The Difference Between IUI vs IVF : Assisted Reproductive Technology
The Center for Endometriosis & Fertility in Newport Beach, California
IUI and IVF
Intrauterine insemination (IUI) and in vitro fertilization (IVF)
Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two widely used fertility treatments which increase the chances of pregnancy. This page aims to be helpful to those contemplating these treatments as understanding the difference between IUI vs IVF is a practical education starting point for your fertility aspirations and journey.
The key difference between IUI vs IVF is that with IUI fertilization occurs internally (as the sperm is directly injected into the). With IVF, mature eggs are retrieved from ovaries and fertilization occurs externally in a lab. For a comprehensive understanding of receiving IVF treatment here at The Center for Endometriosis and Fertility, click here.
- Ovarian Stimulation: Naturally, a woman typically releases one mature egg per month during ovulation. Ovarian stimulation uses medications to stimulate the ovaries to develop and release multiple mature eggs. With multiple eggs, their quality can be assessed and the healthiest can be selected for fertilization. Also, having multiple mature eggs increases the chances of successful fertilization and making multiple embryos available, of which additional can potentially be frozen for future pregnancy attempts.
- Egg Retrieval: (also called oocyte retrieval) is a minor surgical procedure usually done with sedation using ultrasound guidance where a needle is inserted through the vagina to remove mature eggs from your ovary in preparation for fertilization.
- Sperm Collection: Your partner or a sperm donor provides a sperm sample. The collected sperm will undergo preparation to select the healthiest and most motile sperm for fertilization.
- Fertilization (2 approaches): In a lab with the conventional IVF approach, the retrieved eggs and sperm are placed together in a culture dish to encourage natural fertilization. However in situations wherein there are male fertility issues such as a low sperm count, abnormal shape or poor motility – an approach called ICSI (Intracytoplasmic Sperm Injection) can be performed. With ICSI a single healthy sperm is selected and injected directly into the cytoplasm of a mature egg using a microscopic needle.
- Embryo Development: Approximately 16-18 hours after either conventional IVF or ICSI, the eggs are examined under a microscope to check for signs of fertilization. A successfully fertilized egg (now called a zygote) is continuously monitored in the lab for several days.
- Embryo Transfer: The now embryos are graded based on their health, development and then selected for the embryo transfer procedure. One or more healthy embryos are selected and transferred into your uterus using a thin catheter. The aim is for an embryo to implant in the uterine lining, leading to pregnancy.
IUI Explained
Intrauterine Insemination (IUI) Explained
Intrauterine Insemination (IUI) is a treatment that aims to increase the chances of pregnancy by placing sperm directly inside a woman’s uterus during her most fertile time. Pinpointing the right time for insemination is determined with ovulation monitoring or tracking using ultrasounds and possibly ovulation tracking kits.
Your partner or a sperm donor provides a sperm sample. In a clinical setting the sperm is prepared, essentially ‘washed’, separating the strongest and fastest (motile) sperm from other components in the semen.
On the day of insemination a thin flexible tube places the concentrated, healthy and motile sperm through the cervix directly into the uterus, bringing the sperm closer to the egg awaiting fertilization in the fallopian tube. From this point if the sperm and egg meet, fertilization will happen followed by implantation, and you’ll have a positive pregnancy test in about two weeks.
Why consider IUI?
- Mild male factor infertility: Low sperm count or decreased sperm motility
- IUI helps same-sex couples or single women choosing to use donor sperm
- Unexplained infertility: Sometimes couples can’t find a specific reason for infertility
- Cervical issues: Scarring or unfavorable cervical mucus affecting sperm travel
Points to remember:
- Success varies depending on factors such as age, health, reason for infertility, and whether medication is used to stimulate ovulation / releasing more than one egg.
- The actual IUI procedure is quick and often feels no different than a pap smear.
(Click here for a comprehensive explanation of In Vitro Fertilization or IVF)
IUI v. IVF : Advantage & Disadvantage Table
The Difference Between IUI v. IVF : Advantage & Disadvantage Table
| Feature | IUI | IVF |
|---|---|---|
| Procedure | Less invasive. Sperm placed inside the uterus. | More complex. Eggs retrieved, fertilized in the lab, embryos transferred to the uterus. |
| Cost | Usually significantly less expensive per cycle but may require several cycles before pregnancy is achieved. | Much more expensive per cycle & often has a higher chance of success with a single cycle. |
| Medications | May involve less medication, or none at all. | Typically requires intensive ovarian stimulation medications. |
| Success Rates | Generally lower success rates per cycle compared to IVF, especially with increasing age. | IVF generally has higher success rates per cycle compared to IUI, especially for more complex infertility causes |
| Suitable For | Mild male factor infertility, unexplained infertility, cervical factor infertility, use of donor sperm. | Can address a wider range of infertility causes, including blocked fallopian tubes, advanced maternal age, severe male factor infertility, endometriosis, genetic concerns. |
| Risk | Suitable for milder infertility issues, low risk of multiple pregnancy (generally twins). | IVF can address a wider range of infertility factors, has a higher risk of ovarian hyperstimulation syndrome (OHSS- causing the ovaries to swell and become painful). Low risk of multiple pregnancy with the transfer of 1 embryo. |
Not reflected in this table but essential in considering the difference between IUI vs IVF is age and the cause of infertility. Female age and specific infertility diagnoses influences both IUI vs IVF success rates and which treatment offers a better chance of success.
