If you and your partner are one of the 19 percent of couples in the U.S. who are having difficulties conceiving a child, or are an LGBTQ couple wanting to start a family, you may be considering either Intrauterine insemination (IUI) or in-vitro fertilization (IVF). Although sometimes confused, the two processes are quite different.
Intrauterine insemination (IUI)
“IUI is a process where we typically time an intrauterine insemination at the time a woman is ovulating,” says Lauren Elizabeth Verilli, MD, MSCI, an OB/GYN and reproductive endocrinologist and infertility specialist at University of Utah Health. “We will often give the female patient medication to help her ovulate more regularly or to ‘super’ ovulate and release more than one egg.”
The sperm is placed through the cervix directly into the woman’s uterus. The process reduces the amount of time it takes for the sperm to travel to fertilize the egg in the woman’s fallopian tubes.
IUI is often used when the male partner has mild male factor infertility (such as a low sperm count) or unexplained infertility or when endometriosis is an issue. University of Utah Health advises that couples plan on three to six cycles of IUI.
In-vitro fertilization (IVF)
In-vitro fertilization is a more complicated process. According to Verilli, the doctor will give the female patient a high dose of hormones to help grow and nurture as many eggs as possible in one cycle. The eggs are then removed from the ovary during a surgical procedure and fertilized with the desired sperm.
“We nourish the embryo development in our lab for five to seven days until we have an embryo that is ready to implant into the uterine lining,” Verilli explains. “At that point, the best quality embryo is typically transferred back to the woman's uterus. Under some circumstances, we will freeze the embryos and perform additional testing on them prior to planning a transfer.”
IVF is used for many reasons, and the indications continue to evolve. Some of the classic reasons include when severe male infertility is a factor, fallopian tubes are blocked, or concern about passing on genetic disorders exists.
IVF, with its high rate of effectiveness, comes at a cost. A June 2022 Forbes article pointed out it could cost $12,000-$35,000, depending on the center and medications needed for a single cycle of ovarian stimulation, egg retrieval, and embryo implant. Many insurance plans include coverage for fertility testing and treatment, however, that can help defray costs.
Other Differences Between IVF and IUI
IUI is often the procedure used first since it is significantly less invasive and fertilization occurs in the woman’s body. It is also less expensive. “IVF has an overall higher success rate compared to IUI for many couples,” Verilli says. “IVF harnesses a woman’s reproductive potential in a much more robust way than IUI.”
Genetic testing of the embryos is possible as well in the case of families with serious genetic disorders. So how do couples decide which procedure to use?
“A big factor is where patients are on their fertility journey and what they have already tried,” Verilli says. “In addition, some conditions require IVF, such as when no sperm is in the ejaculate or when genetic testing of embryos is desired. For a majority of couples, both IUI and IVF are good options, and the decision to choose either one is made after lengthy discussions with their fertility physician.”