IUI vs. IVF: Which Is Right for You?

Assisted reproductive technology (ART) is a term that describes all of the treatment options that help people get pregnant. Some people use ART because they have trouble getting pregnant. Others use ART because they’re working with a third person — like a surrogate or donor — to have a baby. 

Two of the most well-known types of ART are intrauterine insemination (IUI) and in vitro fertilization (IVF). But what’s the difference? And how do you know which is right for you? 

ART is time intensive, expensive, and often comes with a lot of anxiety. So it’s natural that you want to choose the “best” option. Let’s take a look at the differences between IUI and IVF and what to consider when deciding which option is best for you. 

What is IUI?

IUI is a type of ART that can help you become pregnant. During IUI, a healthcare provider uses a catheter (tube) to place sperm directly into the uterus. IUI takes place in a provider’s office (either an OB-GYN or a reproductive endocrinologist). 

Your provider will ask you to lie down like you would for a gynecological exam. They place a speculum in your vagina so they can see your cervix. Then they’ll insert a catheter through the opening of your cervix into your uterus. The sperm goes from a prepared vial through the catheter into your uterus. The entire process takes only a few minutes. 

When most people refer to IUI, they really mean the entire IUI cycle and not just the procedure itself. An IUI cycle can look very different from person to person. Some differences in IUI cycles include:

• Monitoring: IUI is done when you’re ovulating, which is when you’re most likely to get pregnant. Urine or blood tests can measure hormone levels and show when you start to ovulate. Some people are able use at-home urine test kits while other people need to get blood work.

• Medications: Some people may need to use medications to help increase their chances of IUI success. Some people take medications by mouth and others may need to use injectable medications.

What is IVF?

IVF is a more complicated type of ART. During IVF, an embryologist (a healthcare specialist) mixes eggs and sperm  outside the body. They keep any embryos that form in a special incubator for 3 to 5 days. Then, in most cases, they use a catheter to place one embryo directly into the uterus. 

The entire IVF cycle has multiple steps. In the first part of IVF, you’ll use a combination of medications to grow as many eggs as possible. During this time, you’ll see your reproductive endocrinologist nearly every day for bloodwork and ultrasounds. 

Once your eggs have grown, you’ll have an egg retrieval. During this step, your provider will use an ultrasound and a needle to collect the eggs growing in your ovaries. Because this is painful, you’ll get anesthesia so you’re not awake during the procedure. 

Then it’s time for the actual IVF process. After the provider places the embryo into your uterus, you’ll wait 2 weeks and then take a pregnancy test. 

How do you choose between IUI and IVF?

The choice between IUI and IVF comes down to a couple of factors, including your specific situation and insurance coverage.

Your specific situation

If you’re using ART because you’re experiencing infertility, you may be a better candidate for either IUI or IVF. Many times, trying IUI first is very reasonable because it’s less invasive. But some people might need to skip IUI and go straight to IVF if they:

• Have blocked fallopian tubes

• Have different cervical or uterine anatomy

• Have severe inflammation in the cervix or uterus

• Do not menstruate

• Have a very low sperm count

Some experts also recommend that women older than 40 go straight to IVF. 

Keep your specific situation in mind as you make your decision. Not everyone experiencing infertility is the same — what might work for someone else might not be right for you.

Insurance coverage

Insurance carriers typically won’t cover IVF services until you’ve tried IUI. Some insurance companies require you to try two or three cycles of IUI before covering IVF. So for most people, skipping IUI and going straight to IVF isn’t an option. 

If you’re not a candidate for IUI, your reproductive endocrinologist will request that your insurance company waive the IUI requirement. In this case you can move directly to IVF without trying IUI first.

What are the success rates for IUI vs. IVF?

Both IUI and IVF can increase the chance that you’ll get pregnant. When looking at published success rates for IUI and IVF, it’s important to keep your own situation in mind. Your chances of getting pregnant might be higher or lower. Different things affect success rates, like age, underlying medical conditions, use of fresh or frozen sperm, and fertility clinic experience.

In general, IUI success rates are about 15% to 20% per cycle. This may sound low, but your chance of getting pregnant by having sex is only 20% each month (though that number goes down as you get older). In other words, for some people experiencing infertility, IUI gives them about the same chance of getting pregnant each month as they could expect if they weren’t experiencing infertility. 

IVF has slightly higher success rates of 25% to 35% per cycle. That means IVF gives you a slightly better chance of getting pregnant than if you were trying to get pregnant by having sex.

The chance of getting pregnant with IUI and IVF generally goes up with more cycles. But after a certain number of cycles, there’s a drop off in success rates. 

What are the costs for IUI and IVF?

Infertility treatment costs can add up. Fertility medications are very expensive, but you’ll also have to factor in the cost of: 

• Appointments

• Blood work

• Ultrasounds

• Anesthesia

• Procedures 

IUI can cost between $500 to $4,000 depending on the type of medications, bloodwork and monitoring, as well as the insemination procedure.

IVF is much more expensive due to the medications and multiple procedures to achieve a successful implantation. IVF can cost over $20,000 per cycle. And it can take multiple cycles, so costs can add up quickly.

Your insurance provider may cover some or all of the costs. But you may be required to meet a deductible before your coverage starts. If your insurance does not cover fertility treatments, or only covers limited treatments, your fertility clinic will offer you a self-pay rate. While this amount may still be quite high, your clinic may offer payment plans and discounts depending on your income. 

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Written by:

Jennifer Sample, MD

After a fellowship, Dr. Sample worked as the medical director at the University of Kansas Hospital Poison Center (The University Of Kansas Health System Poison Control Center), which served the state of Kansas for poison exposures. In 2007, she returned to Children’s Mercy Hospital in Kansas City, Missouri, as a consultant in clinical pharmacology and medical toxicology.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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