What’s the Difference Between IUI and IVF?
By Melissa Gokhman, RN, BSN, Fertility Coach on Fertility Outreach
It is estimated that 1 in 5 people are impacted by infertility in their reproductive age, with many needing medical assistance to help achieve their dreams of growing their family. As many who have been through can agree, starting fertility treatments can be a challenging but hopeful journey.
The path to pregnancy and parenthood may involve different treatment options, depending on your medical history and specific needs. Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two of the most popular treatment options used when faced with fertility challenges. By working with a professional healthcare provider such as a fertility specialist (reproductive endocrinologist or RE), you can create a plan that includes the best treatment option to increase your chances of a successful pregnancy.
So, let’s dive in and explore the differences between IUI and IVF, what you can expect with each procedure, and considerations for those seeking fertility treatment.
The IUI Process
Typically, IUI (commonly referred to as “artificial insemination”) is one of the first treatment options recommended by a fertility specialist since it is considered a less invasive and more cost-effective option. IUI is often a “first-line” treatment option when it comes to fertility care for many individuals and couples, such as women who want to become a single parent by choice and same-sex couples (when donor sperm is needed). IUI is also usually recommended for couples with certain male factor challenges, such as low sperm motility (the ability for sperm to move through the reproductive tract to meet the egg) or couples diagnosed with unexplained infertility.
In terms of the treatment itself, IUI involves placing washed sperm into a woman’s uterus around the time of ovulation (the release of a mature egg). A male may produce his sperm sample at home or in the clinic (unless using sperm that’s been previously “cryopreserved” or frozen, either from a partner or donor). During the procedure (performed by a nurse or RE), the sperm is inserted into a thin catheter, which then bypasses the cervix and is placed directly into the uterus. Once the sperm is placed into the uterus, the goal is for it to swim up the fallopian tube to find and fertilize the mature egg, increasing the likelihood of successful fertilization (hopefully to become a viable pregnancy).
An IUI treatment cycle may involve taking certain medications, such as those that help with “ovulation induction.” This is typically the case for anyone struggling with ovulation issues, such as someone who has polycystic ovarian syndrome (PCOS). These medications work by prompting your body to release hormones that increase the chances of your ovaries releasing a mature egg. To increase your chances of a successful IUI cycle, the IUI itself should be done around the time of ovulation. This often requires at-home monitoring of your menstrual cycle using ovulation predictor kits (OPKs) to help detect ovulation. It may also require you to go into the clinic for bloodwork and ultrasounds starting on a specific day of your cycle to monitor the development of a mature follicle and help determine when ovulation may occur. Once a mature follicle has developed, a “trigger shot” may be prescribed by your doctor to help ensure ovulation does occur. Your IUI will then typically be scheduled 36 hours from the time of your trigger shot.
The IUI procedure is “simple” in that it usually lasts only a few minutes, and anesthesia is not typically needed. The procedure starts with a woman lying flat on her back on an exam table with her feet placed in the stirrups (similar to the positioning for a standard ultrasound). A speculum is then placed inside the vagina to visualize the cervix. Once the cervix is seen, the thin catheter holding the sperm is inserted inside the uterus. After the procedure, you can go home and relax without major restrictions (though be sure to talk to your doctor about any specific instructions for your unique journey).
The IVF Process
IVF, one of the main treatment options within assisted reproductive technology (ART), is typically more complex and involves more steps than IUI. The process involves fertilizing a mature egg with sperm outside the body in a special lab to create embryos. IVF may be recommended when surgery or other fertility treatment options (like IUI) have not led to a successful pregnancy, when a woman has a low ovarian reserve, a history of recurrent pregnancy losses, or a tubal challenge such as blocked tubes. IVF may also be recommended for male factor infertility challenges, such as low sperm motility (movement) or poor morphology (shape).
Retrieval
The IVF process usually begins with taking fertility medications for “ovarian stimulation,” which encourages the ovaries to produce multiple follicles in hopes that those follicles contain eggs. This differs from a “normal” menstrual cycle, or even a typical IUI cycle when one mature egg develops and releases during ovulation—the goal for IVF is to get multiple eggs to develop during one cycle. Similar to IUI, an IVF cycle requires frequent monitoring with multiple bloodwork and ultrasound appointments. Also, similar to some IUI cycles, once the follicles grow to the “right” size, a trigger shot is administered. This will trigger the final maturation of the eggs before they are retrieved from the ovaries (36 or so hours later).
