Deciding when it’s more appropriate to undergo IUI or IVF is a personal choice and, as we’ve covered in the previous six lessons, there are multiple factors to consider. In this lesson our goal is to describe which approach is more favorable, depending upon each priority.
As you’ll recall, many women should not consider IUI at all because the nature of their fertility issues won’t allow IUI to be of help. These include women with severely diminished ovarian reserve, both fallopian tubes blocked, or a partner who has an extreme case of male factor infertility.
To help you weigh whether to do IUI or IVF, we've developed 6 key criteria (and which treatment wins out in each) that you may want to consult in making your decision. Which criteria are most important is a personal decision.
Women who start with IVF as opposed to IUI, or switch earlier from IUI to IVF, record faster “time to pregnancy.” In one well-regarded study, women who started IVF immediately conceived faster than women who initially tried two IUI cycles before converting to IVF.
Provided women who fail with IUI discontinue treatment after a few cycles and have the ability to do multiple IVF cycles, their odds of ultimately taking home a baby should be similar to women who started with IVF or embarked upon it earlier.
Each IUI cycle costs roughly $500 - $4,000 while IVF typically costs $20,000. On a “cost-per-live-birth” basis, IUI looks favorable.
However, after roughly 3 IUI cycles most IUIs will not work and and at this point the “cost-per-live-birth” for each additional IUI becomes unacceptably high.
Those fearful of conceiving with multiples should strongly consider IVF and only transferring one embryo at a time. In these circumstances, just 1% of pregnancies lead to twins, and triplets are even more rare. Alternatively, 8 - 30% of medicated IUI pregnancies lead to twins. Finally, the least preferable circumstance is do to IVF with multiple embryo transfer, where in women under 38 years of age, 30% of pregnancies culminate in a multiple birth.
Women especially apprehensive about suffering a miscarriage (as opposed to not conceiving in the first place) are better off doing IVF with pre-implantation genetic screening of aneuploidies. While PGT-A costs an additional $5,000, in older women it reduces the risk of miscarriage substantially.
IUI creates less burden on patients than IVF does, but it can still be demanding. While IUI cycles often require taking oral medication, attending a handful of monitoring appointments and the insemination itself, IVF often demands weeks of monitoring appointments, self injecting hormones, a surgical procedure to retrieve eggs and another appointment to transfer embryos. Undergoing IVF places heavier calendar and travel restrictions on patients than IUI does.
IVF creates more embryos than IUI and allows for any resulting embryos to be stored indefinitely. This has three benefits:
Each IVF cycle is more likely to be capable of delivering multiple embryos and thus multiple children. According to one large study, nearly 20% of IVF patients produce enough embryos in a single cycle to have two children
IVF allows patients to safely transfer one embryo at a time (which we covered above) to reduce the risk of a multiple birth
IVF allows families to do multiple, successive cycles (while they are younger and more fertile), stockpile embryos (known as "embryo banking"), and estimate how many children this will deliver. If they think another IVF cycle is needed to meet their goals, they can cycle again while they are still younger with higher odds it will be productive
Having extra embryos from IVF creates more options but, of course, some people might feel that having extra embryos as a negative, and deciding what to do with unused embryos in the future can be difficult.
Many patients deliberate whether to begin with IUI or IVF
For patients with severely diminished ovarian reserve, impaired sperm, two blocked fallopian tubes or an inhospitable uterus, they should not consider IUI
IVF presents a faster time to pregnancy but if IUI patients have the ability to convert to IVF eventually, whether they start with IVF or IUI does not change the odds they will have a baby
IUI is considerably cheaper on a “per cycle” basis. For appropriate patients, it is cheaper on a “per live birth basis” provided it is discontinued after a few unsuccessful cycles
Patients who are very concerned with a multiple pregnancy should preference IVF, provided it’s accompanied with a single embryo transfer
For women women who, when presented with the option, would prefer not to conceive rather than suffer a miscarriage, IVF accompanied with PGS ($5K cost) is helpful
IUI, even under the most intense type (gonadotropin drugs with monitoring) is less burdensome, invasive and restrictive on schedules
IVF is clearly more effective in producing more embryos and more children from a single cycle. The ability to freeze embryos allows better ability to plan a family and do transfers when one is ready to have more children