For any woman or couple facing infertility, the task of deciding on your next steps can feel very daunting. Of course, there’s no substitute for the advice of a fertility specialist, but a general idea of what to expect can help give you confidence. You might be wondering what is the difference between In Vitro Fertilization (IVF) and IUI, or artificial insemination?
In very general terms, IUI tends to be the first choice of treatment for fertility problems which are not very complex, leaving the option to progress to IVF if it becomes necessary.
We have put together an overview of these two treatments to help you understand what is involved in each of them.
What is IUI?
IUI is one of the simplest of the available fertility treatments.
It involves using a catheter to place sperm directly inside a woman’s uterus at the time of implantation.
In the natural process of conception without treatment, a woman’s ovaries produce a mature egg each month, which leaves the ovary and travels along the fallopian tube towards the uterus. Sperm that has been deposited in the vagina through intercourse travels through the cervix through the uterus and up the fallopian tube toward the egg. Millions of sperm are lost in the cervix and do not travel to the fallopian tube. When the two meet, they join to form the early stage of an embryo which then travels down the fallopian tube into the uterus. If all goes well, it will implant in the lining of the womb and pregnancy begins.
In IUI, this natural sequence of events is given some assistance. A sample of sperm is prepared in the laboratory so that only the best moving sperm are concentrated together. This sperm is then deposited directly into the uterus without having to swim there on its own, which can be challenging, especially if the sperm do not swim well. IUI places a higher concentration of moving sperm closer to the ovulated egg. Often a woman will have taken medication prior to the IUI procedure to ensure she will ovulate around the time of the procedure, so egg and sperm can meet.
What types of infertility can IUI treat?
Whether IUI can be helpful in any individual case depends on the cause of infertility. Some of the conditions which may be treated with IUI include:
- When a woman does not ovulate regularly
- Sperm that does not swim properly and need help getting through the cervix and meeting the egg
- Mildly decreased sperm counts
- Cervical abnormalities, like when there is severe scarring of the cervix that prevents sperm from traveling past the cervix and into the fallopian tubes.
- Cases of unexplained infertility in which there is no known cause
Who needs artificial insemination or IUI?
There are many different individuals and couples who can benefit from artificial insemination:
- Couples dealing with male infertility at a mild or moderate level. If the semen analysis carried out during infertility tests has shown a below-average sperm count or abnormalities in size and shape, IUI can help by concentrating the healthy sperm and eliminating those of inferior quality.
- Lesbian couples or single women, who use donor sperm to conceive
Where do I find a sperm donor for IUI?
For cases where donor sperm is required, the majority of patients use commercial sperm banks as their source of donor sperm. You can find out a lot about a potential donor before making your choice. For example, you can access information about the donor’s ethnic or racial background, education, and physical characteristics. It’s also reassuring to know that sperm banks always screen donors for sexually transmitted diseases (STDs) such as chlamydia, syphilis, gonorrhea, hepatitis, HIV, and others. The FDA and the Centers for Disease Control and Prevention (CDC) recommend that frozen semen from a licensed sperm bank be used in order to prevent STDs.
Anonymous sperm donor vs. known sperm donor
If you are considering using a known donor, you should:
- Know the law applying to sperm donation in your state and follow it strictly
- Have the donor supply the sperm sample to your physician. This is essential both for medical and legal reasons and so that the sperm can be properly prepared for the IUI process and the necessary health checks for the donor can be performed.
- Check that any consent forms signed in the presence of the physician are in line with what you intend for parental status.
- In all circumstances avoid any form of verbal agreement; agreements should always be in writing, drawn up by an attorney, and signed by both parties.
What can I do to increase the success of an IUI cycle?
If IUI is your chosen treatment for infertility, there are some steps you can take to give yourself the best chance of achieving pregnancy. These include:
- Working with the right reproductive endocrinologist who has your interests at heart.
- Incorporate lifestyle changes to include a healthy diet, moderate exercise, and avoidance of smoking and alcohol.
- Do all you can to stay calm, stress free, and optimistic during the process. Whether your chosen relaxant is meditation, a walk in the park, or a warm bath with scented candles, do whatever you can to stay stress-free.
How does IUI compare with IVF?
When weighing the options, the pros and cons of intrauterine insemination (IUI) and in vitro fertilization (IVF) will, of course, be explored fully in discussion with your physician. In general terms, you can expect IUI to be a simpler process, less invasive, and lower cost. Some fertility specialists recommend attempting one or more cycles of artificial insemination before moving to IVF but this does not apply to everyone. For example, for an older woman, to try artificial insemination first may take up valuable time and the recommendation could well be to move straight to IVF. But before you can compare the two treatments, you need to know what exactly you could expect from IVF.
What is in vitro fertilization (IVF)?
In the well-established fertility treatment of IVF, unlike IUI, the meeting of sperm and egg takes place outside the body, in the laboratory (in vitro). This gives fertility practitioners a lot more control over the selection of a genetically normal embryo that has the best chance of establishing a successful pregnancy. IVF is the fertility treatment with the highest likelihood of taking home a healthy baby. These are the stages involved in IVF:
- Ovarian stimulation with hormonal medication is performed over a period of around 10-14 days. During this time, progress is monitored through ultrasound scans and blood tests. When enough oocytes (eggs) have developed in the ovaries, a final hormone injection triggers the maturing of the oocytes. Thirty-six hours later, egg retrieval is scheduled to take place in the fertility clinic.
- The eggs are retrieved in a simple process which takes about 15-20 minutes and is carried out in the doctor’s office under light sedation. The ovaries are accessed through the vaginal cavity and each of the follicles containing an egg is punctured. The fluid containing the eggs is aspirated through a very fine needle. The patient rests for a brief time and can then go home with an escort. Usually, the patient feels back to normal the day after.
