IUI vs. IVF: Success Rates, Differences, Cost & Timeline

For millions struggling with infertility, fertility treatment offers hope. However, evaluating your options can be overwhelming and confusing. This in-depth IUI vs. IVF guide breaks down the differences between the two treatment pathways to empower your decision-making process.

In this article:

• IUI vs. IVF: What's the best option?
• Intrauterine Insemination (IUI)
• In Vitro Fertilization (IVF)
• Reciprocal IVF (RIVF)
• Should I choose IUI or IVF?
• How much does IUI cost?
• How much does IVF cost?
• IUI vs. IVF Success Rates
• Potential Risks of IUI & IVF
• How many IUI cycles should I try before switching to IVF?
• Can I choose the gender of my baby with IUI or IVF?
• Mental Health & Fertility Treatment
• Your Next Step Towards Parenthood

IUI vs. IVF: What's the best option?

When it comes to fertility treatment, the truth is that there is no one right answer. Every family-building journey is unique, which is why undergoing comprehensive fertility testing before deciding on a treatment pathway is so crucial to your success. 

The results of these tests will provide important information for both you and your doctor, providing a clearer picture of your current fertility and any potential underlying issues you may not be aware of. Having this information will help your doctor design the best treatment plan for your specific case, increasing your chances of a healthy pregnancy.

Let's take a look at some of the best ways to evaluate your fertility before we explore the differences between IUI and IVF treatment.

Common Fertility Tests

Timing is everything during the diagnostic testing process. On the third day of your menstrual cycle, blood work is performed to check three important hormone levels:

1. Follicle stimulating hormone (FSH) is a hormone secreted by the pituitary gland that helps manage the menstrual cycle and stimulates the ovaries to produce eggs. FSH levels can be used to diagnose issues like polycystic ovary syndrome (PCOS), irregular vaginal bleeding, and ovarian cysts. Low FSH on Day 3 can indicate good baseline fertility.
2. Leutinizing hormone (LH) is also secreted by the pituitary gland. Higher than normal levels of LH can indicate several disorders, including ovarian failure and polycystic ovary syndrome (PCOS).
3. Estradiol (E2) is the most important form of estrogen. It is primarily made in and released from the ovaries and adrenal cortex. Low E2 levels can be an indicator of issues like PCOS or ovarian failure.

What does an AMH test tell you?

An Anti-Müllerian hormone (AMH) test is also common during this stage to help measure ovarian reserve (the quantity of eggs left in the ovaries). This can offer insights into your chances of pregnancy. This blood test can be performed at any point in the menstrual cycle.

What other diagnostic tests can I expect?

A short procedure called a hysterosalpingogram (HSG) can evaluate the status of your fallopian tubes, which are the pathway your eggs travel from the ovaries to the uterus. A saline sonogram (SHG) can provide a more detailed picture of the health of the uterus itself. 

What to Know About Donor Sperm

Whether you are a single mom by choice or a couple, choosing a sperm donor is a big decision on your family-building journey. There are several donor arrangements to consider: an anonymous (de-identified) donor, open ID (open door) donor, or a known donor. 

Opting for a sperm bank donor is generally considered to be the safest option, as they have been screened thoroughly for infectious diseases and genetic risk factors, and have already been counseled on their release of parental rights.

Note: Even if you select an "anonymous" donor, it is highly likely that your child will be able to find their donor in the future, thanks to services like 23andMe and Ancestry.

Understanding IUI & IVF: The Basics

Did you know that 1 in 6 people worldwide struggle with infertility?

Thankfully, advancements in assisted reproductive technology have brought hope in the form of options like intrauterine insemination (IUI) and in vitro fertilization (IVF), two of the most common and effective fertility treatment methods.

Let's compare the differences between IUI and IVF, including how each method works, ideal candidates, costs, success rates, emotional impact, and potential risks or complications. By the end, you will have an in-depth understanding of what each treatment pathway involves, which will help empower you to make informed decisions with your fertility doctor.

