The two most common infertility treatments are intrauterine insemination (IUI) and in vitro fertilization (IVF). But these treatments are quite different. This guide will explain IUI vs. IVF and the difference in the process, medications, costs, success rates, and side effects.
What is IUI (intrauterine insemination)?
IUI, sometimes known as “artificial insemination,” is a non-surgical, outpatient procedure in which a physician inserts sperm from a male partner or sperm donor directly into a female patient’s uterus. IUI increases a patient’s chances of pregnancy by giving sperm a head start, and ensuring insemination happens at the time of ovulation—but it’s less effective, less invasive, and less expensive than IVF.
IUI is often the first step in fertility treatment for many patients, and can be a great option for those dealing with PCOS, other anovulation, cervical mucus problems, or sperm health issues; same-sex couples; single mothers by choice; and patients with unexplained infertility.
What is IVF (in vitro fertilization)?
IVF is a treatment in which a female patient’s eggs are surgically removed from the ovaries fertilized in a laboratory, with sperm from a male partner or sperm donor, to create embryos. (“In vitro” is Latin for “in glass,” and refers to the process of fertilizing an egg in a laboratory dish.) Then, the resulting embryo(s) are transferred back to the uterus in hopes of achieving pregnancy.
Because this procedure allows doctors to bypass the fallopian tubes, it’s a good choice for patients with blocked, damaged, or absent fallopian tubes. It also requires just one sperm cell for each egg, allowing for successful fertilization even in the most severe cases of male infertility. Generally speaking, IVF is the most powerful and successful treatment for all forms of infertility, including age-related infertility and unexplained infertility.
IUI vs. IVF: the process
Both IUI and IVF cycles take about two weeks, but an IVF cycle is more involved than an IUI cycle. Let’s review:
The IUI process
Like most fertility treatments, an IUI cycle begins with the first day of your period. Then, for about 12–14 days, your doctor will use bloodwork and ultrasound to monitor your menstrual cycle, ensuring that an egg is maturing properly for ovulation. Ovulation is when a mature egg breaks free from the ovary and begins its journey down the fallopian tubes, where it can be fertilized in an attempt at pregnancy.
This monitoring leads up to the culmination of the cycle—the actual IUI, which typically happens on the day of ovulation (either just before or just after ovulation). The first step of the IUI is for a male partner or sperm donor to provide a semen sample. The sample is “washed,” a term for the process in which healthy sperm is isolated from the remainder of the seminal fluid to increase chances of fertilization. Finally, the sperm sample is inserted into the uterus via a thin catheter, and fertilization is allowed to happen as it would during a natural cycle—the sperm swim toward the egg and, hopefully, find and penetrate it.
Medicated vs. unmedicated IUI
Some IUI cycles do not use medication. This may be appropriate for those without fertility issues who are using donor sperm, or for hetero couples in which the female partner does not have any ovulation issues. An unmedicated cycle requires less monitoring, but may be less effective.
Depending on your diagnosis, your doctor may recommend an IUI cycle that uses medication to prompt ovulation. This method is often used for women who have difficulty ovulating on their own (perhaps due to PCOS) or for those who want to increase their chances of getting pregnant with a single cycle. An IUI cycle may use oral medications, such as Clomid or letrozole, or may use the type of injectable hormone medications (called gonadotropins) typically associated with IVF.
The IVF process
Because IVF is most successful when doctors can attempt fertilization on a larger number of eggs, a female patient is typically placed on a course of injectable, ovary-stimulating medications to prompt her body to produce multiple eggs in one cycle. These medications are taken for approximately 8–12 days, and the patient is simultaneously monitored with ultrasounds and bloodwork to ensure the medication is working properly.
When the eggs are sufficiently mature, they are retrieved from the patient’s ovaries in a brief outpatient surgical procedure, during which she is placed under sedation. The male partner provides a semen sample; the sperm from his sample is combined with the female partner’s eggs, and then watched carefully by an embryologist for about five days. The embryos that develop and survive can then be transferred back to the uterus in hopes of conception, or can be frozen to use in a later pregnancy attempt.
IVF with ICSI
ICSI—intracytoplasmic sperm injection—is one of the reasons that IVF is more successful than IUI for those with severe male factor infertility. ICSI is a process by which a single sperm will be injected directly into an egg (as opposed to simply mixed together in a laboratory dish and allowed to fertilize naturally, as during a non-ICSI cycle). This gives the opportunity for pregnancy to those with very low sperm count, sperm that was extracted directly from the testicles, or sperm with difficulty moving or penetrating the egg due to its shape or structure.
IVF with genetic testing
Another one of the benefits of IVF vs. IUI is that, with IVF, the embryos that are created in the lab can be biopsied for genetic testing. This allows patients to test embryos for general genetic health (ensuring they have the proper number of chromosomes), for gender selection, and for specific single-gene disorders, such as cystic fibrosis. Learn more about genetic testing for embryos.
