrasounds and blood tests every 2-3 days.
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Trigger ShotWhen follicles reach target size, a precise trigger shot (hCG or Lupron) induces final egg maturation exactly 36 hours before retrieval.
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Egg RetrievalOutpatient procedure under IV sedation. Eggs retrieved via ultrasound-guided needle through vaginal wall. Takes 15-30 minutes. Recovery same day.
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FertilizationEggs combined with sperm in lab. ICSI (injecting single sperm into egg) used if needed for male factor or previous fertilization issues.
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Embryo DevelopmentEmbryos grow in incubator for 5-6 days to blastocyst stage. Optional PGT-A genetic testing at this stage. Updates provided throughout.
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Embryo TransferFresh transfer 5 days after retrieval, or frozen transfer in a subsequent cycle. Simple procedure—catheter places embryo in uterus. No sedation needed.
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Pregnancy TestBlood test 9-11 days after transfer confirms pregnancy. Extra embryos can be frozen for future use.
Success Rates Compared
One of the biggest differences between IUI and IVF is success rates. While IVF costs significantly more, it also has substantially higher per-cycle success.
While IUI has lower per-cycle success, multiple IUI cycles may achieve similar cumulative rates as one IVF cycle—at lower total cost for appropriate candidates. Three IUI cycles (~35-45% cumulative) may cost $3,000-$6,000 vs. one IVF cycle (~45-50%) at $15,000-$25,000.
Cost Comparison
Cost breakdown for typical IVF cycle:
- Medications: $3,000-$6,000
- Monitoring: $1,500-$3,000
- Egg retrieval: $3,000-$5,000
- Lab/embryology: $3,000-$5,000
- Embryo transfer: $1,500-$3,000
- ICSI (if needed): $1,500-$2,500
- PGT-A (optional): $3,000-$6,000
- Frozen transfer: $3,000-$5,000 per FET
When IUI Is the Right Choice
Mild Male Factor
Sperm count or motility slightly below normal (but total motile count >5 million post-wash). IUI concentrates healthy sperm and places them closer to the egg.
IUI RecommendedUnexplained Infertility
All tests normal but pregnancy hasn't occurred after 12 months. IUI with ovulation induction often effective before moving to IVF.
Start with IUIDonor Sperm
Single women or same-sex couples using donor sperm with no other fertility issues. IUI is the simplest, most cost-effective approach.
IUI First ChoiceCervical Factor
Cervical mucus issues or previous cervical surgery. IUI bypasses the cervix entirely, delivering sperm directly to the uterus.
IUI RecommendedOvulation Issues (Mild)
Irregular ovulation that responds well to oral medications. Combining ovulation induction with IUI improves timing and sperm delivery.
Start with IUILimited Budget
When IVF costs are prohibitive, trying 3-4 IUI cycles first makes sense if you're a reasonable candidate (under 38, open tubes, adequate sperm).
Consider IUI FirstWhen IVF Is the Right Choice
Age Over 40
Time is critical. Per-cycle success rates with IUI are very low over 40, making IVF the more efficient choice despite higher cost.
Go Directly to IVFBlocked Tubes
If both fallopian tubes are blocked or damaged, IUI cannot work—sperm cannot reach the egg. IVF is the only option.
IVF RequiredSevere Male Factor
Very low sperm count, poor motility, or high DNA fragmentation. ICSI (part of IVF) can achieve fertilization with minimal healthy sperm.
IVF with ICSIEndometriosis
Moderate to severe endometriosis significantly reduces IUI success. IVF offers substantially better outcomes for this diagnosis.
IVF RecommendedLow Ovarian Reserve
High FSH, low AMH, or low antral follicle count. IVF maximizes egg retrieval from limited supply; IUI wastes precious cycles.
Go Directly to IVFGenetic Testing Needed
History of genetic conditions, recurrent miscarriage, or advanced maternal age. Only IVF allows PGT testing of embryos before transfer.
IVF RequiredFertility Preservation
Want to freeze embryos for future family building or before medical treatments. IVF is required for egg/embryo freezing.
IVF RequiredFailed IUI Cycles
After 3-4 unsuccessful IUI attempts, continuing IUI rarely changes outcomes. Time to escalate to IVF.
Move to IVFYou're over 40, have blocked tubes, severe male factor, or low ovarian reserve. In these cases, IUI success rates are so low that the time spent (3-6 months for 3 IUI cycles) could further reduce your IVF success. Consult with a reproductive endocrinologist to determine the most efficient path.
The Stepped Approach: IUI Before IVF
Many fertility specialists recommend a "stepped" approach for appropriate candidates—starting with less invasive, less expensive treatments before moving to IVF:
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Timed Intercourse (1-3 cycles)Ovulation induction with Clomid or Letrozole, monitoring, and timed intercourse at home. Success: ~10-15% per cycle.
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IUI with Oral Medications (3-4 cycles)Adding IUI to ovulation induction increases success slightly by optimizing sperm placement. Success: ~15-20% per cycle.
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IUI with Injectables (1-2 cycles)Stronger stimulation produces more eggs but increases multiple pregnancy risk. Success: ~18-25% per cycle. Often skipped.
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IVFIf IUI unsuccessful after 3-4 cycles, move to IVF for significantly higher per-cycle success.
Making Your Decision: Questions to Ask
Before deciding between IUI and IVF, discuss these questions with your fertility specialist:
- What is my diagnosis? — Some diagnoses clearly indicate IVF; others are appropriate for IUI trial.
- What are my age-specific success rates for each option? — Your clinic's data for your age and diagnosis matters more than national averages.
- How many IUI cycles do you recommend before IVF? — Most studies show diminishing returns after 3-4 IUI cycles.
- Given my situation, is IUI likely to work, or would I be wasting time? — Honest assessment saves time and money.
- What's the cost difference at your clinic? — Factor in total expected costs including multiple IUI cycles vs. one IVF.
- Does my insurance cover either treatment? — Coverage may influence the decision significantly.
- What are the risks with each approach? — Multiple pregnancy risk with IUI vs. procedural risks with IVF.
Frequently Asked Questions
Generally yes—IUI involves fewer appointments, no surgical procedure, milder medications, and less time commitment. However, multiple failed IUI cycles can be emotionally draining. Some patients prefer to move directly to IVF for higher per-cycle success rather than endure repeated unsuccessful IUI attempts.
It depends on how low. IUI requires at least 5-10 million total motile sperm after washing to have reasonable success. Below this threshold, IVF with ICSI is typically recommended because it requires only one healthy sperm per egg.
Several factors may indicate skipping IUI: age over 38-40 (time is critical), blocked fallopian tubes (IUI can't work), severe male factor, low ovarian reserve (don't waste precious eggs on low-success cycles), moderate-severe endometriosis, or need for genetic testing. In these cases, time and money spent on IUI is unlikely to result in pregnancy.
Studies consistently show that if IUI is going to work, it usually works within the first 3-4 cycles. Continuing beyond this point has very low success rates. Most doctors recommend transitioning to IVF at this point, as it offers a significant increase in per-cycle success and may identify issues (like fertilization problems) that IUI couldn't reveal.
Not necessarily. With modern IVF, single embryo transfer (SET) is standard practice for good-prognosis patients, reducing twin rates significantly. Ironically, medicated IUI may have higher multiple pregnancy rates because you can't control exactly how many eggs ovulate. IUI with injectables can have 15-25% multiple rates without careful monitoring.
Absolutely. Many patients conceive first children via IUI but need IVF for subsequent pregnancies due to age-related fertility decline or changed circumstances. Prior IUI success is actually a positive prognostic factor for IVF.
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