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI), which may also be referred to as artificial insemination, is a relatively simple form of assisted reproduction that is often used as a first-line treatment for infertility. Here's how IUI works and how it can help you conceive:

The IUI Process

IUI is typically performed in conjunction with ovulation-inducing medications to optimize the timing of insemination with the release of mature eggs. Your doctor will help you decide whether a natural IUI cycle with insemination or an IUI cycle that includes superovulation and insemination is best for you.

What is superovulation? Often used in IUI cycles, superovulation involves taking fertility medication to "trick" your body into developing more than one egg per month. This can dramatically increase your per-cycle chance of pregnancy.

1. A semen sample will be collected from your male partner or chosen sperm donor, then washed and concentrated to enhance its quality. The sperm is introduced to the uterus during ovulation using a thin, flexible catheter.
2. This process bypasses the cervix and increases the number of sperm reaching the fallopian tubes, thereby increasing the chances of fertilization.
3. The IUI procedure itself is quick, usually taking around 5-10 minutes total, and is performed in your doctor's office or fertility clinic.

How long does an IUI cycle take?

The length of an IUI cycle can vary depending on several factors, including whether or not ovulation induction medications are used and your response to those medications. An IUI cycle can last anywhere from two weeks to a month.

Natural cycle (no medication): In a natural cycle, the IUI procedure is typically timed with your natural ovulation cycle. Cycle length can vary, but is usually around 28 days, similar to a regular menstrual cycle.

Stimulated cycle (with medication): When ovulation-induction medications are used, the IUI cycle may be slightly longer. The medications are usually started at the beginning of the menstrual cycle and continue for about 5-12 days. The IUI procedure is then timed with your expected ovulation, which typically occurs 24-36 hours after you take a trigger shot of human chorionic gonadotropin (hCG).

Here's a more detailed breakdown of a typical medicated IUI cycle:

• Day 1: Start of menstrual cycle
• Days 2-5: Start taking ovulation-inducing medications (e.g. Clomid, Letrozole)
• Days 5-12: Continue taking medications
• Days 10-14: Ultrasound monitoring to track follicle growth and determine timing of ovulation
• Day 12-16: Trigger shot of hCG to induce ovulation
• 24-36 hours after trigger shot: IUI procedure
• 14 days after IUI: Pregnancy test

Is IUI painful?

There is little to no discomfort associated with the IUI procedure itself.

The ovarian stimulation phase of IUI treatment can cause some discomfort depending on the individual and the specific medications used, but it's generally not considered painful, and not all IUI cycles involve the use of stimulation medication.

Here's a breakdown of potential discomfort during ovarian stimulation:

• Injections: The medications used to stimulate the ovaries are typically self-administered injections. You may experience minor pain, bruising, or soreness at the injection site.
• Bloating: These medications can cause the ovaries to enlarge, leading to mild bloating or abdominal discomfort.
• Breast tenderness: You may experience breast tenderness due to hormonal changes.
• Mood swings: Hormonal fluctuations can lead to mood swings or emotional shifts.

Note: While discomfort is possible, most patients find it tolerable and similar to the symptoms they experience during a regular menstrual cycle. If you experience severe or persistent pain during ovarian stimulation, it's important to contact your doctor.

Is IUI right for me?

Written by experts and easy to understand, this free, step-by-step guide to IUI dives deeper into this lower cost option.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is the most effective fertility treatment method currently available, and has helped bring over 12 million babies into the world since 1978. IVF is a more complex and invasive procedure compared to IUI, involving several meticulously timed steps.

The IVF Process

1. Ovarian stimulation: Fertility medications are taken to stimulate the ovaries to produce multiple eggs, as opposed to the single egg released during a natural menstrual cycle.
2. Egg retrieval: Once the eggs have matured, they are retrieved from the ovaries through a minor surgical procedure called transvaginal oocyte retrieval. This is performed under sedation or light anesthesia and involves using a needle guided by ultrasound to gently aspirate the eggs.
3. Fertilization: The retrieved eggs are then fertilized with sperm in a laboratory dish. This can be done through conventional IVF, where egg and sperm are placed together and fertilization occurs naturally, or through intracytoplasmic sperm injection (ICSI), where a single sperm is directly injected into each egg.
4. Embryo development: The fertilized eggs, now embryos, are carefully cultured in the IVF laboratory for several days, allowing them to develop and grow under the watchful eye of professional embryologists.
5. Embryo transfer: Around Day 5 of development, the remaining embryos are biopsied for preimplantation genetic testing (PGT) and frozen for transfer at a later date or transferred back into the uterus (this is referred to as a "fresh transfer"). During the 20-30 minute procedure, an embryo is transferred into the uterus using a thin catheter. 

