IUI vs. Ivf: Which One Is Right for You?
Nowadays, infertility is a common issue: according to World Health Organization (WHO), about 15% of couples are affected by infertility [1], and according to the Centers for Disease Control and Prevention (CDC), about 1 in 5 women (19%) between the ages of 15 and 49 with no prior births, are unable to get pregnant after one year of trying [2].
Despite being emotionally and physically draining, infertility can be cured. There are a lot of solutions for prospective parents struggling to conceive — starting from simpler modalities — such as ovulation induction (OI), intrauterine insemination (IUI), or surgical correction of conditions related to infertility — and finishing with an Ivf treatment.
Two of the most commonly offered by fertility experts procedures are intrauterine insemination (IUI) and in vitro fertilization (IVF). But what is the difference between IUI and Ivf procedures, and how can you understand which one is right for you? Here is everything you need to know before making a final decision.
What Is IUI?
IUI, or intrauterine insemination, sometimes called “artificial insemination,” is one of the most common procedures used to treat mild male factor infertility and unexplained infertility.
It is a non–invasive procedure where the partner’s or donor’s sperm is gently placed into the woman’s uterus around the time of ovulation with a small IUI catheter after being washed and processed.
By washing the sperm, its motility can be improved as low motility and dead sperm cells will be removed, meaning the sperm will be able to swim faster. Also, placing it directly into the uterus around the time of ovulation gives the sperm more direction to enter the fallopian tube where the egg is actually waiting, and this increases the chance that they will meet and fertilization will be successful.
IUI is typically only used for up to three or four cycles because chances of success drop off after that. According to commonly cited statistics, the success rate per IUI cycle range from 10% to 20%. And if having three or four IUI cycles, it is possible to cumulate up to a 60% chance of conceiving.
Benefits of IUI treatment
IUI treatment comes with three main benefits. The first benefit of IUI is that it is not as time–intensive as Ivf; it requires less medication, fewer office visits, fewer ultrasounds, and fewer blood tests.
The second benefit of IUI is that it’s less invasive than Ivf. While Ivf requires surgical egg retrieval with the patient asleep under anesthesia, the IUI is performed in the clinic without anesthesia or sedation. It takes 5 to 10 minutes to complete.
And the third benefit is the price — IUI is lower cost than Ivf treatment. The Bundle’s cost usually covers base fee fertility assessment, monitoring appointments, and IUI procedure. Medications are prescribed individually as each case is unique, and their cost varies from patient to patient and from cycle to cycle.
How Much Does IUI Cost?
A typical medicated IUI cycle costs $1,000 to $5,500. Non–medicated IUI cycle, also called as Natural, is less expensive as it eliminates medication used to stimulate the ovaries to produce more eggs in a single cycle.
Costs before the IUI Procedure (Non–Donor IUI) include:
●Base fee: $500 to $1,500 (typically includes monitoring appointments, bloodwork, and sperm wash).
●Fertility assessment: $250 to $500. This assessment usually involves a consultation, a physical exam, an ultrasound of the ovaries, and a blood test.
●Semen analysis: $100 to $300.
●Medications like Clomid or Letrozole: $100 to $200 per cycle.
●Injectable medications — Gonadotropins (are given when a stronger response is required): $2,000 to $3,000 per cycle.
●Monitoring appointments & bloodwork: typically included in the base fee.
Costs of Intrauterine Insemination:
Insemination represents the process of actually injecting washed sperm into the uterus and costs $150 to $500. Some IUI cycles involve doing a second insemination a day after the first to improve the odds of success for that cycle.
What Is IVF?
In vitro fertilization, or IVF, is the most effective fertility treatment available for prospective parents with a wide range of fertility issues. However, it is an intense medical process involving a series of procedures following each other.
During natural conception, a woman’s egg, which is released from the ovary during ovulation, is fertilized by a sperm in a fallopian tube. Through IVF, the fertilization process occurs in the Ivf laboratory, where embryologists: assess the eggs, fertilize the eggs using the partner’s or donor’s sperm, grow the embryos, and transfer the embryos back into the woman’s uterus to attempt pregnancy.
While IVF is more invasive, time–intensive, time–consuming and expensive than IUI, the pros are higher pregnancy rates in most cases (about 50% per cycle), and access to many powerful add–ons such as SingleStim protocol, DuoStim protocol, single egg retrieval, two egg retrievals in a single cycle, in vitro maturation, pausing an Ivf cycle, cryopreservation of unfertilized oocytes, sperm freezing, genetic testing (PGT–A, PGT–M, PGT–SR, PGT–P), vitrification of not transferred embryos for future pregnancy attempts, shipping cryopreserved embryos, FET cycle, and Egg/Sperm or Duo Donation.
Benefits of Ivf treatment
One of the top benefits of IVF is that there are higher success rates because there is not only direct placement of the egg and sperm together but also possibility to use micromanipulation techniques such as ICSI (intracytoplasmic sperm injection), preimplantation genetic testing for aneuploidy (PGT–A) to screen for extra or missing chromosomes, preimplantation genetic testing for monogenic diseases (PGT–M) to look for specific gene mutations that the embryo is at risk of inheriting based on the egg and sperm genes, preimplantation genetic testing for structural rearrangements (PGT–SR) to test for translocations, inversions, insertions and/or deletions within individual chromosomes, preimplantation genetic testing for polygenic disorders (PGT–P) to screen for the risk of polygenic diseases such as heart disease, diabetes and cancer.
Another upside is the current trend of banking embryos for future FET cycles. Despite embryo banking has some emerging issues and challenges, as not each embryo can be vitrified and stored for future use, the advantage of having extra embryos or the only embryo cryopreserved for the transfer is an excellent advantage that possible only with Ivf.
