How Do I Choose Between IUI and IVF?
Intrauterine insemination (IUI) and in-vitro fertilization (IVF) are two common fertility treatment options. For new patients, choosing whether to pursue IUI or IVF can be a difficult decision. In this article, we will give a complete breakdown of the two procedures and discuss associated medications, costs, and success rates.
What is intrauterine insemination (IUI)?
IUI, sometimes called artificial insemination, is a non-surgical outpatient procedure where a fertility doctor or nurse inserts sperm directly into the uterus. Your IUI timing is key, as it should be performed around the time your ovary is releasing an egg for fertilization. This procedure increases your chance of pregnancy by reducing the distance sperm must travel to reach the egg.
What is a cycle like?
Like other fertility treatments, your care team will begin tracking your cycle at the beginning of your period. Patients opting for a medicated IUI cycle will start taking hormone medication, such as Clomid or letrozole, which stimulates the ovaries to produce more eggs. This increases the chance that one will successfully fertilize. However, some choose to go without medication in an unmedicated cycle.
IUI treatments are performed around your regular cycle. When you are about to ovulate, it is time to perform your IUI procedure. Sperm can live in the reproductive tract for up to five days, and this timing ensures that sperm are ready to fertilize the released egg.
First, the sperm must be collected for the procedure, either from a donor or a partner. The sample is first “washed” to separate the individual sperm from the rest of the seminal fluid. Next, a catheter is placed through the cervix into the uterus. The sperm is then injected into the uterus through the catheter.
When is IUI recommended?
Usually, an IUI is recommended for couples under 35 who have had trouble conceiving naturally or are pursuing fertility treatment for non-medical reasons, such as a same-sex couple using donor sperm.
What is in-vitro fertilization (IVF)?
IVF is slightly more invasive than an IUI procedure. Here, an individual’s eggs are removed from the ovaries and fertilized in the laboratory before being transferred back into the uterus.
What is a cycle like?
Like IUI, an IVF treatment cycle begins at the start of your period. To maximize the number of eggs to be fertilized, most patients are given hormone medication that stimulates the body to grow multiple eggs. When the eggs have grown to an appropriate size, your doctor will retrieve them in the clinic. These eggs will be fertilized in the embryology lab and placed in an incubator to develop to the blastocyst stage, about 5 or 6 days after fertilization.
Adding Intracytoplasmic Sperm Injection (ICSI)
ICSI is a common form of IVF where instead of placing the sperm in the dish with the egg and allowing fertilization to occur on its own (like in conventional IVF), one single sperm is injected directly into the egg for fertilization.
Adding PGT-A
Another benefit of IVF is that it allows for genetic testing of the embryos before implantation to ensure that they are healthy. Preimplantation genetic testing (PGT) can check for chromosomal abnormalities and specific single-gene disorders like sickle cell anemia or cystic fibrosis.
When is IVF recommended?
IVF bypasses many common obstacles to achieving pregnancy, especially male factor infertility and fallopian tube blockages. This procedure allows your doctor to bypass the fallopian tubes entirely, which means that it is a great option for those with absent or blocked tubes. IVF is a powerful fertility treatment, with high success rates for many different types of infertility.
Cost of IUI vs IVF
In Ontario, the Ontario Health Insurance Plan (OHIP) compensates patients for some parts of their fertility care. Below we have highlighted the costs associated with each procedure:
| Treatment type | Cost | Covered by OHIP | Not covered |
|
IUI |
Average from $1500 to $4000 | Unlimited cycles (cycle monitoring & insemination procedure) | Medication costs
Sperm wash Purchasing/shipping/storing donor sperm |
|
IVF |
Average from $10,000 to $15,000 | 1 full IVF cycle covered for individuals under 43 years of age | Subsequent IVF attempts
Costs associated with donor sperm/eggs Storage fees for embryos, sperm or eggs |
Success Rates
Although IVF is more expensive than IUI per cycle, it may be a cheaper and more time-efficient option in the long run for certain patients due to significantly higher success rates. For IUI, studies show an average rate of clinical pregnancy between 5-15% per cycle for patients under 40 years of age1.
For IVF patients under 35 undergoing IVF, clinical pregnancy rates are reported as:
- Roughly 36% per cycle in Canada2
- 50-60% after three cycles3,4
For good IVF candidates, this procedure’s high success rates mean that someone might only need one IVF round to achieve pregnancy versus needing many IUI cycles. Many studies agree that after 3 unsuccessful IUI cycles, further IUIs are unlikely to result in a pregnancy. At this point, the “cost-per-live-birth” becomes very high for additional IUI procedures.
Do other factors influence success rates?
Exact success rates for either treatment option depend on both clinic and patient factors. A patient’s medical history, diagnosis, and age can all play a role in determining the chance of success with IVF or IUI. Additionally, success rates can differ between fertility clinics. One of the main factors influencing a clinic’s overall IVF performance is the quality of the embryology lab and the experience of the embryologists . If you are interested in learning more about factors to consider when choosing an IVF clinic, you can find more information here.
Which is right for me: IUI or IVF?
Each fertility treatment method comes with benefits and drawbacks. IUI is cheaper per cycle and less invasive but has lower success rates. IVF typically shows a faster time to pregnancy and can reduce the chance of miscarriage through genetic testing (PGT) but is significantly more expensive per cycle.
It is important to speak with your fertility specialist, as factors like age, fertility diagnosis and medical history might make you a better candidate for one treatment over another. Your doctor can further discuss each treatment option, working with you to develop a treatment plan unique to your family-building goals.
If you have questions about whether IUI or IVF is right for you, book a consultation today.
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