Two Paths to Conception
For couples experiencing difficulty conceiving, assisted reproductive technologies offer structured treatment options. Two of the most common procedures are Intrauterine Insemination (IUI) and In Vitro Fertilisation (IVF). While both aim to achieve pregnancy, they differ significantly in complexity, invasiveness, cost and success rates. Understanding these differences is essential for informed decision-making.
What Is IUI?
IUI is a relatively simple procedure in which processed (washed) sperm is placed directly into the uterus around the time of ovulation, bypassing the cervix and shortening the distance sperm must travel to reach the egg. The procedure itself takes only a few minutes and is performed in the clinic without anaesthesia.
IUI is typically combined with ovulation induction medications to increase the number of mature eggs available, thereby improving the chances of fertilisation.
What Is IVF?
IVF is a more complex procedure involving multiple steps. The ovaries are stimulated with injectable hormones to produce multiple eggs, which are then retrieved under ultrasound guidance (ovum pick-up). The eggs are fertilised with sperm in a laboratory, and the resulting embryos are cultured for 3–5 days before one or two are transferred into the uterus.
In cases of severe male factor infertility, Intracytoplasmic Sperm Injection (ICSI) — where a single sperm is injected directly into each egg — may be used.
When Is Each Recommended?
IUI is generally recommended as a first-line treatment for unexplained infertility of short duration, mild male factor infertility, ovulatory dysfunction (in combination with ovulation induction), and cervical factor infertility. IVF is typically recommended when IUI has not succeeded after 3–4 cycles, when there is bilateral tubal blockage, severe male factor infertility, advanced maternal age, diminished ovarian reserve, endometriosis affecting fertility, or when genetic testing of embryos (PGT) is desired.
Success Rates
Success rates depend on multiple factors including the woman's age, the cause of infertility and the number of cycles attempted. In general, IUI success rates are approximately 10–20% per cycle for women under 35, and IVF success rates are approximately 40–50% per cycle for the same age group. Success rates decline with age for both procedures.
Cost Considerations
IUI is significantly less expensive than IVF, both per cycle and cumulatively. However, if multiple IUI cycles are unsuccessful, the cumulative cost may approach that of a single IVF cycle while delivering lower overall success rates. A transparent discussion of costs, timelines and realistic expectations is an important part of the treatment planning process.
Making the Decision
The choice between IUI and IVF is not a one-size-fits-all decision. It should be made collaboratively between the patient and the fertility specialist, based on a thorough evaluation of both partners, the identified cause of infertility, the couple's age, treatment history and personal preferences.