How long does an IVF cycle take?

While an IVF cycle itself only takes around four weeks, the full process (including your preconception health regimen and fertility testing) can take up to four months, from your initial consultation to when you have your first beta hCG test to see if you’re pregnant (around 9-10 days after embryo transfer). 

Is IVF painful?

While certain steps of the IVF process can cause discomfort, it should not be excruciatingly painful. If you experience severe or persistent pain at any stage, it's important to contact your doctor right away.

The level of discomfort associated with IVF varies for each person and depends on which specific step in the process you are in. For example:

• Ovarian stimulation: Injections of fertility medications can cause bruising or soreness at the injection site. You may also experience bloating or mild discomfort due to ovarian enlargement.
• Egg retrieval: This is a minor surgical procedure performed under sedation and/or anesthesia, so you shouldn't feel pain during the retrieval itself. Afterward, you may experience mild cramping, bloating, or soreness (similar to menstrual cramps).
• Embryo transfer: This procedure is typically not painful and is often compared to the feeling of a pap smear. You may experience mild cramping afterward.
• After embryo transfer: You may notice mild cramping, bloating, or breast tenderness due to the hormonal medications used during the IVF process.

IVF is one of the most successful fertility treatment options available - but it's not the only option available to you. Let's talk about a variation on this fertility treatment pathway for same-sex female couples who both want to participate in the process.

Reciprocal IVF (RIVF)

In a reciprocal IVF cycle, one partner’s eggs are used to create embryos, then the other partner carries the pregnancy and delivers the child. This can be a wonderful option in situations where both partners want to participate in the pregnancy!

The RIVF Process

1. Ovarian stimulation: Partner A will take fertility medications to produce multiple eggs. As a result, only Partner A will be genetically linked to the future child.
2. Egg retrieval: When those eggs are mature, Partner A will undergo an egg retrieval.
3. Fertilization: The eggs are combined with designated donor sperm in the IVF laboratory, while the partner who wishes to carry the pregnancy (Partner B) begins medication to prepare their uterus for transfer. 
4. Embryo transfer: When the timing is optimal, one of the couple's resulting embryos is transferred to Partner B's uterus, and if successful, they will carry the pregnancy to term.

Similarly to a traditional IVF cycle, a pregnancy test (via blood work) is performed 9-10 days after embryo transfer to see if the cycle has been successful.

Should I choose IUI or IVF?

The decision to pursue IUI or IVF should always be made in consultation with a qualified fertility specialist. A board-certified reproductive endocrinologist is a fertility specialist with extensive training that allows them to assess your individual circumstances, medical history, and infertility diagnosis in order to recommend the most suitable treatment pathway.

Have a thorough discussion with your doctor about the potential benefits, risks, costs, and success rates of each treatment option so you can make an informed decision.

Am I a good candidate for IUI treatment?

IUI is often recommended as a first-line treatment for those with unexplained infertility, irregular cycles or ovulation, and mild male factor infertility. Same-sex female couples and single mothers by choice often try IUI treatment before moving on to IVF if no major fertility issues are present.

Other issues that may be overcome with IUI:

• Infertility associated with endometriosis
• Cervical factor infertility 
• Polycystic ovary syndrome (PCOS)

Am I a good candidate for IVF treatment?

IVF can help treat a wide range of infertility issues, and is a highly effective family-building option. It is also part of the process for same-sex male couples pursuing biological parenthood through egg donation and surrogacy.

