By Cristina Mestre Ferrer BSc, MSc (embryologist) and Óscar Oviedo Moreno MD (gynecologist).
Last Update: 04/19/2016

When a couple is unable to conceive naturally, they may start considering turning to alternative options to achieve pregnancy.

In the case of straight couples, they are advised to visit a fertility clinic after one year trying to conceive with no luck, or six months if the woman is above 37 years of age. Single mothers by choice or lesbian couples have no choice but to turn to assisted conception if they want to have a child.

Assisted Reproductive Technology (ART) involves a wide range of fertility treatments, so it is only normal that the following doubt crosses most patient’s mind when they get started: artificial insemination or in vitro fertilization?

Choosing your fertility treatment

At first, choosing one or another fertility treatment depends on the specialist, since s/he is the one who best knows the indications of each technique and can take into account the potential risks involved as well as the chances of success. Nevertheless, it is the patient who finally accepts the treatment and decides whether s/he wants to undergo it. In some cases, however, patients prefer to undergo a technique that requires less involvement of the specialist or more risks.

Ideally, patients should trust the specialist and accept his/her criteria, since the aim is to choose that technique that requires as less involvement as possible for real odds of success to be reached.

Differences between insemination and IVF

Artificial insemination is a simpler procedure: it involves the deposition of the semen inside the woman’s uterine cavity. Egg fertilization takes place inside the female reproductive system as it occurs in natural conception.

In the case of IVF (in vitro fertilization), however, the eggs are previously retrieved from the woman in order to perform the fertilization in the laboratory and then transfer the embryos obtained. This technique is more complex than intrauterine insemination and requires surgery for follicular puncture, which is done under mild anesthesia.

Medications to induce ovulation and produce a greater number of eggs per cycle are used in both methods. By doing this, we increase the odds of success. Ovarian stimulation varies depending on the technique chosen. In the case of IUI, the dosage of medication is considerably lower that in IVF, since fewer follicles are needed. While for IUI the aim is to get 2 or 3 follicles to get a maximum of two mature eggs, for IVF the goal is to obtain 12 or more without it posing a problem for the patient, as each egg will be retrieved via follicular puncture.

Indications

Indications vary depending on each technique. In the case of intrauterine insemination:

  • It is advisable for women under 35-37 years of age.
  • Patients should have regular menstrual cycles or with minimal alterations.
  • Patients must present tubal patency and no evidence of severe male fertility problems.
  • As for the male partner, his semen sample must reach the minimum values, with a Motile Sperm Concentration (MSC) of at least 3 million sperm.

On the other hand, IVF is indicated in cases of more severe fertility problems are detected:

  • Ovulating is essential for IVF to be the technique of choice. However, obtaining a response from the ovary is easier in this case, since the dosage of fertility drugs administered is a greater one.
  • Having tubal patency is not a prerequisite.
  • It is indicated in cases of previous IUI failure.
  • Although there must exist a minimum sperm count, it can be carried out even if a mild-to-moderate male infertility issue is detected.

Cost

The cost of a fertility treatment might vary from clinic to clinic. However, whatever the final cost is, there is a significant difference between the cost of artificial insemination and in vitro fertilization.

The cost of artificial insemination may range from €700 to €1,500, whereas in vitro fertilization can reach €3,000 and even €4,000, as it includes surgery, egg fertilization in the laboratory and the subsequent embryo transfer. Given that the entire process requires more involvement of the specialist, it implies a higher overall cost.

Even though fertility medication are not usually included in the overall cost by default, patients are advised to add the cost of medications, as it may vary greatly. For intrauterine insemination, ovulation induction drugs may cost from €200 to €400, while in the case of in vitro fertilization it is around €700-1,000.

Odds of pregnancy

Pregnancy success rates also differ depending on the technique. While in the case of intrauterine insemination they are around 20%, with IVF almost 40% can be reached. It should be noted that these are just approximate figures, which is to say, they depend on the cause of infertility and the woman’s age to a great extent.

In general, women under the age of 30 are those with the highest odds of success. With artificial insemination, the woman’s age is a key factor and, as a matter of fact, many clinics do not perform IUIs on women older than 37 years of age due to the low chances of getting pregnant they present. In the case of IVF, women under 35 are those with the best prognosis.

To sum up, it should be clear that there is no better treatment than other, yet each one is more adequate than the other depending on the patient. Adapting the treatment as much as possible to the patient is crucial, given that each woman and each individual person has a different personal situation.

FAQs from users

How many IUI cycles should you do before moving on to IVF?

By Óscar Oviedo Moreno MD (gynecologist).

In couples with a good prognosis, that is, under the age of 37, with a normal sperm sample, we recommend 4 IUI attempts before moving on to IVF. In the case of single women or donor insemination cycles, up to 6 attempts are recommended. It depends on the clinical history of each patient, though.

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Authors and contributors

 Cristina Mestre Ferrer
BSc, MSc
Embryologist
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information
 Óscar Oviedo Moreno
Bachelor's Degree in Medicine & Surgery from the University of Caldas (Colombia). Specialist in Internal Medicine by the Pontificia Universidad Javeriana of Bogotá. Degree standardized in Spain in 2003. Specialist in Gynecology & Obstetrics from the Complutense University of Madrid, with residence at Hospital Clínico Universitario San Carlos de Madrid. Expert in Reproductive Medicine and Certification in Obstetric-Gynecologic Ultrasound (levels I, II and III). More information
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One comment

    1. emma müller

      In our case, based on my problem (PCOS) and that of my hubby (20% sperm DNA fragmentation), doctor told me to give IUI a try but I said ‘no’, we would go straight for an IVF. I was 34 then and my odds of success with IUI were 15%, whilst those of IVF were 40% and the cost difference was not too abysmal… Besides, with IVF you are likely to have spare embryos that can be frozen for second IVF cycle in case the first one doesn’t work. The result was pregnancy!!! My baby is now 1.5 years old 🙂 Besides, IVF is the only way through which one can see whether she’s got high quality eggs or not. I don’t understand why people are advised to undergo IUI in the first place when they’re actually desperate at a psychological level. It’s like wasting their money…