IUI vs IVF : Process & Complexity Table
The Difference Between IUI vs IVF : Process & Complexity Table
| Feature | IUI | IVF |
|---|---|---|
| Ovarian Stimulation | May or may not use medication to stimulate the release of one or more eggs. | Requires intensive hormone injections to stimulate the development of multiple eggs. |
| Egg Retrieval | No egg retrieval procedure. | Involves a minor surgical procedure to retrieve eggs from the ovaries under sedation. |
| Sperm Preparation | Sperm is washed and concentrated in a lab to boost quality. | Sperm preparation in the lab may involve standard washing or more advanced techniques (ICSI) if needed. |
| Fertilization | Sperm and egg meet inside the woman’s fallopian tube naturally.* | Eggs and sperm are combined in a lab dish, and fertilization is closely monitored. |
| Embryo Transfer | No embryo transfer takes place. | Selected healthy embryo(s) are transferred back into the woman’s uterus using a thin catheter. |
| Embryo Testing | No embryo testing takes place | Embryos can be biopsied and tested to rule out chromosomal abnormalities that may lead to birth defects or miscarriages. |
| Embryo Banking | No embryo banking takes place | Extra embryos may be frozen and saved for future pregnancies |
| Overall Invasiveness | Less invasive overall. | Significantly more invasive with procedures, medications, and monitoring. |
*Risk of multiples with IUI is higher: Multiples introduce complications. Women undergoing IUI commonly supplement their treatment with hormones or medication to induce ovulation. In a given cycle this can produce the release of more than one egg and therefore increases a couple’s chances of having twins or multiples. This is why careful monitoring of a woman’s ovarian follicles (Each with the potential to release an egg for fertilization) is required to assure only a safe number are mature prior to the IUI (but this cannot entirely eliminate the risk). Having said that, the risk of multiples from IVF has significantly declined. Advances in IVF, notably genetic screening of embryos, means only one embryo per IVF cycle.
In special circumstances, the patient may consider transferring 2 embryos into the uterus and if this results in excess embryos from an IVF cycle, these can be frozen to be available for future treatment.In sum, IUI helps create the optimal environment for fertilization to happen naturally within the body and IVF bypasses natural processes taking greater control and aiming to achieve fertilization and initial embryo development in a laboratory setting. If you’re contemplating the difference between IUI vs IVF for you, know there’s no one-size-fits-all answer. Factors like your infertility diagnosis, age, and cost considerations all play a role.
IUI’s Lower Pregnancy Success Rates per Cycle
The Difference Between IUI vs IVF: IUI’s Lower Pregnancy Success Rates per Cycle
Outline below is an explanation on why IUI usually has lower pregnancy success rates per cycle as compared to IVF.
Control Over Fertilization: With IUI, even with precisely placed sperm at an equally precise and optimal time, sperm is not guaranteed to either find the egg and successfully fertilize it – at the end of the day it’s still a natural process. With IVF, a scientific protocol is performed in a clinical environment, a lab. Thus in a controlled setting eggs and sperm are combined, increasing the chances of fertilization where any fertilization issues can be identified.
Egg and Embryo Quality: With IUI there’s no direct evaluation or assessment of egg quality prior to fertilization. It’s very possible for some eggs to harbor unseen issues making them less viable. With IVF eggs undergo clinical inspection prior to fertilization followed by stringent monitoring of developing embryos. The healthiest embryo(s) are selected for transfer, dramatically improving the chances of using a healthy fertilized egg. The embryos can also be genetically tested with IVF to ensure that only genetically normal embryos are transferred, reducing the risk of miscarriage.
Responding to Specific Infertility Causes: IUI is far more limited in what it can address, primarily helping with pinpointing timing and forwarding sperm along with their journey. However IVF helps overcome a range of issues such as:
- Severe sperm problems: ICSI (injecting a single healthy sperm into the egg) in IVF overcomes this obstacle.
- Blocked Fallopian Tubes: IVF entirely bypasses fallopian tubes, as fertilization takes place in a lab.
- Endometriosis: Can cause inflammation in the reproductive tract, and IVF’s success isn’t as severely impacted as IUI.