Given that the IVF process involves administering ovarian stimulation hormones, which leads to producing more eggs, plus hormonal fluctuations, possible side effects, frequent blood work, many ultrasounds, and the surgical removal of the eggs (including sedation), the process can take more of a physical toll on your body and is considered more invasive than the IUI procedure.
During the egg retrieval procedure, every follicle in both ovaries is “aspirated” using an ultrasound-guided probe with a fine needle that penetrates the vaginal wall to the ovaries. The length of the procedure varies from patient to patient and depends on many factors, such as the number of follicles that need to be aspirated.
Fertilization
During this time, the male partner produces his sample (if it was not produced at home), similar to the IUI procedure (though each fertility clinic has its protocol regarding sperm collection). Once the follicles have been aspirated, the embryologist will search for the eggs (because not every follicle aspirated may contain an egg). Each mature egg is then combined with sperm for fertilization, which is done via traditional IVF or intracytoplasmic sperm injection (ICSI). In traditional IVF, sperm is placed in a laboratory petri dish with a mature egg for fertilization to occur on its own. With ICSI, a tiny needle is used to insert a single sperm inside a mature egg (which may be a great option for couples who face male infertility factors such as low sperm count). An embryo is then created once successful fertilization takes place. The embryologist closely monitors the progression and development of the embryos over the next few days.
Transfer
A fresh or frozen transfer of the embryo into the uterus is planned once it is determined to be ready for transfer by the fertility specialist (RE) and embryologist, in hopes that it implants into the uterine wall and progresses to a pregnancy.
Any remaining embryos not transferred can be cryopreserved or “frozen” for future use during a frozen embryo transfer (FET) cycle. Generally, freezing embryos may be recommended if you are at an increased risk of ovarian hyperstimulation syndrome (OHSS) during your IVF cycle, if your uterine lining doesn’t develop to an optimal thickness during your cycle, or if you choose to genetically test the embryos before transfer. With genetic testing of the embryos, cells are taken from the embryo for testing, which provides information about the embryo’s genetic makeup.
Now that embryos are created, you may ask yourself: “How many embryos should I transfer?” Guidelines have been issued by the Society for Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine (ASRM), recommending the ideal number of embryos for transfer, considering different factors such as patient age and embryo quality. Here in the United States, the choice of how many embryos to transfer is a decision to be made by the patient and their provider, with the patient’s and offspring’s best interest in mind.
The transfer process itself is not so different from an IUI: it’s a relatively quick procedure on an exam table, with legs in stirrups, via catheter, and there typically is no anesthesia involved. It is often recommended to “take it easy” that day and resume normal activity the next (though be sure to ask your healthcare provider if there are any specific recommendations and/or restrictions for your unique journey).
Additional Considerations for IUI vs IVF
Costs
Costs for IUI and IVF vary widely depending on many factors based on each individual’s fertility diagnosis and challenges. For example, costs may be different for natural cycles versus medicated cycles, and also depending on how much medication and monitoring is needed per cycle. Costs also depend on each clinic’s pricing, as well as individual circumstances when it comes to insurance coverage. Unfortunately, many
insurance companies do not provide fertility coverage, including coverage for IUI or IVF. Only 19 states have an insurance mandate to cover some portion of fertility treatment, making pursuing fertility treatments a financial stressor for many aspiring parents. But there are simple tips to consider that can help manage the financial part of treatment, such as following up with your insurance provider to know what is covered, looking into potential grants or loans, and asking if your fertility clinic offers any payment plans.
Success Rates
To conclude, fertility treatments like IUI and IVF have provided hope for many and have come a long way in helping families facing fertility challenges. However, their use varies depending on the complexity of the fertility issues faced by each aspiring parent. An understanding of each procedure is essential for anyone seeking fertility treatment to make informed decisions that suit their unique situations.
