IVF vs IUI: the differences, costs and success rates

In theory, trying to have a baby is simple: you find a partner, have unprotected PIV sex for a few months, and get pregnant. In reality, the process can be much more complicated for some people. You might have a same-sex partner, for example. You or your partner could have a condition that affects your fertility, such as polycystic ovary syndrome or PCOS. Or maybe you’re one of the roughly 13% of couples who suffer from infertility, defined as the inability to get pregnant after a year of trying. These are all reasons your doctor might mention IVF or IUI.

These are two methods of reproductive assistance. In other words, they are meant to make it easier for you or your partner to get pregnant. They do this by placing sperm directly into the uterus (IUI) or by using sperm to fertilize an egg outside the body and then inserting that fertilized egg directly into the uterus (IVF). They both have pros and cons, and a doctor can explain what makes the most sense for you and your unique situation. But making reproductive health decisions can be stressful and confusing, so we asked a few experts what you need to know about these two popular options for people trying to conceive.

What is IUI?

IUI is an acronym for “intrauterine insemination”. With this medical procedure, healthy sperm is placed in your uterus as close to the time of ovulation as possible, according to the American College of Obstetricians and Gynecologists (ACOG). Sperm can come from your partner or from a donor.

Having sperm placed directly into your uterus at or near ovulation (which can be determined by tests such as an ovulation predictor kit or OPK) already increases the chances of conceiving. But doctors can take additional steps to make conception even more likely. “Many times I add a drug called Clomid to make sure ovulation will happen,” says Jane Frederick, MD, reproductive endocrinologist and medical director of HRC Fertility in Orange County, California. Clomid works by increasing levels of hormones that mature eggs, causing ovulation. “It allows me to time the cycle,” says Dr. Frederick. With the IUI, “it’s like having more horses at the door,” says Dr. Frederick. There is also a technique called “sperm washing”, in which individual, healthy, motile sperm are isolated from semen before being used for IUI, in hopes of further increasing the chances of fertilization.

What is IVF?

IVF, which stands for “in vitro fertilization”, is a bit more complicated. This is done in cycles, by ACOG, which may include:

  1. Obtaining an egg. Patients are usually given drugs called gonadotropins to trigger ovulation and produce multiple eggs. Once the eggs are ready, they are removed from the ovaries with a needle.
  2. Fertilization of eggs. Sperm can be added to eggs in a lab, or a single sperm can be injected into each egg.
  3. Embryo transfer. A few days after fertilization, one or more embryos are placed into the uterus through the vagina. Any healthy embryos that are not transferred can be frozen and stored for future use.

IVF is primarily performed for women with infertility caused by damaged or blocked fallopian tubes, severe endometriosis, or other unexplained fertility issues, according to ACOG.

Advantages and disadvantages of IUI

IUI is “less involved and less invasive than IVF,” says Iris Insogna, MD, fertility expert at Columbia University Fertility Center. Plus, if you’re having trouble conceiving, your insurance will often require you to try a certain number of cycles of IUI before you can move on to IVF, says Adrienne Neithardt, MD, reproductive endocrinologist at Boston IVF. .

“IUI is less aggressive, involves fewer doctor visits, and is less emotionally taxing than IVF,” says Dr. Neithardt, noting that it’s often a good option for single women and those in relationships. another woman.

Success rates “are lower than with IVF – there’s a 10-15% chance of pregnancy per cycle with IUI,” says Dr. Insogna. And, she adds, that number doesn’t take into account the risk of miscarriage, which occurs in 10 to 20 percent of known pregnancies. Dr. Frederick points out, however, that individual success rates depend on a lot of different factors, including the woman’s reproductive health, sperm quality and the patient’s age.

If you’re using anti-ovulation drugs like Clomid or Letrozole, and many doctors do this with IUI, there’s also a slightly higher than average risk of having multiples, says Dr. Insogna. It’s “a bit above average compared to conception without pills,” she adds.

Advantages and disadvantages of IVF

IVF is more invasive and complicated, but it can be an important tool for people with certain reproductive issues, such as being older, having a partner with poor sperm quality, experiencing frequent miscarriages, and having fallopian tubes. blocked. “Patients who have a genetic problem, such as carrying a gene with fragile X syndrome, can have their embryos tested to see which ones are healthy,” says Dr. Frederick.

IVF also has a higher success rate – around 40%, with individual success varying by person, says Dr. Insogna. “IVF also has the added benefit of preserving fertility,” she points out. “If the goal is to have more than one child, having extra frozen embryos to use for the future can be very helpful.”

Cost of IVF vs Cost of IUI

Insurance coverage is an important factor here. “Some policies may not offer fertility treatment coverage, some may only cover IUI cycles, and some may cover both IUI and IVF cycles,” says Dr. Insogna. “Out of pocket, the IUI is much cheaper, around $2,000 if you use ultrasound and blood tests for monitoring.

IVF is “much more expensive, usually between $12,000 and $15,000, depending on the drugs used and whether embryo testing is desired,” she says.

But it’s hard to predict in advance what the final cost will be, says Dr. Neithardt. “If you compare cycle to cycle, hands down, IUI is a lot cheaper,” she says. “But you may need to have six to seven cycles of IUI to have a fighting chance, and then the cost of IUI starts to become comparable to IVF.”

Dr. Neithardt recommends that you consider your overall family planning goals. “If you only want one child, it might be best to do an IUI,” she says. “If you want more than one, IVF might be better because you can freeze your embryos.”

But the bottom line is that it’s important to talk to your doctor about your options, says Dr. Frederick. A lot of factors, including your age, the quality of the sperm you’re working with, your personal health status and, of course, your budget, will help dictate which procedure is best for you.

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