The key difference between IUI and IVF is that in IUI, fertilization takes place internally. That is, the sperm is injected directly into the woman’s uterus. So, if fertilization is successful, the embryo implants there as well.
With IVF, fertilization takes place externally, or outside of the uterus, in a lab. The sperm and the egg are combined for fertilization and after this process, one or more of these successfully fertilized eggs would be placed in the woman’s uterus. Ideally, the fertilized egg would then implant in the lining of the uterus, resulting in pregnancy and delivery of a full-term baby or babies.
IVF has higher success rates than IUI. IUI is considerably less expensive than IVF and less invasive. It is generally recommended that couples try three rounds of IUI before moving on to IVF.
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IVF and IUI have a few factors in common, and they mostly have to do with preparing for treatment and the basic processes of human conception.
Before insemination or fertilization, both IUI and IVF may include a regimen of fertility drugs to increase success rates in fertilization or in the case of IVF, to assist in ovulation and aid in egg retrieval. Also, both treatments can include processes to isolate the highest quality sperm from provided samples for use in fertilization.
For both IVF and IUI to be successful, an egg must be fertilized and then implant in the lining of the uterus and develop into a full-term infant, or multiple infants. That’s pretty much the bare bones version of the internal mechanics of human conception.
How many IUI cycles should I do before I move to IVF?
This depends on a few factors: your personal diagnosis, age, budget and family goals. Historically, many patients did 3–6 IUI cycles before moving on to IVF 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.
Comparison between IUI and IVF
What is IUI?
Intrauterine insemination (IUI), also known as artificial insemination, is a simple procedure that is performed in office. The doctor places sperm that was previously collected and processed in the lab, into the uterine cavity. Before insertion, the lab “washes” the sperm by removing seminal fluid and concentrating the sperm.
IUI can be performed with the assistance of fertility treatments to increase ovulation function or performed during the woman’s natural ovulation. Over-the-counter ovulation predictor kits can be used to determine when the woman is ovulating.
The sperm is placed higher into the uterine cavity so it bypasses the cervix, making the trip through the fallopian tubes shorter. This increases the number of sperm that has a chance of meeting the egg.
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What is IVF?
In vitro fertilization (IVF) is a fertility treatment, or assisted reproductive technology (ART) procedure, in which a man’s sperm and a woman’s eggs are combined outside the woman’s body in a lab.
Before the fertilization can take place, the woman takes fertility medication to stimulate the ovaries to assist in successful egg retrieval. The egg retrieval is performed under sedation and insemination is performed the same day.
After the fertilization, the embryo is monitored carefully to determine when transfer to the uterus should be made.
Comparing the process
The IUI process
An IUI procedure is the process of directly injecting sperm into the top of the uterus. This increases the odds of conception by reducing the distance the sperm must travel to meet the egg. That said, when most people talk about IUIs, they’re referring to the steps leading up to and after the actual procedure. An IUI treatment can be summarized into a few steps:
. IUI Preparation – Before your IUI procedure, men and women can make changes to their diet, add beneficial supplements or medications, and utilize holistic therapies like acupuncture and massage to ensure the best possible outcome from IUI. Taking this time to focus on improving the quality of your eggs pays off exponentially because it’s something you have the power to change. Best results are seen if adopted for 90 days prior to treatment.
. Egg Development – This step is either part of the woman’s natural egg development or stimulated with medications and lasts roughly 5-14 days. Once your follicles are optimal size, a trigger medication may be given to finalize egg maturation and trigger ovulation. This phase of egg development may or may not be accompanied by ultrasound and bloodwork monitoring.
. Insemination – This is done as close to the day of ovulation as possible. During insemination, washed and concentrated sperm is injected into the top of your uterus through a small catheter inserted through the vagina and cervix. Once injected, the catheter is removed. You can expect the insemination to take just a few minutes. It is possible to experience mild cramping post-procedure. The sperm used in your IUI can usually be collected at the office performing the IUI (preferred if possible), frozen and shipped to the center, collected fresh at your home and shipped to our centers using our sperm shipping kits (not advised), or ordered and sent to our office from a donor agency. Fresh semen samples are prepared in our laboratory to obtain a concentration of active sperm.
