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IUI or IVF? What to Consider

Intrauterine insemination (IUI) vs. in vitro fertilization (IVF)

is a question that gets asked of fertility doctors quite often. "Should we do IUI (also known as artificial insemination) or go straight to IVF?" Or, "How many cycles of IUI should we try before moving to IVF?"

The Cost of IUI

IUI is much less expensive than IVF and can be a cost-effective solution for infertile couples. Keith Blauer, M.D., a fertility doctor with Reproductive Care Center in Utah, says his fertility patients are most likely to request an IUI procedure first. "This is often a cost benefit issue," he says. "Our patients in Utah are very cost conscious and prefer to try less expensive options first even if the pregnancy rate is low."

IUI can cost anywhere from $300 to $2,000 per cycle depending on the fertility clinic, the type of fertility drugs used, and the type of monitoring and blood work that is performed.

Who May Benefit from IUI?

To understand why IUI may be helpful to a couple having trouble conceiving, it's important to understand how far sperm has to travel to fertilize an egg — from the vagina through the cervix (which limits the number of sperm that keep traveling), into the uterus and up into one of the fallopian tubes. With an IUI, the male partner's semen is collected, "washed" in a laboratory to concentrate the sperm and remove seminal fluid (which can cause severe cramping), and then slowly injected via a catheter into the woman's uterus. By putting the sperm directly into the uterus, they have much less distance to travel to the fallopian tubes.

A couple may benefit from IUI if:

  • the female partner has an ovulation disorder and has been unable to get pregnant with only the ovulation-inducing fertility drugs
  • the female partner has cervical factor infertility, such as scarring, or problems with the cervical mucus (which can be caused by fertility drugs such as Clomid)
  • the male partner has a low sperm count, low sperm motility (movement) or poor morphology (shape)
  • the male partner has ejaculation problems
  • the male partner freezes his sperm to preserve fertility before a surgery or cancer treatment, such as that for testicular cancer
  • the couple is using donor sperm in order to conceive

IUI may also be used as a first-line treatment for unexplained infertility, mild endometriosis or advancing maternal age. "For IUI, the woman must have at least one open fallopian tube, reasonable egg quality and the ability to induce ovulation if needed, and the male partner must have adequate semen parameters," Dr. Blauer says.

IVF is indicated as the course of treatment for patients with blocked fallopian tubes, advanced endometriosis, failed IUI cycles, very poor sperm parameters/severe male factor infertility or vasectomy. In these cases, patients will probably spend less per live birth than if they chose IUI-based treatment.

IUI and Ovulation-Inducing Medications

IUI can be performed without fertility drugs, but the chances of success are greater if ovulation-inducing medications are used. However, there is also the very real risk of becoming pregnant with multiples when taking fertility drugs with IUI.

Typically, the female partner will take an oral fertility drug such as Clomid (clomiphene citrate) or Letrozole/Femara. Other times, gonadotropins — injections containing follicle stimulating hormone (FSH) may be used. In addition, hCG may be administered in order to trigger ovulation and optimally time the insemination. The procedure can be timed by ovulation predictor kits (OPK) which determine the most fertile time in a cycle by detecting the presence of luteinizing hormone (LH) in the urine. Or, the physician can monitor the growth of the ovarian follicles via ultrasound and confirming blood tests.

"Our most commonly used protocol is Clomid — 100 mg a day on days 3 through 7 with the IUI the day following a '+' on the OPK," Dr. Blauer says. However, he says the most successful protocol is IUI with a combination of Femara and injectable FSH plus ultrasound monitoring.

If IUI is performed in conjunction with injectable fertility drugs, the risk of multiples increases significantly. Therefore ultrasound monitoring of the follicles is very important in order to reduce this risk. If too many mature follicles develop, the IUI cycle can be canceled, or it can be converted to an IVF cycle.

IUI Success Rates

Typically, it is recommended that a couple move on from IUI after three to six failed cycles.