- The eggs are then fertilized with sperm that has been optimized in the laboratory so that sperm with poor morphology or motility are discarded and the healthiest remain. Fertilization usually takes place through Intracytoplasmic Sperm Injection (ICSI). In this high-precision technique, the best single sperm are selected and individually microinjected into each egg.
- For five to six days following fertilization, the developing embryos are cultured in the laboratory until the blastocyst stage of development has been reached. This represents growth of about 200 cells. We at RMA culture embryos exclusively to the blastocyst stage, because published data demonstrates that extended embryo culture results in improved implantation rates and pregnancy outcomes. This means we will never do an embryo biopsy – or an embryo transfer – at three days, or anything less than the blastocyst stage.
- At RMA, once the embryos reach the blastocyst stage, they are tested through a process called Preimplantation Genetic Testing for Aneuploidy (PGT-A), which lets doctors know which embryos have a normal number of chromosomes. While genetically normal embryos are much more likely to lead to pregnancy and healthy babies, the transfer of abnormal embryos will either result in no pregnancy, miscarriage, or an affected baby. While testing is occurring on a small part of the embryos, the embryos themselves are frozen, awaiting a receptive uterus. A large, prospective study performed recently at RMA confirmed that performing an embryo biopsy does not harm the embryo and does not decrease the likelihood of implantation.
- Once doctors have identified a genetically normal embryo for transfer, they wait for the endometrium to be ready so that Frozen Embryo Transfer (FET) can occur at just the right time for the uterus to accept the embryo and pregnancy to occur.
- Frozen embryo transfer is the process by which a woman takes hormonal medication in preparation for an embryo to be transferred into the uterus. Frozen embryo transfer has a higher likelihood of pregnancy compared to fresh embryo transfer, in which the embryo is transferred into the uterus 5 days after an egg retrieval procedure.
- In RMA clinics, FET has become the standard of care for all IVF patients because this is known to lead to higher rates of implantation and improve obstetrical outcomes.
- Finally, one normal embryo is transferred into the woman’s uterus. This is a quick and painless procedure that does not need any sedation and the woman can return home shortly afterward.
Who needs IVF?
Women and couples with infertility are likely to be recommended IVF as their best option for treatment in various scenarios:
- If the woman has damaged, blocked or absent fallopian tubes
- If the woman has ovulation disorders, endometriosis, or uterine fibroids
- If the male partner has sperm with abnormal morphology or low mobility
- When either partner has a detectable genetic disorder they want to avoid passing on to their children
What are the risks of IVF?
Very slight elements of risk are associated with any medical intervention but for IVF the most notable risk in the past has been multiple births. The impact of multiple births on birth weight, premature delivery, and post-natal complications is well known. This is largely due to the practice over the past 30 years of transferring two or more embryos during IVF. Thanks to PGT-A testing and Single Embryo Transfer (SET), however, doctors can now feel confident about transferring just one normal embryo. At RMA, we have established SET as the standard of care going forward. With SET, the risk of multiple births is drastically reduced.
How does IUI compare with IVF?
IUI and IVF can both be used successfully to achieve pregnancy, and which is the right treatment for you depends on your personal circumstances. A full medical and fertility history, various diagnostic tests, and discussion will help your physician make the right recommendation.
How do costs compare for IUI and IVF?
In general, the cost of IVF is higher than for IUI, but IVF confers the highest pregnancy rates per cycle. It is impossible to put a precise figure on the two treatments for comparison as much will depend on your personal treatment program. You can see some ballpark figures on the website of the Society for Assisted Reproductive Technology. It also contains an overview of the differences between IUI and IVF.
Does insurance cover IUI and IVF?
Coverage for infertility treatment varies from patient to patient and from one insurance provider to another. We at RMA aim to help you with our informational guide to insurance coverage details. We also provide you with a reference list of questions to ask your provider in order to be crystal clear about the extent of your personal coverage.
How do the IUI and IVF experiences compare?
From the patient experience perspective, IVF is a more time-consuming process overall, although the length of time before pregnancy is achieved varies greatly according to how many cycles are necessary. However, because IVF is a more direct and effective route to pregnancy than IUI, it is often a less time-consuming process. For example, a patient could spend many months trying to succeed at IUI, only to succeed during the first cycle of IVF. While many patients opt for IUI at the start of their fertility journey because it is less invasive and more affordable, success rates for IVF are considerably higher.
How do success rates for IUI and IVF compare?
Pregnancy rates resulting from a course of IUI are typically lower than those from IVF. For example, if a couple has an IUI cycle over a number of months, success rates could be up to 15-20% per cycle. This depends on variables like the age of the woman, whether fertility drugs have been used, and the underlying reasons for infertility.
Success rates for IVF also vary according to individual circumstances, with the most significant factor again being the age of the woman. At RMA, the likelihood of live birth after transfer of a single, genetically normal blastocyst is 60-65% on average. It is a legal requirement in the US for success rates of fertility clinics to be reported to the CDC. This includes live birth rates and other outcomes. The Society for Assisted Reproductive Technology also reports on these statistics. All of our RMA clinics report their results individually and you can check them in the published data. You should remember that results for different clinics are not always comparable with each other because of differences in the patient base.
Getting in touch with RMA
Wherever you are in the U.S., and whatever the stage of your fertility journey, RMA can offer you treatment and care that is local, personal, and informed by the expertise of our unique global network. Our large team of physicians means that your first appointment can be in just a few days.
Use our website links to find your nearest clinic, or fill out our online contact form. You may want to discuss the pros and cons of IUI and IVF or you may just want to explore all the options that might be available. The sooner you take that first step to discuss your fertility issues with one of our physicians, the sooner you can decide on the next step in your fertility journey and take one step closer to achieving your dream of holding your own new baby in your arms.