. Post Procedure – If the IUI is successful, a blood pregnancy test will be positive in two weeks. Once a heartbeat is detected via ultrasound, the pregnancy has a 90-95% probability of resulting in a live birth.
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Regardless of the type of IVF procedure you’re having, most can be simplified into a few key steps:
. Treatment Preparation – Similar to IUI, you can help give your fertility a boost by changing your diet, adding beneficial supplements or medications, enhancing your immune system, utilizing holistic therapies, and changing your lifestyle to ensure the best possible outcome from IVF.
. Ovarian stimulation – You’ll take stimulation medications to increases both the quantity and quality of eggs. This usually begins during days 2-4 of your cycle and continues for around ten days. You’ll be closely monitored during this time to track your uterine lining, follicular development, and hormone levels. Once the follicles are optimal size, a trigger medication is given to fully mature the eggs.
. Egg retrieval and sperm collection – Egg retrieval happens 35 hours after the trigger shot. It is done under light anesthesia and takes just 5-10 minutes. During retrieval, a tiny hollow needle is pierced through the vaginal wall towards an ovary. At this point, the fluid that contains the developed eggs is drained from the follicles and immediately taken to the IVF laboratory, where they will be fertilized and developed. Sperm is collected the same day as the procedure by ejaculation into a sterile specimen container, frozen ahead of time, via a donor, or through more advanced sperm retrieval procedures. Next, the sperm is washed, placed in a solution similar to the fallopian tubes, and used for fertilization.
. The laboratory – This is when the harvested eggs are fertilized by an embryologist. Once fertilized, they’re grown 3-5 days until they’re able to be transferred into the woman’s uterus. Prior to the transfer, the embryos can be genetically tested. Although testing isn’t right for everyone, it’s useful for some people as it may help prevent miscarriage, passing on known genetic disorders, and can also be used to choose the sex of the child.
. Embryo transfer – At this point, 1-2 embryos are gently placed into the woman’s uterus through a small catheter. Any unused embryos can be frozen for future use.
. Post transfer – You’ll likely take progesterone and estrogen to improve implantation and pregnancy rates. If the transfer is successful, a blood pregnancy test will be positive in 10-14 days. From there, ultrasounds are used to ensure the implantation site as well as check for a heartbeat. The good news is that once a heartbeat is detected, the pregnancy has a 90-95% probability of the pregnancy resulting in a live birth.
Comparing the Success Rates
. IUI Success Rate
IUI results in a significant number of pregnancies especially with unexplained infertility. The average live birth rate is as follows:
. Below 35 years - 13 percent
. 35-37 years - 10 percent
. 38-40 years – 7 percent
. Over 40 years – 4 percent
IVF Success Rate
While the pregnancy rate for IVF is relatively high, not all conceptions result in a live birth. However, this depends on many variables, including the female age, the duration of infertility, and the type of oocyte or sperm used. Success varies with the age of the woman, as follows:
. Below 35 years - 54 percent
. 35-37 years - 40 percent
. 38-40 years – 26 percent
. Over 40 years – 8 percent
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Comparing the Risks and Side effects
IUI Risks and Side effects
Intrauterine insemination is a relatively simple and safe procedure, and the risk of serious complications is low. Risks include:
. Infection. There's a slight risk of developing an infection as a result of the procedure.
. Spotting. Sometimes the process of placing the catheter in the uterus causes a small amount of vaginal bleeding. This doesn't usually have an effect on the chance of pregnancy.
. Multiple pregnancy. IUI itself isn't associated with an increased risk of a multiple pregnancy — twins, triplets or more. But, when coordinated with ovulation-inducing medications, the risk of a multiple pregnancy increases significantly. A multiple pregnancy has higher risks than a single pregnancy does, including early labor and low birth weight.