The success of IUI depends on many factors, with age being one of them. At the Reproductive Care Center, the positive pregnancy test per IUI cycle for 2009-2011 for all protocols (Clomid, Femara and Femara/FSH) range from 13 percent for ages 41-42 to 19 percent for women under 35.

According to the American Society for Reproductive Medicine (ASRM), if IUIs are performed monthly with fresh or frozen sperm, success rates can be as high as 20 percent per cycle. However, this depends on whether fertility drugs are used, the age of the female partner, the infertility diagnosis and other factors, such as how experienced the lab is in preparing and washing the sperm. In addition, the fertility team is important to the success of an IUI cycle, too, says Dr. Blauer.

"We have a great nurse practitioner team that focuses on optimizing each cycle."

After learning more about IUI vs. IVF, are you considering in vitro fertilization (IVF)? Visit www.howmuchdoesivfcost.com for more information.

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Comments

Hello, my husband and I have been trying for 2.5 years. All tests for him and I are fine, but no pregnancy. He is 42 and I am 41. I have been told that IUI might work but only 1 try and then should go straight to IVF. Is this correct?

M1b2 - I'm sorry to hear that you've been struggling to conceive. I am not a doctor nor do I have any medical training but given that you are over the age of 40 I think you should strongly consider IVF. When you are over the age of 40 your ovarian reserve (egg quality) begins to decline so time is of the essence. If you need help finding a fertility specialist in your area I am happy to help. Feel free to email me directly at Julie@fertilityauthority.com

My husband I would like to have a baby but he had a vasectomy 10 years ago. I'm 36 but the females in my family are very fertile and we conceive very easily. What would you suggest as the best option for us and what will the cost be for the treatment?

Hi Sab- I would be happy to help you! I will need more details from you first, please contact me at Jenna@fertilityauthority.com with the following information.

Name:
Zip Code:
Months TTC?:
Age & DOB:
Insurance:

Looking forward to hearing back from you!
Jenna

WE ARE BOTH 30YRS. TRYING FOR 4YRS. WIFE'S 1 TUBE BLOCKD. NOT CONCEIVED AFTER TAKING 6CYCLES OF HSG INJ. WHAT SHOULD WE GO FOR IUI OR IVF?

I would recommend you get the appropriate tests so that a doctor can best advise you. We can help arrange an appointment! Please email us carecoordinator@fertilityauthority.com. Looking forward to getting the ball rolling!

Hi there my hubby is all good in his department but for myself periods are like a roller coaster n producing eggs well that'd another story I know docs can only do their best but what chances do I have falling preggie the ivf Thanks

Hi there, I am 29 and have not tried to fall pregnant naturally as I have severe PCOS and endometriosis. So severe that even a breakthrough bleed on the pill is either non existent or 1 day. As my problem is ovulation, would IVF be the best option? I cannot be off the pill as my hair is so oily and my skin is so so bad it's a nightmare. Thanks :)

Hi Megan,

You may be a candidate for IVF, though you would have to stop taking birth control pills in order to conceive by any means. Give us a call at 1-855-955-BABY (2229) if you would like to schedule a fertility consultation with a doctor in your area.

Best,
Kim

URGENT - Hi there. Good day. Need advise, we married for 6 years. Im 32 & my hubby 35. Recently my hubby was diagnosed with Azoospermia. Which we have no idea at all on this. After seeing a Fertility Doctor. We was advised on sperm donor. Is it safe? And do i go for IUI or IVF??? Im confused. Need help. Appreciate & TQ very much!

Please help me ...i am 25 and have been trying to get pregnant for 5 year had two miscarriages one in 2010 and one 2011 ....me and my husband really want a child but we are running out of options now we want to try ivf ...but not sure I did all the test everything thing is fine and my husband sperm are slow but doctor said it Ok should still get pregnant... we're one of the unexplained infertility were scared that it won't be successful if we do iui so we're going for ivf but I need advice I have no family and there no one to turn to ...any advice is greatly appreciated