Common issues that can be overcome with IVF:

• Ovulation disorders
• Blocked or damaged fallopian tubes
• Infertility associated with endometriosis
• Polycystic ovary syndrome (PCOS)
• Moderate to severe male factor infertility
• Recurrent pregnancy loss
• Secondary infertility
• Unexplained infertility after failed IUI cycles

A Note on Genetic Disorders

When there is a risk of passing on a genetic disorder to your future child (e.g. sickle cell anemia or cystic fibrosis), IVF with preimplantation genetic testing (PGT) can be used to select healthy, chromosomally-normal embryos for transfer. 

Paying for Fertility Treatment

How much does IUI cost?

The cost of IUI varies significantly depending on various factors, including the clinic, your geographic location, and whether medications are used. Be aware that some clinics may advertise lower upfront costs for IUI treatment, but fail to include essential pieces of the process, such as fertility testing, monitoring, or medication.

One cycle of IUI in the United States can cost anywhere from $500 to $7,000 or more.

The reason this range is so wide is due to the customizable nature of the treatment. For example, one patient may require donor sperm, frequent clinic monitoring, and medication to induce ovulation, while another opts for a more simple, unmedicated cycle with a partner.

It's also important to acknowledge that because the success rate for IUI is lower than IVF, multiple cycles are often needed to achieve a successful pregnancy, which can increase the overall cost.

Note: Some insurance plans will cover a portion of the IUI costs, including medications and procedures. It's crucial to check with your insurance provider to determine your specific coverage and out-of-pocket expenses.

How much does IVF cost?

IVF is a considerably more expensive procedure than IUI.

The cost of a single IVF cycle in the United States also ranges widely - anywhere from $15,000 to $30,000. This cost encompasses various aspects, including fertility medications, egg retrieval, fertilization, embryo culture, embryo transfer, and sometimes additional procedures like PGT and ICSI.

The cost of IVF can escalate if multiple cycles are needed to achieve a successful pregnancy. Some clinics offer package deals or discounts for multiple cycles, which can potentially reduce the overall cost. However, it's crucial to carefully review the terms and conditions of these packages before making a decision.

IVF can be a substantial financial investment. Thankfully, more insurance plans are starting to cover at least a a portion of the costs. Coverage for IVF is often limited, with many plans requiring specific criteria to be met, such as a diagnosis of infertility and a certain number of failed IUI cycles.

IUI vs. IVF Success Rates

Keep in mind that success rates for both IUI and IVF can vary significantly depending on various factors, such as age, underlying fertility issues, sperm and egg quality, genetics, and the number of treatment cycles performed.

What is the success rate for IUI?

On average, the success rate per IUI cycle ranges from 10% to 20%. However, for couples with unexplained infertility or mild male factor infertility, success rates can be higher.

It's important to note that IUI is often recommended as a first-line treatment due to its relative affordability and less invasive nature. Even if an IUI cycle does not result in a successful pregnancy, it can provide valuable information about your fertility and help guide future treatment decisions.

What is the success rate for IVF?

IVF success rates are generally higher than IUI. However, these numbers fluctuate greatly depending on factors like age, embryo quality, and underlying fertility issues.

• Age: Women under 35 generally have the highest success rates, while the rates decline significantly for women over 40.
• Embryo quality: The quality of embryos selected for transfer plays a crucial role in determining the success of IVF. Embryos with good morphology and genetic makeup have a higher chance of implantation and successful pregnancy.
• Uterine receptivity: The uterine lining must be adequately prepared to receive an embryo and allow implantation to occur.
• Clinic expertise: The experience and expertise of the fertility clinic and its embryology laboratory can significantly impact the success rates of IVF.

Illume Fertility IVF Success Rates

The number of live singleton births per intended egg retrieval (this includes all embryo transfers), using your own eggs at Illume Fertility:

• Age 35 or younger = 53.3%
• Ages 35-37 = 43.5%
• Ages 38-40 = 26.1%
• Ages 41-42 = 12.9 %
• Ages 42+ = 3.4 %

The number of live singleton births per new patient, using own eggs at Illume Fertility (in other words, the odds of you having a baby using your own eggs doing IVF as a new patient at our practice, are as follows):

• Age 35 or younger = 76%
• Ages 35-37 = 69%
• Ages 38-40 = 51.9%
• Ages 41-42 = 32.1%
• Ages 42+ = 10.3%

What is the national average IVF success rate?

