Medically reviewed by Cordelia Nwankwo, MDMedically reviewed by Cordelia Nwankwo, MD

Fertility challenges are common, affecting about 10-15% of people worldwide, or about 1 in 7 couples. Many people end up using fertility treatments on their journey to parenthood. For instance, recent research shows that 43% of American adults have either used fertility treatments themselves or know someone who has.

Two of the most prevalent treatments for infertility are intrauterine insemination (IUI) and in vitro fertilization (IVF). IUI is a fairly simple in-office procedure in which a sperm sample is placed directly into the uterus at the time of ovulation. IVF involves a multi-step process where both egg and sperm are retrieved and combined in a laboratory, resulting in an embryo that is implanted into the uterus.

What Is IUI?

IUI is an in-office procedure in which sperm is directly inserted into the uterus around the time of ovulation. Though the procedure is simpler than IVF, it does involve several steps. Here’s how the procedure works:

1. A sperm sample (from a partner or donor) is collected, usually through masturbation.
2. The sample is “washed,” a procedure where the seminal fluid is removed, and sperm becomes more concentrated.
3. The IUI procedure is performed during the time that ovulation is occurring. The IUI procedure involves the insertion of a narrow tube in the cervix and into the uterus, where the sperm sample is deposited.

Benefits

IUI is considered a first-line treatment for many types of fertility issues and is usually tried before IVF because it is simpler and less invasive. Some of the benefits of IUI are that it:

• Is a short, in-office procedure
• Has few side effects
• Has a low risk of complications
• Is low cost

Risks

In general, IUI doesn’t come with risks. However, in rare cases, complications can occur.

For instance, if you are taking medications to induce ovulation as part of your IUI, you may produce multiple eggs, which can result in twins, triplets, or other higher-order conceptions.

There is also a very small risk of infection, such as pelvic inflammatory disease (PID), after an IUI procedure.

Who Is IUI Right For?

Many people can benefit from an IUI procedure, such as people who are looking to get pregnant without a partner or LGBTQ+ families. IUI may also be a good fit for people who have health conditions that can affect their ability to become pregnant, including:

• Endometriosis (a condition in which uterine-like tissue grows on the outside of the uterus)
• Ovarian dysfunction
• Male infertility
• Unexplained infertility
• Cervical abnormalities that prevent successful pregnancy

What Is IVF?

In vitro fertilization, or IVF, is a process that involves embryo creation and implantation. It's done through the course of a menstrual cycle. It’s often necessary to try IVF more than once. Several steps occur during an IVF procedure:

1. Ovulation is stimulated with hormones and other fertility drugs.
2. One or several eggs are retrieved. Egg retrieval is an in-office procedure where eggs are extracted with a fine needle. You will be given medicine to help you relax and reduce pain.
3. Sperm is mixed with the eggs in a laboratory to create embryos.
4. One or more embryos are transferred into the uterus via the vaginal canal. If an embryo successfully implants into the uterus, you will become pregnant.

At times, IVF is performed without egg retrieval, such as when you are using donor eggs. Sometimes, donor sperm will be used.

Benefits

IVF offers hope for many people who otherwise may not have the option of pregnancy. For instance, people who need to postpone pregnancy for any number of reasons—including career, cancer treatment, or surgery—can preserve sperm, eggs, or embryos to be used through IVF later in life.

Also, people who find that other fertility treatments, such as IUI, aren’t working may be more successful with IVF.

IVF also provides the chance of fertility for different family types, such as people in the LGBTQ+ community or people who wish to have children without a partner.

Risks

Although IVF is generally a safe procedure, it's a time-consuming process and can be stressful, especially if repeated cycles are necessary.

There are a few other risks associated with IVF to be aware of:

• Fertility medications involved in IVF can cause uncomfortable side effects like headaches, mood changes, abdominal pain and bloating, and bruising at hormone injection sites.
• At times, multiple pregnancies can result; this can be minimized by transferring fewer embryos.
• In rare cases, you may develop ovarian hyperstimulation syndrome (OHSS), where fluid builds up in the abdominal region, causing weight gain, bloating, nausea, and vomiting.
• In other rare cases, egg retrieval procedures can result in infections, bleeding, or damage to organs.

Who Is IVF Right For?

IVF is a good option for people who have tried other less invasive fertility treatments that haven’t succeeded. It’s helpful for people with the following conditions:

• Primary ovarian insufficiency
• Unexplained fertility
• Damaged fallopian tubes
• Endometriosis
• Male infertility, including very low sperm count
• Advanced maternal age

Success Rates

Success rates of IUI and IVF depend on many factors, including the overall health of the people using the treatments, the competency of the facilities or providers, and the reasons that the procedures are being used. Overall, IVF has a higher success rate than IUI.

Success rates for IUI vary. One study found that the success rate for one cycle of IUI is about 11%. When IUIs were tried several times, the success rate rose to 19%. Other studies have found IUI success rates that varied from 5% to up to 70% per cycle.

IVF success rates can vary widely based on age, type of transfer (fresh or frozen embryo), and the success rates of the clinic performing the transfer. In one study, researchers found that pregnancy was achieved 19% of the time when couples used fresh embryo transfer and 28% of the time when couples used frozen embryos.

Other research shows IVF under the age of 35 was associated with a success rate of 45%. Success rates begin to decline with age. For example:

• 32% for ages 35-37
• 21% for ages 38-40
• 10% for ages 41-42
• 3% for ages 42 and older

Your healthcare provider can discuss the health factors that may affect your IUI or IVF success. They can also recommend quality fertility clinics to seek treatment.

Cost and Insurance

Many insurance companies don’t cover fertility treatments like IUI or IVF. However, this can depend on which state you live in. Some states require insurance companies to cover these procedures, while others do not. As of 2022, 20 states have legislation requiring insurance companies to cover certain fertility treatments. You can contact your insurance company directly or your state’s health department to understand your benefits.

If you are paying out of pocket, IVF is much more expensive than IUI. Typically, IVF costs between $12,000-$17,000 per cycle, while IUI costs between $300-$1,000 per cycle.

Other Considerations

Various factors affect the success of both IVF and IUI. Each individual—and couple—has a unique health and fertility profile. While one procedure will work well for some folks, it may not work as well for others. Factors that influence the success of fertility treatments include:

• Your age, as the older you are, the more likely you are to have issues with fertility, including during fertility treatments
• The reason behind your fertility issue and how much it may affect successful conception, implantation, and pregnancy
• The facility you are using to perform the procedure and its expertise and success rates

It’s vital to discuss all of these factors with a healthcare professional as you begin your journey with fertility treatments. They can also advise you on ways to optimize the success of a particular treatment, including lifestyle factors like abstaining from alcohol and smoking, dietary considerations, and getting enough sleep.

A Quick Review

Both IUI and IVF are fertility treatments used to help people and couples with conditions like male infertility, endometriosis, unexplained infertility, and infertility due to advanced age. These treatments can also benefit people who are looking to get pregnant without a partner or LGBTQ+ families.

IVF involves much more extensive treatments and tends to have more side effects than IUI. While IVF tends to have higher success rates, it’s much more expensive than IUI. You should speak to a healthcare provider to determine which procedure is right for you.

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