IVF vs. IUI: Which Fertility Treatment is Right for You?

Assisted reproductive technologies (ART) are medical interventions that are used to help people who are facing challenges with infertility to build their families. Infertility can occur in both men and women equally and there are a variety of causes for infertility.. When it comes to family building, fertility testing is conducted on both  partners to systematically rule out the possible causes of infertility. 

Infertility itself is defined as the condition whereby people trying to build their families are unable to do so after 12 months of having regular unprotected sex. Assisted reproductive technologies can improve reproductive health challenges that have to do with quality and quantity of eggs and sperm produced by men and women. ART has also been successfuly used to bypass some reproductive challenges such as blocked fallopian tubes or poor sperm motility. 

We shall be discussing the role of IUI and IVF in reproduction, how they work, and how successful they are.  As well, we shall touch on the key differences between the two and how this impacts their success as treatment options. We shall also answer a few commonly asked questions at the end of this article. Let us get started, shall we?

What is IUI?

IUI is the common term used to refer to intrauterine insemination. It is a non-invasive fertility treatment procedure sometimes used as a first line of treatment for couples facing fertility challenges. It is also used when individuals are trying to become pregnant using sperm donation. Typically a sperm sample is placed into the vagina or the uterus during a person’s ovulation window to increase the likelihood of becoming pregnant. 

How IUI Works

IUI relies on a person’s natural menstrual cycle and therefore the timing has to be accurate in order to increase the chances of becoming pregnant. A professional healthcare provider will calculate the ovulation window based on a person’s menstrual cycle. As well, the person trying to become pregnant may benefit from using an ovulation tracker to ensure greater accuracy in timing. 

During the ovulation window, a semen sample is placed into the uterus using a catheter at a medical facility. The person who will carry the pregnancy will be required to lie on their back, with their knees and hips raised in order to facilitate the movement of the semen sample deeper intot the uterus. IUI can also be done at home and for this, the semen sample is inserted into the vagina using a syringe. 

Once done, the person remains lying down for about 20 to 30 minutes to avoid wasting the sperm sample. After about two weeks, a pregnancy test is conducted to confirm whether the treatment was successful or not. If not, another round of IUI can be conducted. In order to increase the chances of success, sometimes, medical practitioners will include ovarian stimulation or even perform two inseminations within one cycle.

Success Rates For IUI

IUI has seen some success which has been good news for people who have preferred to use non-invasive ART. This success however is largely influenced by a person’s medical history, general health, lifestyle, diet and exercise practices. As well, a person’s age has even greater impact where health and medical factors are not an issue. A woman's ovarian reserve and estrogen levels decline as she gets older, which reduces her chances of becoming pregnant naturally. 

For women under the age of 35, there is a 10 to 20 percent chance of success with each cycle. When aged between 35 and 40, the chances of success are five to 15 percent. Once a woman is over the age of 40, their chances of becoming pregnant using IUI is down to between two and five percent each cycle. This translates to IUI having higher success rates for people who are aged 35 and below. 

What is IVF?

In vitro fertilization, more commonly known as IVF, is a treatment that is carried out over several phases. Fertilization is done outside of the uterus in a controlled lab environment and the embryo is placed into the uterus of the person who will be carrying the pregnancy to term. The process can take anywhere from weeks to months, depending on how well someone responds to the treatments.  

IVF Process Step-By-Step

IVF has four main stages; ovarian stimulation and preparation of the uterus, egg retrieval and fertilization, and embryo implantation. 

Ovarian Stimulation

During ovarian stimulation a person takes medications and a series of hormonal injections to stimulate the ovaries to develop more than one egg to maturity for retrieval. In some cases, a fertility expert may first give medications to suppress ovulation. In this way, the development of the uterine lining and the maturity of eggs can be more synchronized. Once the eggs develop to the ideal size a final hormonal injection is administered to facilitate the maturity of as many developed eggs as possible. 

Egg Retrieval

This procedure is a mildly invasive procedure whereby the eggs are retrieved using a specialized fine needle and an ultrasound. The follicles are carefully punctured and the egg within is suctioned out. This procedure is done under sedation to prevent discomfort to the patient. Once the eggs are retrieved they are placed in a controlled environment for examination and fertilization. It is at this stage a patient’s eggs be preserved as they are, or preserved as embryos after the eggs are fertilized. 

Fertilization

The eggs are then placed in a controlled environment and fertilized. There are a couple of ways fertilization can be done. One is by placing sperm close to the egg and waiting for them to swim naturally toward the egg for fertilization. Another is by directly fertilizing the egg with the sperm cell. After fertilization, the embryo is left to develop a bit further for a few more days before it is placed into the uterus for implantation. A pregnancy test done after about two weeks will indicate whether the procedure was successful or not. 

