Before my friends and I began to try—and sometimes struggle—to start families, I didn’t really give infertility much thought. In my 20s, I assumed fertility treatment equaled IVF, but I wasn’t really sure what IVF meant . . . maybe something about a test tube baby? I also had seen that Jennifer Aniston movie about getting pregnant with a turkey baster (The Switch). In my 30s, things changed. Infertility became a reality for people around me, which filled in the details. I learned that IVF wasn’t the only possibility. IUI, a medical version of the turkey baster method, was a more affordable and less invasive procedure. Understanding that couples have options to address infertility helps mitigate fear of the unknown. So, let’s look at the pros and cons of IUI, one of those options.
IUI and IVF: What’s the Difference?
During an IVF (in vitro fertilization) cycle, a woman is given drugs that make more than one egg mature in her body. Those eggs are taken out and combined with sperm in the lab to create embryos. One of the embryos is then transferred back to the woman’s uterus. Any extra embryos can be frozen to use later.
“IVF allows us to help the eggs fertilize, bypass the common problems related to egg transport, and search for the egg that is most likely to make a baby,” explained Dr. Julie Lamb. She sits on the advisory board for Modern Fertility, a women’s health company that helps women make informed decisions about their fertility. “IUI on the other hand washes the sperm and puts it at the top of the woman’s uterus,” she told me. For IUI (intrauterine insemination), the sperm will meet the egg inside the woman’s body, not outside of it.
IUI vs. IVF
There is less control over what happens during IUI, since you are simply trying to optimize conditions for conception, rather than guaranteeing conception like you do with IVF. By washing—or separating—the sperm the male partner ejaculates ahead of time, you make sure you get the best sperm. After monitoring the woman’s cycle, the doctor puts that sperm in the uterus with a catheter when the doctor knows ovulation is happening. Thus, IUI takes the guesswork out of timing sex.
“When time is on your side, it is nice to try the less invasive and less expensive options first. If they work, you can avoid IVF,” Dr. Lamb pointed out. The price difference is no joke. According to Planned Parenthood, a cycle of IUI can cost between $300-$1,000 without insurance. IVF on the other hand typically runs about $15,000 per cycle. The cost can depend on where you live, your insurance, and your medical situation, but the order of magnitude is quite different regardless.
IUI also differs from IVF in that it requires less medication and sometimes no medication at all. “IUI can be done in a natural menstrual cycle, but often medication is added to either induce ovulation in those who don’t release an egg on their own, or to optimize ovulation hormones that often decrease with advancing age,” Dr. Lamb told me. When infertility is unexplained, she added, the maximal benefit of IUI treatment occurs when accompanied by medication. In this case, IUI involves oral fertility drugs, like Clomiphene or Letrozole, which support egg growth, and potentially a shot to trigger ovulation. IVF, however, requires two to three injections per day for eight to 12 days and general anesthesia for egg retrieval. The shots and surgery are what make IVF more invasive.
There is one main disadvantage to IUI compared to IVF: IUI is less successful, which means it could take longer to get pregnant. You have about a 10 to 15 percent chance of getting pregnant on your first IUI cycle. Compare that to about 50 percent for IVF, and perhaps higher if you do genetic testing on the embryo. Also, IUI is not able to decrease miscarriage rates like IVF, because you cannot do the chromosomal screening of the embryo before you implant it.
When Should You Try IUI?
If you are over 35 and have tried to conceive for at least six months, or are under 35 and have tried to conceive for 12 months, Dr. Lamb suggests you consult with a reproductive endocrinologist and do basic fertility testing. IUI doesn’t address all causes of infertility. For example, while it can help with male infertility or unexplained infertility, it does not address issues with fallopian tubes. Seeing a specialist will help you figure out if it’s an option for you. “Whether you consider IUI as the first treatment step depends on a variety of factors such as age, fertility diagnosis, family planning goals, cost and insurance benefit, and comfort level for medical treatment,” Dr. Lamb said.
With IUI, you also have a chance of double the success. The risk of twins is about three percent with a drug-free cycle IUI, just like when you conceive without help. The probability more than doubles when you pair IUI with oral medication, Dr. Lamb said. That’s because the drugs encourage your body to produce more than one egg for ovulation. If both are fertilized, you may have fraternal twins. One study found that 11.6 percent of pregnancies conceived with hormone drugs plus IUI result in multiples.
Summarizing the Pros and Cons
If you’re considering IUI, here is your cheat sheet of what you can expect.
Pro of IUI:
- Less expensive
- Less invasive
- Fewer drugs
Cons of IUI:
- Lower success rate
- Addresses limited number of infertility factors
- Doesn’t decrease chance of miscarriage as much as IVF
- Greater chance of twins and thus high-risk pregnancy
It’s up to each woman and couple to decide how they balance the cost of a fertility treatment with the chance of success. Knowing the facts is the first step.