IUI vs IVF: When Each Makes Sense
Intrauterine insemination (IUI) and in vitro fertilization (IVF) are the two most common fertility treatments, but they are very different in cost, intensity, and the situations in which they make sense.
What IUI Is
IUI is a procedure where prepared sperm is placed directly into the uterus around the time of ovulation. It is typically performed with mild ovarian stimulation or in a natural cycle. The procedure is brief and office-based, involving a thin catheter, and is generally painless. IUI is most useful when sperm count or motility is mildly compromised, when timing of intercourse is difficult, when using donor sperm, or in some cases of unexplained infertility.
What IVF Is
IVF involves controlled ovarian stimulation, egg retrieval, laboratory fertilization, and embryo transfer. It is more intensive, more expensive, and substantially more effective per cycle for most diagnostic categories.
Cost Differences
A typical IUI cycle costs several hundred to two thousand dollars per cycle. A typical IVF cycle costs many times more, often $12,000 to $25,000.
Diagnostic Criteria
IUI is most appropriate when at least one fallopian tube is open, sperm parameters are not severely compromised, and the patient has reasonable ovarian reserve. IVF is typically recommended when tubes are blocked, when sperm count is severely affected, when ovarian reserve is diminished, when there is significant endometriosis, or when patient age makes time-efficiency important.
Success Rates by Age
IUI success rates are modest per cycle, typically in the high single digits to low teens. IVF per-cycle success rates are substantially higher across age groups, particularly under age 35.
The IUI Ladder Approach
A common pattern is the IUI ladder: three to four IUI cycles with progressively more intensive stimulation before moving to IVF. For patients over 35 or with diagnoses unlikely to respond to IUI, skipping or shortening the ladder is often appropriate.
When to Step Up
Many clinicians recommend a candid review after three failed IUI cycles. For older patients, moving to IVF sooner is often appropriate because time is a more limited resource.
Talking to Your Doctor
Ask about per-cycle success rates for your specific situation, expected cost of the full plan including all anticipated cycles, and how the doctor recommends sequencing IUI and IVF.
Frequently Asked Questions
Is IUI cheaper than IVF?
Yes, substantially. IUI typically costs several hundred to two thousand dollars per cycle, while IVF often runs \$12,000 to \$25,000 per cycle.
How many IUI cycles should I try before moving to IVF?
A common pattern is three to four IUI cycles, though older patients often move to IVF sooner.
Is IUI painful?
The procedure itself is brief and generally not painful.
Is IUI appropriate for unexplained infertility?
Yes. IUI is a common first-line treatment for unexplained infertility, particularly in patients under 35 with at least one open fallopian tube and reasonable sperm parameters. Many clinicians try 3-4 IUI cycles before moving to IVF.
What is the success rate of IUI per cycle?
IUI success rates are modest per cycle — typically 8-15% for patients under 35 with appropriate diagnosis. Cumulative success across 3-4 cycles can reach 30-40%. Rates decline meaningfully with age.
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Information only. Not medical advice. Discuss treatment decisions with your healthcare provider.