IUI vs. IVF: cost
As you might imagine based on the difference in procedures listed above, IVF vs. IUI has a very different price point. An IUI cycle—including all monitoring and the insemination procedure but not including medication—costs about $1,000. An IVF cycle—including all monitoring, the egg retrieval, and the embryo transfer but not including medication—costs about $12,000–$20,000, depending on where it’s performed.
Cost of IUI vs. IVF
|All medical care||$1,000|
|All medical care||$12,000–$20,000, on average|
Medication adds another cost. Clomid and letrozole, the oral medications used often with IUI, cost about $30–75 per cycle. Injectable gonadotropins, used most often during IVF, cost $2,000–$6,000, depending on the doses required.
Fertility care here at Extend Fertility is up to 40% less than the national average costs. Learn more about the cost of fertility treatment.
IUI vs. IVF: success rates
While an IVF cycle is more expensive than an IUI cycle, it may be worthwhile for some patients, as IVF has significantly higher success rates.
Chances of success for any one patient will depend on their particular diagnosis, along with their (and their partner’s, in the case of hetero couples) individual medical history and age. But we can look at general statistics for comparison.
Success rates of IUI vs. IVF
|Female patient’s age||IUI success rate||IVF success rate|
IUI vs. IVF: side effects and risks
The potential side effects of IUI or IVF depend primarily on the medication that’s prescribed, if any. An unmedicated IUI cycle has virtually no side effects; the risk of infection from the IUI itself is about 1 in 10,000.
The side effects of Clomid are typically mild. According to clinical studies, the most common side effect is hot flashes, experienced by about 10% of patients. Other less common side effects include bloating, nausea, breast tenderness, weight changes, headaches, blurry vision, and mood swings. Approximately 15% of patients who use Clomid will develop an ovarian cyst, but these cysts are benign and usually resolve on their own after treatment is over.
In our physicians’ experience, patients who take letrozole are slightly less likely to experience side effects, but again, they are typically mild and resolve after treatment ends (typically about 5 days). Common side effects include hot flashes, headaches, and breast tenderness.
The medication protocol with the highest chance of side effects are injectable gonadotropins (FSH) such as Follistim and Gonal-F. These medications are commonly used during IVF, but can also be used during some IUI cycles. About a quarter to a third of patients on injectable FSH will experience side effects, including headaches, mood swings, insomnia, hot or cold flashes, breast tenderness, bloating, or mild fluid retention. Additionally, the injection site could become sore, red, or slightly bruised. Again, these side effects should resolve without additional care after the cycle is over.
Chance of OHSS with IUI vs. IVF
Ovarian hyperstimulation syndrome or “OHSS” is a condition in which the medication used in fertility treatment gets the ovaries working too hard. OHSS is associated with swollen, enlarged ovaries and the collection of fluid in the abdominal cavity.
The chance of OHSS with IUI or IVF once again depends on the medications used, as well as how powerfully a particular patient’s ovaries respond to the medication. The chance of OHSS can be nearly eliminated by using a Lupron trigger, and with close monitoring.
|Medication||Chance of severe OHSS|
|Clomid||Less than 1%|
|Letrozole||0%; letrozole is actually used to prevent OHSS|
|Follistim/Gonal-F with hCG trigger medication||1–2%|
|Follistim/Gonal-F with Lupron trigger medication||Less than 1%|
Chance of multiples with IUI vs. IVF
While many people think of multiples—such as twins, triplets, and more—being the result of IVF, when a single embryo is transferred (the gold standard for IVF), the chance of multiples is quite low. The highest chance of multiples actually comes from a medicated IUI cycle (specifically an IUI cycle with injectables), because doctors have less control over how many eggs are released and fertilized.
|Type of treatment||Chance of multiples|
|Unmedicated IUI||Less than 1% of pregnancies|
|IUI with letrozole||1–13% of pregnancies|
|IUI with Clomid||5–9% of pregnancies|
|IUI with gonadotropins||32% of pregnancies|
|IVF with single embryo transfer||1.6% of pregnancies|
Should I do IUI or IVF?
Whether to do IUI or IVF is a decision often made in collaboration between patient(s) and their doctor. The factors that influence the decision may include the patients’ diagnosis, age, budget, insurance coverage, and personal preferences. For example, a couple in their early 30s with unexplained infertility and no obvious impediments to pregnancy are likely to start with IUI. A woman with blocked, tied, or absent fallopian tubes should start with IVF, which bypasses the tubes.
The best way to understand which is the better treatment for you—IUI vs. IVF—is to have a consultation with a reproductive endocrinologist. Contact us to schedule a consultation.
How many IUI cycles should I do before I move to IVF?
Great question! Again, this is going to depend on a few factors: your personal diagnosis, age, budget, insurance coverage, and family goals. Historically, many patients did 3–6 IUI cycles before moving on to IVF (and this was often what their insurance coverage required), and some younger patients still adhere to this standard. Today, the success rates of IVF is so far beyond that of IUI that many patients—especially older patients, for whom IUI is less effective—will move on to IVF after just 2–3 cycles.
Learn more about the differences between IUI and IVF:
To learn more about IUI vs. IVF—and which treatment is right for you—schedule a consultation with one of our doctors.