Unexplained Infertility: With IUI when there’s no identifiable cause for infertility, its success is less predictable and increases overall chances only slightly. With IVF in the face of unexplained infertility, the advanced clinical approach and stringent monitoring help identify previously hidden issues and optimize a controlled process and chances of success. It also allows for embryo testing to ensure a healthy embryo is being transferred back into the uterus.
The Effect of Age: : With IUI age significantly impacts egg quality and overall success, with rates dramatically declining in general after age 35. With IVF success rates also experiencing an age-related decline, IVF tends to have better success rates across all age groups compared to IUI.
Number of Eggs: IVF medications usually stimulate the release of multiple eggs, increasing the possibility of successful fertilization and potential for freezing extra embryos.
Preimplantation genetic screening (PGT): IVF allows for testing for chromosomal abnormalities or genetic conditions in embryos, leading to the selection of the healthiest embryos and lowering risk of miscarriage.
Important Reminder: Success rates vary and individual clinics, patients, and the skill of physicians all influence specific success rates. Mindful of all this, IUI remains a sensible starting point for many situations, being less expensive and less invasive than IVF. Discussing your unique situation and the difference between IUI vs IVF in the context of your circumstances is a sensible first step. You’re welcome to reach me and engage in a free discovery call wherein I may be more helpful to you.
IUI vs IVF: Time & Cost
The Difference Between IUI vs IVF: Time & Cost
The factors of time and cost have both benefits and drawbacks when comparing the difference between IUI vs IVF. A single round of IUI as a process is significantly shorter than a single IVF cycle. Thus if a first IUI cycle results in success, it could be the quickest path to bringing home a baby. However, it’s also possible to undergo 3 or more IUI cycles to achieve the success rate that could possibly be realized in a single IVF cycle.
Generally speaking, on the cost side of things, a round of IUI is significantly less than the cost of a round of IVF – but the costs certainly add up with undergoing multiple IUI cycles. Depending on your infertility diagnosis and your chances of successfully conceiving with IUI, it may be prudent cost-wise to go directly to an IVF cycle as opposed to enduring multiple failed IUI cycles.
The reality is since time also ages a woman’s eggs, some patients find themselves in the quandary of contemplating time versus cost. Is it a good idea to spend more time and less money with the IUI route, or is spending less time and more money with the IVF route more sensible? Because of the difference in success rates between these two fertility treatments, patients in the age range of late 30s to early 40s may realize pregnancy faster by initially pursuing IVF rather than enduring the time passage that accompanies several failed IUI cycles.
While the above information only provides a brief overview of the difference between IUI vs IVF, it can’t be reiterated enough, everyone’s situation is unique and the variables influencing fertility success are vast. Feel free to contact Dr. Behbehani for a 15-minute phone consultation regarding your particular circumstances. Dr. Behbehani is passionate about helping women facing infertility challenges and is pleased to share more insight on the difference between IUI vs IVF for you, in the context of your circumstances, and possible paths to fertility.
Dr. Sadikah Behbehani is in an OBGYN who specializes in Reproductive Endocrinology and Infertility as well as Minimally Invasive Gynecologic Surgery. She completed her 5 year OBGYN Residency at the well renowned McGill University in Montreal, Canada. She then completed a 2 year fellowship in Reproductive Endocrinology and Infertility (REI) at McGill University which makes her double board certified by the Royal College of Physicians & Surgeons of Canada in both OBGYN and REI. In addition, Dr. Behbehani completed a second fellowship in Minimally Invasive Gynecologic Surgery at the prestigious Mayo Clinic and can perform complex pelvic surgeries with both laparoscopy and robotics.
There are only a handful of physicians in the country with such training and being double fellowship trained in surgery and infertility allows Dr. Behbehani to treat complex gynecologic conditions affecting fertility such as endometriosis and fibroids.
Dr. Behbehani is very passionate about providing the best care to her patients, and she’s able to use her robotic skills and her fertility expertise to remove advanced endometriosis from the pelvis while still maintaining the integrity of the reproductive organs allowing them the best chances of pregnancy. With fibroid removal, Dr. Behbehani is able to skillfully remove large fibroids robotically, and expertly restore the anatomy of the uterus to reduce the chance of scar formation and improve pregnancy chances. Dr. Behbehani is also a mother herself, and feels passionate about helping patients start or grow their families. She is skilled in IVF and fertility treatment and has helped many patients become parents over the years.
As an Associate Professor at the University of California, Riverside School of Medicine, Dr. Behbehani is also heavily involved in medical research and publications. She’s presented at numerous national and international conferences, and her research is consistently quoted in women’s health. She’s a member of many international and national gynecologic societies including American Society of Reproductive Medicine (ASRM), American Association of Gynecological Laparoscopists (AAGL), and the Society of Gynecologic Surgeons (SGS). Click here for an overview of publications involving Dr. Sadikah Behbehani.
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