IVF Success Rates

IVF has a track record of high success rates. This is partly due to the fact that some causes of infertility such as sperm motility, sperm count, low ovarian reserve and blocked fallopian tubes can be bypassed. However, while successful, factors such as the age of the person who will carry the pregnancy to term also affect how successful the treatments are. In some cases, more than one cycle will be done before a person can become pregnant. 

The IVF success rates by age tend to range at 50 to 60 percent for females under the age of 35. Between 35 and 40 years, the success rate goes down to between 30 and 50 percent. Once a person is over 40 years old, depending on the quality of their eggs and whether donor eggs have been used or not, on average,IVF is successful five to 25 percent of the time. Factors that affect IVF success are health, medical history, medical conditions and lifestyle.

Key Differences Between IUI & IVF

The main differences between IUI and IVF are:

• Ovulation - IUI relies on the timing of natural ovulation, while IVF applies ovarian stimulation protocols.Egg retrieval - IUI relies on the mature egg (or eggs) produced in the natural menstruation cycle, while IVF relies on the retrieval of multiple mature eggs after ovarian stimulation.
• Fertilization - IUI fertilization occurs within the fallopian tube as in natural conception, whereas IVF fertilization is done artificially in a controlled lab setting.
• Success rates: IUI has a lower success rate than IVF, and may require more than one cycle before a person can become pregnant.
• Cost: IUI is by far less expensive than IVF.

Who is a Candidate for Each Treatment?

While each treatment is a viable option for family building, different cases present better arguments for the use of each. While IUI may be the first option for many due to its affordability, it may not always be the better option. 

The cases where IUI may be effective are where a woman has problems ovulating and at the same time has not responded to fertility inducing medications; where the male factor infertility is minor, requiring just a ‘little push’ as it were; where donor sperm is being used for family building, and the person carrying the pregnancy to term has no inhibiting fertility issues; and where a male partner had banked their sperm, prior to treatments such as chemotherapy, making them viable for use by their partner using IUI.

IVF is generally highly successful, but is of greater benefit to people who have severe male factor infertility such as particularly low sperm count or very poor sperm motility; where the female partner’s fallopian tubes are blocked; where the female partner’s ovarian reserve is diminished; where the female partner is using donor eggs for family building; where the male partner has a medical history of a vasectomy; where a female partner has endometriosis.

Conclusion

The application of ART to family building is determined on a case by case basis. Each patient must be evaluated and diagnosed before any protocol is applied. Typically, a fertility expert will not only consider a person’s health, medical history, and lifestyle, they will also take into account their family building goals. Each solution will be offered in light of the expected outcome. To know which fertility treatment is best for you, contact our team of specialists at San Diego Fertility.

FAQs:

How much does IUI cost compared to IVF?

IUI costs anywhere between $300 to $1,000 per cycle, without medication and could cost between $500 to $4,000 per cycle with medications. IVF costs range between $10,000 to $15,000 per cycle. If the IVF treatment includes genetic testing, it may cost an additional $5,000 to $12,000 depending on the genetic testing being done. These costs vary depending on the State one lives in, the clinic they go to for treatments and how many rounds will be required. While IUI is more affordable, it has lower success rates than IVF and may require multiple cycles resulting in increased costs. IVF in some cases then becomes the more cost-effective option because of its high success rate. 

Does IUI require fertility medication?

Not all IUI treatments require fertility medication. IUI can be done with or without fertility medications, but it depends on the type of infertility that is being treated. IUI without medication is typically used when there is mild male factor infertility. IUI with medication is typically used for female factor infertility requiring the inducing of ovulation, or requiring a stronger ovarian response to increase the chances of fertilization. This is determined on a case by case basis, and a fertility specialist will recommend the best approach based on your fertility diagnosis and hormone levels.

Is IVF painful?

Some aspects of the IVF process may cause mild discomfort to the patient. For example, ovarian stimulation may cause bloating, mild cramping and mood swings. While egg retrieval is done under sedation, once the sedative wears out, some patients may experience some cramping. Intramuscular progesterone shots may cause discomfort, but these can be substituted for vaginal suppositories. Most patients describe IVF as emotionally challenging rather than physically painful.

How many IVF cycles does it take to get pregnant?

Each case of IVF treatments is different and success rates vary based on the quality of the eggs and sperm being used, a person’s age, if there are any medical conditions that require treatment beforehand, and the nature of the fertility issues being treated. That being said, on average, most couples are able to achieve pregnancy within one to three IVF cycles. Some clinics offer IVF package plans or refund programs to make multiple cycles more affordable.