When patients first decide that they need help to conceive, the array of fertility treatment options available can seem overwhelming. When you begin your research, every piece of information you find tends to bring up more questions than it answers. How can you begin to decide which treatment is the right decision for you?

There is no one-size-fits-all solution to infertility, and the path you take will be unique to your specific case, but there are some common starting points. Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two of the most popular infertility treatments available today. Understanding what they are, who they are intended for, and what the success rates are for these two options will give you a place to begin your conversations with your fertility expert. Here’s what you need to know.

IUI vs IVF: what are the differences?

While these treatments are often mentioned together, they have many significant differences.

• Complexity. IUI refers to one procedure. Prepared sperm is placed directly in the patient’s uterus when she is ovulating in order to aid fertilization. IUI may be performed in sync with a woman’s natural cycle or timed with fertility medications to stimulate ovulation. IVF, on the other hand, is a process which consists of several stages and requires more than one procedure: first the ovaries are stimulated using a series of fertility medications, then the patient undergoes egg retrieval in a day procedure under a mild anesthetic, then after embryos have been created and incubated in the lab, they are placed directly into her uterus in the embryo transfer procedure. Even with the use of fertility drugs, going through IUI is less physically demanding than undergoing IVF.

• Risk of multiples. IUI with fertility medication carries a significant risk of multiple pregnancies, including higher-order multiples (triplets or more). A good clinic will carefully monitor your follicles to make sure that only a safe number are mature before the IUI, but they cannot entirely eliminate the risk. Recent advances in IVF (including blastocyst transfer) mean that most modern fertility clinics now transfer only one or two embryos per IVF cycle. As a result, the risk of multiple pregnancies for IVF patients is much lower than it used to be.

• Success rates. It is never easy to be specific about the success rates of a given treatment as there are so many variables that affect individual cases, but statistically, IUI has lower success rates than IVF, and the gap widens as women age.   
  • IUI with fertility medication (Clomid): average success rates range from 8% to 15% per cycle for patients under 35 to 2% to 5% for patients over 40.
  • IVF using a woman’s own eggs: average success rates range from 40% to 45% for patients under 35 to 15% or less for women over 42.

• Time. The factor of time cuts both ways when you are weighing up these two options. IUI is a much shorter process than IVF, so if your first cycle is successful, it could be the quickest route to bringing home a baby. However, because of the gap in success rates between the two treatments, some patients in their late 30s to early 40s may get pregnant faster by going directly to IVF rather than waiting until they have had several failed IUI cycles.

• Cost. An IUI cycle costs much less than an IVF cycle, and this is a serious consideration for many patients. However, depending on your diagnosis and your chances of conceiving through IUI, it may be more cost-effective to go directly to an IVF cycle rather than dealing with multiple failed IUI cycles before ultimately proceeding to IVF.

When should I try IUI first?

IUI can be an excellent first line of treatment for many patients, depending on their circumstances and diagnosis. If you are a patient who:

• has at least one unblocked fallopian tube
• is able to ovulate, perhaps with the help of fertility medication
• has a healthy ovarian reserve (which means a good amount of healthy eggs)
• has a normal uterine cavity

then you may be a good candidate for trying IUI. This treatment is often very effective for:

• Cervical issues: Scarring or hostile cervical mucus can block fertilization, and IUI provides a way to bypass these obstacles.
• Mild ovulation issues: When used with fertility medications, IUI can help women with irregular cycles conceive “on schedule.”
• Donor sperm: A patient or couple may use donor sperm with IUI to conceive.
• Mild male-factor infertility: The lab preparation of the sperm sample concentrates the healthiest and most active sperm, and placing the sperm directly into the uterus can overcome sperm mobility issues or problems with ejaculation.
• After male fertility preservation: Some men choose to freeze their sperm before cancer treatment or surgery which could impact their fertility. After treatment, assuming that the female partner is a good candidate, IUI can be used to achieve pregnancy.
• Same sex-couples: Female couples may use donor sperm, and male couples may use their own sperm and a gestational surrogate.

If you fit one of these profiles, your fertility team may agree that it makes sense to attempt IUI before considering IVF. Before you begin IUI, it’s good to have a conversation with your partner and doctor about how many cycles you want to attempt. Many people place a limit of three failed IUI cycles, but others may try up to six before moving on.

When does it make sense to go straight to IVF?

There are times when a patient is likely to have better results by skipping over the IUI option and beginning their fertility treatment with IVF. This is a choice each patient will have to make themselves, after close consultation with their fertility specialist. IVF can be a better option for patients who:

• are over the age of 38
• have blocked fallopian tubes
• have reduced ovarian reserve
• decide to use donor eggs
• suffer from advanced endometriosis
• are dealing with severe male-factor infertility which may require the use of advanced technologies such as intracytoplasmic sperm injection (ICSI)
• may require genetic screening

Whether you ultimately choose IUI or IVF, the first step is finding a Los Angeles fertility clinic that prioritizes your individual needs over a generic protocol. You need good information to make a good decision, which is why it is so important to start with an in-depth medical investigation and diagnosis. Understanding exactly which issues may be contributing to your infertility helps you and your doctor create a treatment plan which gives you the greatest chance of success.