As reported by the Society for Assisted Reproductive Technology (SART), Illume Fertility's 76% success rate for new patients age 35 or younger was 8% higher than the 2021 national average for new patients age 35 or younger (68%).  

Note: If you'd like to dig a little deeper into the data or compare national averages of these same demographics, visit SART. You can also utilize their interactive data tool to calculate your cumulative chances of success with IVF.

Reciprocal IVF Success Rates

Success rates for reciprocal IVF (RIVF) vary with age and fertility markers for both partners, but the chances of success are essentially the same as they would be with traditional IVF - with some studies suggesting they might even be slightly higher.

Because it is a relatively new technique, there haven't yet been many studies looking specifically at success rates for reciprocal IVF. However, the research that has been performed so far is encouraging - in one 2017 study, 60% of couples who underwent reciprocal IVF (with the average age of the egg donor partner being 32) successfully achieved pregnancy.

Note: Success rates of couples engaged in reciprocal IVF may be higher than the published success rates of fertility patients, because, in many cases, they aren’t struggling with traditional "infertility" — it’s their relationship, not their biology, that makes medical intervention beneficial.

Potential Risks of IUI & IVF

While both treatment methods offer hope for those struggling to conceive, it is important to be aware of any potential complications that could occur. Your doctor will discuss any possible risks with you prior to treatment and ensure you are informed and comfortable with the plan you've agreed upon. 

What are the risks with IUI treatment?

IUI is generally a safe procedure with minimal risks. However, there is a small risk of infection, multiple pregnancies, and ovarian hyperstimulation syndrome (OHSS), a rare condition where the ovaries become swollen and painful due to the medications used for ovulation induction.

The risk of multiples does rise with IUI and ovulation induction medication. Your chance of multiples with IUI using Letrozole is 1%-13%; with Clomid, 5%-9%; and with injectable gonadotropins, 32%. 

Source: American Society for Reproductive Medicine

What are the risks with IVF treatment?

Most risks or complications associated with IVF are related to potential side effects from the fertility medications used during treatment. Ovarian hyperstimulation syndrome (OHSS) is also possible, though severe cases are rare.

While you might assume that the chances of having twins, triplets or higher order multiples increases with IVF, it is actually quite low due to the fact that most doctors will only transfer one embryo at a time. The vast majority of twins that result from fertility treatments are fraternal twins, associated with treatments that stimulate more eggs to grow each month, as well as with IVF cycles during which two or more embryos are transferred.

About 1% of patients who undergo IVF with single embryo transfer will have identical twins. In the general population, identical twins occur in only 0.4% (4 per 1000) of pregnancies. Identical twins occur when a single embryo splits into two separate but genetically identical embryos, often developing in a single pregnancy sac.

IUI & IVF: Frequently Asked Questions

Which procedure is more painful, IUI or IVF?

The IUI procedure itself is typically painless, similar to a pap smear. You might experience some mild cramping during or after, though not all patients do. 

When it comes to IVF, there are two main procedures (egg retrieval and embryo transfer). Egg retrievals are performed under anesthesia and sedation, so the procedure itself should be completely pain-free.

Embryo transfers are typically painless or only involve mild discomfort, such as cramping, bloating, or vaginal discharge. Some patients may experience discomfort when the speculum is inserted or from having a full bladder, which helps guide the ultrasound used during transfer.

How many IUI cycles should I try before switching to IVF?

Most fertility specialists recommend trying 3-4 cycles of IUI before moving on to IVF. However, this can vary depending on individual circumstances, including insurance requirements and the underlying cause of infertility.

Does insurance cover IUI and IVF?

Insurance coverage for IUI and IVF varies widely depending on the insurance provider, state laws, and your specific policy. Some plans may cover a portion of the costs, including medications and procedures, while others may not offer any coverage at all. It's crucial to check with your insurance provider to determine your specific coverage and out-of-pocket expenses.

Note: If you have minimal or no insurance coverage for fertility treatment, there are  various grants, loans, and clinic-specific financial plans available to help offset the cost.