I'm so sorry for your losses. Deciding between IUI and IVF really depends on your particular situation. Many doctors believe that IVF is the best treatment for unexplained infertility, and for issues related to sperm. If you'd like support from other women in your situation, I recommend the forums on www.FertileThougths.com. And if you'd like a second opinion from a fertility doctor, please let me know and our Patient Care Advocates can help you schedule an appointment. Best, Claire

I am 27 years old and my husband 38 . He has a low sperm count and poor morphology. My tests are very good. We went to two doctors , one of them say iui is good for us. The other said ivf . We don't what we should do? For me I afraid from the ivf process , we are thinking to do one cycle iui , if failed go to ivf.please what you advise me?. Can iui success from one cycle or it will be worthless ? Thanks.

hello i have had one kid already with no help but me and my husband have been trying for 4 years now after our first baby and we are about to start out first IUI and want to no would that be the best way to go or should i go right in to a IVF

I'm sorry to hear you are having a hard time getting pregnant. Whether you should do IUI or IVF depends on your specific situation. I would suggest a consultation with a fertility doctor for a fertility workup. If you need help finding a doctor in your area, or if you need additional information, our Patient Care Advocates can help. Please call us toll-free at 855-955-2229 or email carecoordinator@fertilityauthority.com. Best, Claire

My husband and I are trying to have children we would like to know which is better iui or ivf

Whether IUI or IVF is a better option depends on your personal situation. Please contact our Patient Care Advocates at 855-955-2229 or carecoordinator@fertilityauthority.com if you'd like information and to schedule a consultation with a fertility doctor. Best, Claire

Hi there my husband and I have just been referred to a fertility clinic. We found out he has a low count and poor mortility. Hes 31 and I'm 27. Do u think IUI is the best option? What should we expect?

I can't give you medical advice, there are a number of factors that will influence your treatment. I would recommend having a good list of questions to ask your doctor, so your consultation is very informative. You may also want to connect with other women in a similar situation at www.FertileThoughts.com. I wish you all the best, Claire

My second wife if fertile. I have had two children but I got a vasectomy and had a car accident that required me to get an penal implant with an internal pump in my testical sack. Can you take a needle and withdraw my sperm for Intrauterine insemination? Will my insurance cover this? How much does it cost per cycle? Dallas

One of our Patient Care Advocates can answer your questions regarding sperm aspiration and costs. Please give us a call toll free at 1-855-955-2229 or email carecoordinator@fertilityauthority.com. Best, Claire

Only your fertility doctor can advise you on what is the best treatment for your situation. If you would like to connect with a fertility doctor in our network, give us a call toll free at 1-855-955-2229 or email carecoordinator@fertilityauthority.com. Best, Claire

i am 36, had stage 4 endo recently removed and have slightly narrow tubes...husband has lower sperm count (less than 15). should we opt for iui or ivf?

hi there my husband had an vasecetomy 10 years ago can we do iui or must he first have an vasectomy reversal

Hi Nicolene, With a vasectomy, it is possible to do a sperm extraction procedure. The doctor may recommend IVF rather than IUI. If you are looking for a fertility doctor in your area, give us a call at 1-855-955-BABY (2229). Thanks! Kim

its 10 yrs that we got married..we never had a proper intercourse....due to professional stress..now that we opted for iui since my husband is having long time erection problems..sperm count is very fine..my tubes and follicular study is also fine...I want to conceive naturally rather than going for iui.but due to age factor weopted for iui..I am 32 yrs and my husband is 41 yrs..pls suggest..

Hi Gudguduu, Only a fertility doctor can tell you for sure if IUI is recommended for your situation. If you would like to connect with a fertility doctor in our network, give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com Best, Kim

hi ,I have a child, were conceive naturally and now I want to become pregnant and get born male manner iui, I do not suffer from any contraindications for pregnancy and my husband as well, how much the cost of using this method to determine the sex? How much cost if you want to get the twins male or male and female

Hi Hiba, In order to conceive a boy, you would have to do IVF with gender selection. The cost of IVF averages $12,000 per cycle and the cost of PGD for gender selection averages $5,000 on top of that. If you are interested in working with a fertility doctor near you to do IVF with PGD, give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com Best, Kim

Hello doctor. We r married since one n half yr. my husband had erectile dysfunction but it has been successfully operated. Stil we r not able to have normal sex as theres lack of penetration. This is very frustrating esp bcoz we do not know the cause. There's increased family pressure and our own longing for a child. We both are in thirties. His semen analysis and my usg are normal. I have regular period with 30 day cycle. Can u plz suggest me the treatment for our sexual problem and also guide us wether we should go in for IUI or ivf? Kindly mention their cost too.