How Much Does IVF Cost?
A single Ivf cycle using own eggs and the partner’s sperm — ovarian stimulation, egg retrieval, embryo creation, and embryo transfer— without preimplantation genetic testing and add–ons such as endometrial scratches, embryo glue, immune therapy, intralipid infusions, and embryo vitrification can range from $10,000 to $20,000, depending on the patient’s case and individual needs. Medications can account for up to 40% of those charges, and if the patient needs some add–ons like DuoStim Protocol, Multiple Egg retrieval, Mock Embryo Transfer, Genetic Testing or Cryopreservation of Fertilized Embryos, — the total cost will be plus $5,000 to $10,000.
IVF multi–cycle programs that cover 2 or 3 IVF cycles are more expensive and range from $15,000 to $30,000 without medication. Adding $2,000 to $7,000 for injectable hormones to each IVF cycle will increase the total cost drastically.
Minimal stimulation cycle IVF, or mini IVF, also called micro–IVF or a low–dose IVF, is done with minimal medications and is less expensive because fewer medications are administrated to stimulate the ovaries to produce more eggs. The lower hormone dose will likely result in fewer eggs developed and retrieved and, thus, fewer possible embryos created. A standard micro–IVF cycle costs around $5,000 to $10,000 plus medications, ranging from $200 or less for Clomid to $1,000 to $2,500 for injectable hormones.
Non–medicated Ivf cycle, also called Natural, is less expensive than mini Ivf because it doesn’t involve ovarian hyperstimulation using the drugs. The management of the cycle focuses on the natural development of the single egg in a single cycle, and only in the last stages it involves using medications to prevent spontaneous ovulation. The major odd associated with this cycle is having the only egg that can be used in the embryo generation process. And if the only embryo survives the early stages of development — it will be transferred into the mother’s uterus. If no viable embryo results after fertilization — the cycle will be canceled. The approximate cost of Natural Ivf is around $5,000 to $9,000.
Costs before the IVF Procedure (Non–Donor IVF) include:
●Base fee: $5,000 to $30,000 (typically includes monitoring appointments, bloodwork, sperm wash, egg retrieval, embryo creation, and fresh embryo transfer).
●Fertility assessment: $250 to $500. This assessment usually involves a consultation, a physical exam, an ultrasound of the ovaries, and a blood test.
●Semen analysis: $100 to $300.
●Medications like Clomid or Letrozole: $100 to $200 per cycle.
●Injectable medications (Gonadotropins): $1,000 to $7,000 per cycle.
●Monitoring appointments & bloodwork: typically included in the base fee.
Costs of Embryo Creation in IVF laboratory and Fresh Embryo Transfer:
●Egg retrieval: typically included in the base fee.
●Anesthesia (during egg retrieval): typically included in the base fee.
●Sperm washing: typically included in the base fee.
●Conventional fertilization: typically included in the base fee.
●Intracytoplasmic Sperm Injection (ICSI): typically included in the base fee.
●Mock Transfer Cycle: $250 to $500.
●Fresh embryo transfer: typically included in the base fee.
IUI or IVF: What Is Right for You?
If you’re choosing what is better in your case — IUI or IVF, the first person to talk to is your healthcare provider, as they know your medical history, your specific case and have enough information about which fertility treatment you should try first.
Opting between IUI and IVF generally depends on the specific issues you are dealing with. For example, IUI is a good option for patients with mild male factor infertility (low sperm count, decreased sperm motility, erectile dysfunction, or problems with ejaculation) and unexplained infertility if a woman has at least one open and functioning fallopian tube. It also is often a top choice for single women using donor sperm or female couples using donor sperm.
IVF is the best option for patients who may have ovulation problems, endometriosis, blocked fallopian tubes, or if there is a low sperm count or low sperm motility. It is also a good option for those of advanced maternal age, as the number of eggs and egg quality decreases with age. IVF also allows embryologists to test embryos before scheduling the transfer to increase the chance of a successful pregnancy and decrease the risk of miscarriage.
Which Option Has Higher Success Rates: IUI or IVF?
Although IVF is more expensive, more intensive, and more invasive than IUI, there is a reason so many singles and couples struggling with infertility do it: it has higher success rates. For women under 35 years old, the chance of conceiving and giving a live birth after a single Ivf cycle can be around 50%, while the success rate of IUI is about 5% to 20% per cycle.
What If IUI/IVF Doesn’t Work?
It is discouraging to note that not each IUI or IVF cycle is successful. But even if you have no success with IUI or IVF, there are other options. When IUI does not work, IVF is usually the next step. If IVF does not work, your fertility expert can recommend adding preimplantation genetic testing to the next cycle, which can help provide more insight. Or, after failed fresh embryo transfer, if you have cryopreserved embryos, you can start a FET (frozen embryo transfer) cycle.
Changing medical protocols like starting DuoStim Ivf protocol to obtain more oocytes and competent embryos in a short time–frame and having two egg retrievals — in the same cycle — after that pausing an ongoing Ivf while waiting for the results of preimplantation genetic testing as well as rescheduling fertility assessment, taking a deeper dive into lab results from different blood tests can make a big difference.
There is also the use of donor eggs (Egg Donation), donor sperm, donor embryo, and gestational carrier that you may need for success. Holistic care, including psychological support and acupuncture, can also help lower fertility treatment's stress and anxiety, which can sometimes be longer and harder than expected.
References
1. World Health Organization (WHO): Infertility. Accessed 9/14/2020.
2. Assisted Reproductive Technology (ART): ART Success Rates. Centers for Disease Control and Prevention. Accessed 4/15/2022.