Can I choose the gender of my baby with IUI or IVF?

Preimplantation genetic testing (PGT) can identify the biological sex of each embryo prior to transfer, which provides an opportunity for gender selection during IVF. Many patients opt to transfer their highest graded embryo instead of an embryo of a specific sex.

It is not possible to pre-identify or select the sex of a baby conceived through IUI, since sperm and egg are fertilizing inside the body (and not inside the laboratory, where the resulting embryos can be biopsied and sent out for PGT before being transferred to the uterus). 

What are some alternatives to IUI and IVF?

While IUI and IVF are the most common fertility treatment methods, they aren't the right fit for everyone. You may need or want to explore alternative options, such as:

• Surgery: In some cases, surgical intervention may be necessary to correct underlying fertility issues, such as removing fibroids, polyps, or endometriosis.
• Donor conception: For single parents by choice, same-sex LGBTQ+ couples, and those with more complex issues like premature ovarian failure or severe fertility issues, utilizing donor egg, sperm, or embryo can make the dream of having a baby a reality.
• Fostering or adoption: Though rarely a simple or easy path, fostering or adoption can also be beautiful ways to expand your family.
• Surrogacy: This involves working with a gestational carrier (surrogate) who undergoes an embryo transfer and carries a pregnancy for the intended parents.

How do you choose which partner is the donor or carrier for RIVF?

It depends! You will discuss this with your fertility doctor, who can provide insights into who might be the better candidate for each role in this process.

For example, if there is a younger partner (or a partner with a more robust ovarian reserve), they may be the best egg source. Sometimes one partner has a stronger desire to carry the pregnancy and deliver the baby. If you and your partner have a preference, your doctor will do everything they can to accommodate your wishes.  

Mental Health & Fertility Treatment

The journey through infertility and fertility treatments can be an emotional rollercoaster, filled with hope, disappointment, anxiety, and stress. Both IUI and IVF can take a real toll on your mental health, and it's important to acknowledge and address these emotional challenges.

The Emotional Impact of IUI

IUI, being a less invasive and less complex procedure, is often associated with lower levels of emotional distress when compared to IVF. However, the anticipation and waiting for the results of each IUI cycle can be just as anxiety-provoking. If you are taking fertility medication to stimulate ovulation, the resulting hormonal fluctuations can also have a significant impact.

The uncertainty of whether treatment will be successful (and navigating disappointment when it isn't) can lead to intense emotional highs and lows, putting a strain on your relationships and overall well-being.

The Emotional Impact of IVF

IVF does involve more complex medication protocols and procedures, a higher financial burden, and other challenges that can evoke a wide range of emotions. It's no secret that the process of ovarian stimulation, egg retrieval, embryo transfer, and the two-week wait can be both physically and emotionally demanding. 

Talking to fellow fertility patients (or a friend or family member who has undergone fertility treatment) can be comforting and help you feel more prepared for what's ahead.

The anticipation of each step, coupled with the fear of failure, can be quite taxing. The hormonal fluctuations caused by fertility medications can also exacerbate mood swings and emotional instability. For the millions of hopeful parents without IVF coverage, the financial strain can add another layer of stress and anxiety.

Set Yourself Up for Success

Regardless of the treatment path you choose, it's important to understand the emotional and physical challenges that often arise when navigating infertility. Making an effort to develop healthy coping mechanisms and build strong support systems before you begin treatment can be incredibly helpful.

This may involve seeking individual or couples therapy, practicing mindfulness and relaxation techniques, joining support groups, engaging in hobbies and activities that bring you joy, and prioritizing self-care. Open communication with partners, family, and friends is also crucial and offers space for emotional expression, validation, and support.

Your Next Step Towards Parenthood

Understanding all the differences between IUI and IVF and deciding on a treatment path can be daunting. When you choose to work with a board-certified reproductive endocrinologist, you can feel confident that you're making an informed choice that aligns with your goals and increases your chances of achieving a successful pregnancy.

While this journey may not always be straightforward, with the right support and treatment protocols, you will be able to reach the other side and embrace the joy of parenthood.