Hi Simran, I am so sorry you are going through this. You may be a candidate for either IUI or IVF if the semen analysis and ovarian reserve results are normal. The best way to know for sure is to consult a fertility doctor. Give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertiliyauthority.com and we will help you connect with a trusted doctor near you. The cost of IUI averages around $1,000 per cycle and the cost of IVF averages $12,000. Best of luck! Kim

We want twins, Will IUI or IVF help us produce twins?

Hi Robert, You could have twins with either procedure depending on the use of fertility drugs. Many doctors are helping patients achieve a single gestation pregnancy because it is safer for the mother and babies. There are no guarantees either way, but you might have a greater chance of having twins with IVF. It is more controlled. If you would like to connect with a fertility doctor, give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com Best, Kim

Hi..my sperm count is nil...I have a problem of vericocele.... My wife conceived 3yrs back through me only...but she had miscarriage after 6 months pregnancy... After that my vericocele problem started.... My sperm count became nil....but I still have sperm production in testis...should we go for iui or ivf.....reply soon....thanks....

Hi vicky, IVF is the best option for varicocele. A fertility doctor and urologist can work together to retrieve sperm from behind the varicocele and will need to work quickly to use the sperm in an IVF cycle. Give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com if you would like to connect with a fertility doctor who specializes in the treatment of male factor infertility. Best, Kim

My Husband and I have been TTC for exactly one year. Husband is 52, myself 42. I conceived twice (M/C at 10 weeks and again at 3weeks). We have had extensive testing and everything comes back normal. (ie: sperm count fine. FSH 6.4, AMH 4.8. Ultrasound shows great lining and many follicles in both ovaries and tubes fine). We have seen two different fertility specialist. One stated I did not nedd intervention that everything shows eventually we will conceive again. The other specialist said that if I were younger with the same test results he would say no intervention. However due to my age he believes that we are a good canidate for IUI and because of good test results we could conceive successfully. Up to this point we have had no intervention at all; no meds of any kind. Should we try a few cycles using meds alone or go straight to IUI because of age?

Hi Denise, I am so sorry you are going through this. Some studies have shown that women over the age of 40 should go straight to IVF because then you can do genetic testing (PGD) to make sure your embryos are genetically normal. Chromosomal abnormalities account for nearly 60% of all miscarriages. That could be what is going on in your case. If you would like to connect with a fertility doctor in your area, give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com Thinking of you! Kim

Hello my name is daisey and my husband and i are trying to have a baby for a year now and we had no luck due to the fact that he and his ex had a sperm sample tested that told him that they had slow mobility, recently we found out we were on our way to having a baby and sadly he thinks it not his. please tell me how this could happen.....

Hi Daisey, Sperm regenerate every 3 months and it is possible that your husband's sperm improved. Only a doctor can tell you for sure. Best of luck, Kim

My husband and I are a new couple(1 year and half) and we have been trying since day one but no luck. I am 25 and he is 35, We are scheduled to start the IUI next week; however i'm not sure if that would be the best choice considering the cost, the time and the dedication, wouldn't it be more cost effective if we went straight to IVF?

Hi Yasmine, It really depends on your diagnosis. You are young, so there is a good chance IUI will work, but if you have severe female or male factor infertility, IVF may be the best course of treatment. Best, Kim

we miss for 4 times, after 3 months heartbeats got OFF and we miss it. But now no development from first month. suggest me what to do. we r from India, Gujarat. hirenv2004@yahoo.co.in +91 9824704501

I need more a dives to have a baby, aim in ivf program at moment. Thanks Jane

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