. Ovarian hyperstimulation syndrome. Sometimes the ovaries over-respond to fertility medications (particularly the medications given as injections) and a condition called ovarian hyperstimulation syndrome may result. A large number of eggs may be matured at one time and possibly released. This can result in an enlarged ovary, fluid buildup in the abdomen, and cramping. In very rare cases, ovarian hyperstimulation syndrome can result in fluid buildup in the chest and abdomen, kidney problems, blood clots, and twisting of the ovary.
If you’re currently taking fertility medications for IUI and experience any of the following symptoms, you should call your doctor immediately.
. Dizziness or lightheadedness
. Sudden weight gain of more than 5 pounds
. Shortness of breath
. Nausea and vomiting
. Severe abdominal or pelvic pain
. Sudden increase in abdominal size
IVF Risks and Side effects
Risks of IVF include:
. Multiple births. IVF increases the risk of multiple births if more than one embryo is transferred to your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does.
. Premature delivery and low birth weight. Research suggests that IVF slightly increases the risk that the baby will be born early or with a low birth weight.
. Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful.
Symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.
. Miscarriage. The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15% to 25% — but the rate increases with maternal age.
. Egg-retrieval procedure complications. Use of an aspirating needle to collect eggs could possibly cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also associated with sedation and general anesthesia, if used.
. Ectopic pregnancy. About 2% to 5% of women who use IVF will have an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can't survive outside the uterus, and there's no way to continue the pregnancy.
. Birth defects. The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived. More research is needed to determine whether babies conceived using IVF might be at increased risk of certain birth defects.
. Cancer. Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumor, more-recent studies do not support these findings. There does not appear to be a significantly increased risk of breast, endometrial, cervical or ovarian cancer after IVF.
. Stress. Use of IVF can be financially, physically and emotionally draining. Support from counselors, family and friends can help you and your partner through the ups and downs of infertility treatment.
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Who is a good candidate?
Who is a good candidate for IUI?
. IUI candidates
Before considering an IVF, which is a costly procedure, people with the following conditions can try IUI as a first fertility treatment:
. Low sperm count and motility in male partners
. Male partners with retrograde injection problem
. Women with PCOS (Polycystic ovary syndrome). (IUI for PCOS patients has a higher success rate compared with other infertility problems.)
. Women with mild to moderate endometriosis
. Women with cervical mucus problem
. Women with semen allergies
. Couples who rarely have sexual intercourse
Generally, the best candidates for IUI are those who have:
. Sufficient quality eggs
. Adequate hormone levels
. Male partner with sufficient sperm count
. Fallopian tubes that are in good health and not blocked
. Realistic expectations about the outcome of the procedure, because pregnancy is not guaranteed and people may need to undergo more cycles of IUI in the future.
IUI doesn’t work for people with:
. Severe endometriosis
. Blocked fallopian tubes
. Previous pelvic infection
Who is a good candidate for IVF?
. IVF candidates
In-vitro fertilization is usually recommended for these people:
. Women with ovulation problems and low-quality eggs
. Women with blocked fallopian tubes
. Women with endometriosis (a condition in which the tissue that makes up the uterine lining grows outside the uterus).
. Men with low sperm count and/or motility
. Couples suffering from infertility with unknown cause (unexplained infertility), especially if other treatments have been unsuccessful.
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. IUI Cost
The cost of an IUI cycle in Iran is different from clinic to clinic and depends on many factors such as medications, whether sperm is provided by the partner or third-party donor, and the package of examination and post-op care. The cost of an IUI cycle in Iran is between $100-200.
. IVF cost
The cost of a cycle of IVF depends on many factors, including the fee of the specialist and clinic, medications needed, and the number of embryos you want to get implanted.
Costs also vary depending on the pre-implantation diagnosis (PGD), and post-op care services. Additionally, some couples need egg donation, which increases the overall cost of treatment. Typically, the cost of a cycle of IVF in Iran starts from $ 1300.
Chance of Multiples
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
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Comparing the Safety
. Both procedures are safe, and the risks are minimal. Proper monitoring, medication choice and dosage, and general care greatly reduce the risks and side effects.
. IVF requires “surgery” under anesthesia, whereas an IUI does not.