What Is the Difference Between IUI and IVF?

By BSc, MSc (embryologist), MD, FACOG, FACS, FACE (reproductive endocrinologist), MD (gynecologist) and (invitra staff).
Last Update: 05/15/2020

There are several types of fertility treatments and assisted reproductive techniques that can help infertile men and women achieve pregnancy and fulfill their dream of parenthood.

The most widely used treatments, and therefore the best known in today's society, are artificial insemination (AI) and in vitro fertilization (IVF).

Each of these techniques is indicated for different patients and different fertility problems. Therefore, it is very important to be familiar with them and to know which treatment is the most appropriate to ensure success.

Choosing your fertility treatment

All couples who do not achieve pregnancy after one year of unprotected sex should start to see a fertility clinic to have their infertility tested.

The recommended waiting time is reduced to 6 months in women over 36 years. Neither will it be necessary to wait if there are obvious problems of sterility.

Once the results of the fertility tests have been obtained, which include hormone analysis, ultrasound and semen analysis, the specialist assesses which technique is the most suitable for each case. Some of the aspects that are taken into account are the following:

The specialist will have to explain all this information to its patients and the reasons why one or another technique is recommended such as the procedures, risks, success rates, etc.

Differences between insemination and IVF

Artificial insemination is a simpler procedure than IVF: 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 a 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 than 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.

When to do AI and when IVF?

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.

When infertility problems are more severe or the woman is older than 37, the most appropriate treatment is IVF. Below, we will comment on its most frequent indications:

In the most severe cases, it will be necessary to use the ICSI technique (intracytoplasmic sperm injection) to fertilize the eggs during an IVF. If you want to know the indications for this particular technique, you can read more here: When Is ICSI Recommended?

Medication for ovarian stimulation

In both AI and IVF, it is necessary to administer hormonal medication to the woman so that controlled follicular development takes place.

In the case of AI, the dose of gonadotropins (FSH and LH) will be much lower than in IVF, since the aim is to achieve only one or two mature follicles for insemination. If a greater follicular development were obtained, there would be a risk of multiple pregnancies.

In in vitro fertilization, on the other hand, ovarian stimulation is greater to achieve a multiple follicular development which results in the production of a high number of eggs and thus increases the possibility of obtaining good embryos.

It is normal to obtain between 6-10 eggs per IVF cycle. After fertilization and embryo transfer, the remaining embryos are vitrified for use in future attempts or to have a second child.

Whether you need to undergo IUI or IVF to become a mother, we recommend that you get your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

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 is 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.

Related topic: Overview of the Main Costs of Fertility Treatments.

Success rates

Success rates also vary significantly between AI and IVF.

Obviously, with IVF there is a greater chance of achieving pregnancy because the 3 or 5-day old embryo already developed is introduced into the uterus. The only thing that should occur naturally in the woman is implantation.

Next, we are going to comment on the birth rates achieved in both techniques depending on the age of the woman, according to the latest data published by the National Health Service (NHS) and Human Fertilisation & Embryology Authority:

Women under <35 years
the birth rate of IVF cycles is 29%, whereas in IUI the birth rate is 18%.
Women between 35 and 37 years
a 23% of the IVF cycles and a 14% of IUI cycles resultes in a live birth.
women over ≥40 years
the birth rate in IVF cycles is between 2-9% while in IUI cycles the birth rate is 1-5%.

As you can see from the figures, age is a very important factor when deciding on an assisted reproduction technique. However, these values also depend to a great extent on the cause of sterility.

In conclusion, there is no one technique that is better than the other. Each treatment must be adapted to each type of patient and all the procedures must be personalized as much as possible to increase success rates as much as possible.

FAQs from users

Does artificial insemination involve the same risks as in vitro fertilization?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

All fertility treatment cycles involving ovarian stimulating medication have similar risks but the difference is the degree of severity. For cycles using only oral or injectable fertility medications, the risks of an ectopic pregnancy, ovarian hyperstimulation syndrome and ovarian torsion are less than 5% in both IUI and IVF cycles.

The difference between IUI and IVF are the pregnancy success rates and risk of multiple births. In an IUI cycle using oral medication, the risk of a multiple pregnancy is less than 5% but increase to 10-15% when injectable fertility medications are used.

The unique distinction of IVF is the ultrasound guided vaginal egg retrieval and the ability to transfer a predetermined number of embryos. As a result, the risks with an egg retrieval included intra-abdominal bleeding, injury to the bowel and bladder, and infection. Fortunately, all of complications occur in less than 1% of cycles. Further, the risk of a multiple pregnancy is directly related to the number of embryos transferred: a single embryo transfer has a 1% risk of dividing into a twin pregnancy; a double embryo transfer can increase the risk of a twin pregnancy in up to 40% of cycles.

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.

Which technique is best for single women or lesbian couples trying to get pregnant - IUI or IVF?

By Zaira Salvador BSc, MSc (embryologist).

All those women without a male partner who wish to become mothers will be able to fulfill their dream thanks to sperm donation. In general, if the woman being treated does not present any infertility problems, artificial insemination with donor sperm (AID) is the best option. On the other hand, if the woman is over 36 years old and her ovarian reserve is affected, she will have to resort to IVF with a sperm donor.

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References

National Health Service. Overview of IVF and its success rates between 2014 and 2016: Link.
Human Fertilisation & Embryology Authority. Intrauterine Insemination (IUI): HOw successful is one cycle of IUI? Source.

FAQs from users: 'Does artificial insemination involve the same risks as in vitro fertilization?', 'How many IUI cycles should you do before moving on to IVF?' and 'Which technique is best for single women or lesbian couples trying to get pregnant - IUI or IVF?'.

Read more

Authors and contributors

 Cristina Mestre Ferrer
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 about Cristina Mestre Ferrer
 Mark P. Trolice
Mark P. Trolice
MD, FACOG, FACS, FACE
Reproductive Endocrinologist
Mark P. Trolice is the Director of Fertility CARE – The IVF Center and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine. He is Board-certified in REI and OB/GYN, and maintains annual recertification. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. More information about Mark P. Trolice
License: ME 78893
 Óscar Oviedo Moreno
Óscar Oviedo Moreno
MD
Gynecologist
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 about Óscar Oviedo Moreno
License: 282858310
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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