What’s the Difference Between IUI and IVF?
If you’re at all familiar with the world of fertility treatments, chances are good that you’ve heard of IUI and IVF. While they are both treatment options to help increase a patient’s chance of getting pregnant, they are quite different in the procedures involved to costs and success rates.
So, what are the differences between IUI and IVF? To help us break it all down, we spoke with reproductive endocrinologist and geneticist Dr. Jonah Bardos, medical director and founding physician at CCRM Fertility in Miami. Keep reading to learn more about IUI and IVF and which option is right for you.
What does a typical IUI procedure look like?
Right off the bat, IUI, or intrauterine insemination, is the lower-cost, less-invasive option of the two fertility treatments.
For some heteronormative couples, even if the woman has open fallopian tubes and the man has high-quality sperm, they just don’t have success with the one egg released during ovulation each month.
IUI is a way to boost their chances of conception by increasing the number of eggs a woman makes per cycle and increasing the amount of high-quality sperm that can meet that egg.
To prepare for the procedure, IUI patients typically take oral medication — some may use injectables — to increase the number of eggs growing each month. Then, around day 9 or 10, you will go into your physician’s office for an ultrasound to see how many eggs are growing.
“This is an important step,” explains Dr. Bardos, “as there are risks to multiples, especially twins and triplets. When the follicles appear large enough to likely contain a mature egg, you will take an injection of human chorionic gonadotropin (hCG) to help the egg complete its maturation process. Some patients may utilize an ovulation predictor kit (OPK) instead of a trigger shot, to time their IUI.”
Then, once the egg begins its maturation process, you will return to the clinic for the IUI procedure, at which time the lab will take the semen specimen and prepare it by removing any dead sperm and getting it ready to fertilize the egg.
“The lab will then concentrate the semen sample into a small pellet that typically contains millions of sperm. Then, the pellet is loaded into a catheter — a thin, flexible tube. A speculum is placed, similar to a pap smear, and the catheter is carefully inserted through the cervix. Those millions of good sperm are injected through the catheter close to the fallopian tubes to increase the chances of fertilization,” says Dr. Bardos.
What about an IVF procedure?
IVF, or in vitro fertilization, is a higher-cost, more invasive option for fertility treatment. With those higher costs and involvement, comes a much higher success rate — which we will look at more closely down below.
“Typically, in IVF, you are taking at least twice daily injections to help stimulate the ovaries to grow multiple eggs. During stimulation, you must visit the clinic several times for blood work and ultrasounds. Depending on how the ovaries are responding to the medications, your doctor may tweak the medications every 1-2 days,” explains Dr. Bardos.
When you have the optimal number of enlarged eggs growing, you will take a hormonal injection, frequently called the trigger shot, which will start the egg maturation process. Then, about 35 hours later, you will undergo an egg retrieval procedure, which does require general anesthesia.
“Once you are asleep, a transvaginal ultrasound is performed and a long needle is placed through the vagina into the ovaries, and the eggs are aspirated — sucked out — and given to the embryology lab. Your partner or donor sperm is then used to inseminate the egg and create an embryo. The embryos are then grown in the lab for 5-7 days at which point they can be biopsied, genetically tested and frozen, or transferred to you,” says Dr. Bardos on the final steps of the IVF process.
To cut to the chase, IVF has significantly higher success rates than IUI.
“Typically, patients with unexplained infertility have about a 2% chance of conceiving each month — that’s not nothing, so don’t stop trying!” says Dr. Bardos. “With IUI, we can boost that chance per month by about 1-14%, depending on the amount and quality of sperm. In contrast, IVF with a high quality chromosomally normal embryo can have a greater than 80% pregnancy rate and up to a 70% live birth rate after a single embryo transfer.”
Additionally, typically just one IVF cycle can yield multiple embryos that can be frozen, giving you multiple chances for live births.
Which One Is Best For You?
“When a patient comes to see us at CCRM Fertility, the first thing we do is a comprehensive fertility workup, including blood work, a semen analysis, and imaging studies,” says Dr. Bardos. “After the workup, we typically sit down with you to discuss what was found and your goals. If the result is ‘unexplained’ infertility and you are under the age of 38, IUI is typically a good treatment option, depending on the quantity and quality of sperm.”
If you’ve been experiencing longer durations of unexplained infertility, some doctors may suggest moving straight to IVF and skipping IUI altogether.
Dr. Bardos and his team will also look at the male partner and his sperm to determine if that is the cause of any fertility struggles.
“There are multiple reasons why a male partner may not have enough high-quality sperm, making IUI less likely to succeed. We counsel our patients well and explore all their options, but sometimes patients are not yet ready mentally or financially for IVF,” Dr. Bardos explains. “If we believe that a patient can conceive with IUI, that is the route to take since it’s less expensive and less invasive. Additionally, for same-sex couples and single women, donor IUI may be all that is needed to help them achieve parenthood.”
Your team of physicians has your best interests in mind. Working with them to come up with a fertility treatment that is right for you, your goals, and your needs will always yield the best possible results!
Brighid Flynn is a freelance writer based in Philadelphia where she lives with her husband and puppy. She is just beginning her journey toward motherhood.