IUI vs IVF: Pros, Cons, and Key Differences Explained

I've seen so many couples struggle with this decision. Having guided hundreds of families through fertility journeys, I know just how confusing it can be to choose between IUI vs IVF. These approaches differ dramatically in approach, cost, and success rates—and making the right choice matters tremendously.

What is IUI Treatment?

IUI (Intrauterine Insemination) is something I often describe to my clients as "giving sperm a head start." Rather than having sperm swim the long journey through the cervix, a doctor places washed sperm directly into the uterus when the woman is ovulating. This brings the sperm much closer to where fertilisation needs to happen.

How IUI treatment is typically performed

Let me walk you through what actually happens during IUI:

Monitoring the cycle

Your doctor will track your ovulation using ultrasounds and sometimes blood tests. They're looking for growing follicles (which contain eggs) and watching for signs that ovulation is approaching. Some women take medications to help stimulate ovulation or make its timing more predictable.

Sperm preparation

The sperm sample goes through what we call "washing"—a fascinating lab process that separates the strongest swimmers from the seminal fluid. Think of it as creating a concentrate of the healthiest sperm available for fertilisation.

The insemination procedure

The actual IUI procedure is quick and relatively comfortable. The doctor uses a soft catheter to place the prepared sperm directly into the uterus. My clients often tell me it feels similar to having a pap smear—perhaps a bit of cramping, but nothing unbearable. Ten minutes later, you're done!

What is IVF Treatment?

IVF (In Vitro Fertilisation) takes a completely different approach. Instead of simply placing sperm near the egg inside the body, IVF brings both eggs and sperm outside the body, creating embryos in the laboratory before returning them to the uterus.

How IVF treatment is generally done

From working with countless families through IVF, I've seen the emotional rollercoaster it can be. Here's what happens:

Ovarian stimulation

You'll take hormone medications (usually injections) for about 10-12 days to encourage your ovaries to develop multiple eggs rather than the single egg normally released each month. Your doctor will monitor your progress with regular ultrasounds and blood tests.

Egg retrieval

Once your eggs are mature, you'll have a short procedure (about 20-30 minutes) under sedation where the doctor collects the eggs. Using ultrasound guidance, they insert a needle through the vaginal wall to gently aspirate the eggs from the follicles.

Fertilisation in the lab

This is where the magic happens! The embryologist combines the eggs with sperm in the laboratory. If there are concerns about the sperm's ability to fertilise the egg naturally, they might use ICSI (Intracytoplasmic Sperm Injection), where a single sperm is injected directly into each egg.

Embryo culture

The fertilised eggs develop in the laboratory for 3-5 days. During this time, the embryologists monitor them closely to see which ones are developing properly. It's truly incredible to watch an embryo develop from a single cell to a complex structure of many cells.

Embryo transfer

The final step is beautifully simple. Selected embryos are placed into the uterus using a thin, soft catheter. No sedation is needed—it's similar in comfort level to a pap smear. Any remaining good-quality embryos can be frozen for future attempts.

IUI and IVF Side-by-Side

I find that my clients understand best when I lay out the key differences between IUI and IVF clearly. Here's what matters most:

Where Conception Takes Place

With IUI, fertilisation still happens naturally inside your body—the sperm must find and fertilise the egg in the fallopian tube, just like in natural conception.

In IVF, fertilisation happens in the laboratory under controlled conditions, then the already-developing embryo is placed in the uterus.

Procedure Complexity

IUI is straightforward—typically involving sperm washing and the insemination itself, which takes just minutes.

IVF involves multiple medications, frequent monitoring, egg retrieval surgery, laboratory fertilisation, and embryo transfer. Each step builds on the previous one, creating a more complex process.

Treatment Length

An IUI cycle might take 2-4 weeks from start to finish, depending on whether you're using medications to stimulate ovulation.

IVF typically requires 4-6 weeks from the start of medications to the embryo transfer, with more appointments and monitoring throughout.

Financial and Emotional Costs

The cost difference is striking. IUI typically costs between £800-£2,000 per cycle, making it much more accessible for many families.

IVF is significantly more expensive at £5,000-£10,000 per cycle, plus additional costs for medications, genetic testing, or freezing embryos. The emotional investment matches the financial one—IVF tends to be more emotionally intensive because of the higher stakes and more complex process.

Benefits of Choosing IUI

A Less Invasive Option

I've had many clients choose IUI because they wanted to start with something less medically intensive. The procedure involves minimal intervention—no surgery, fewer medications (sometimes none at all), and generally less stress on your body.

Often More Affordable Per Cycle

The cost difference between IUI and IVF can be dramatic. For many people, being able to attempt multiple IUI cycles for the price of one IVF cycle makes it an appealing first step. This accessibility means more people can take that first step toward building their family.

Simpler Process, Fewer Appointments

Many busy professionals appreciate the streamlined nature of IUI. You'll have fewer clinic visits, less time away from work, and a generally simpler medical process. This makes it easier to fit therapy into your life without major disruptions.

Limitations of IUI to Consider

Lower Success Rates Per Cycle

I always make sure my clients understand that IUI success rates (typically 5-20% per cycle) are significantly lower than IVF (which can reach 40-50% for younger women). This means you might need multiple attempts, which can be emotionally challenging.

Not Suitable for All Infertility Issues

Throughout my years guiding families, I've seen that IUI simply isn't effective for certain conditions. If you have blocked fallopian tubes, severe male factor infertility, or advanced endometriosis, IUI likely won't overcome these barriers. Age is another important factor—IUI success rates drop dramatically after age 40.

Risk of Multiples with Medication

When combined with fertility medications, IUI can increase your chances of having twins or triplets. While some families might welcome twins, higher-order multiples carry significant health risks for both the mother and babies. This is something we always discuss carefully when considering all the options.

Benefits of Choosing IVF

Higher Potential for Success

Despite its higher cost and complexity, IVF offers substantially better success rates per cycle. For women over 35 or those with certain diagnoses, this efficiency can be crucial—getting to pregnancy sooner despite the more intensive process.

Addresses Severe Infertility Conditions

IVF can overcome numerous fertility barriers that would make pregnancy impossible otherwise. I've seen it work beautifully for clients with blocked tubes, severe male factor infertility, diminished ovarian reserve, and cases of unexplained infertility that didn't respond to other procedures.

Allows for Genetic Screening (PGT)

For families with known genetic conditions or those who've experienced recurrent miscarriages, the ability to test embryos before transfer can be priceless. This technology helps ensure we're transferring embryos without specific genetic concerns, potentially saving families from heartbreaking losses.

More Control Over the Fertilisation Process

Many of my clients appreciate the transparency IVF provides. You'll know exactly how many eggs were retrieved, how many fertilised, and how the embryos are developing. This level of monitoring can be incredibly reassuring, especially after experiencing the uncertainty of trying to conceive naturally or through IUI.

Challenges of Undertaking IVF

Increased Invasiveness and Medical Steps.

 The IVF is undeniably more medically intensive. You'll need to be comfortable with daily injections, frequent blood tests and ultrasounds, and the egg retrieval procedure.

Significantly Higher Cost.

The financial reality of IVF is challenging for many families. A single cycle can cost five to ten times more than an IUI cycle. When multiple cycles are needed, these costs multiply quickly.

More Demanding on Time and Emotion.

 IVF requires a substantial time commitment for monitoring appointments, procedures, and recovery. The emotional investment matches the financial one—there's often a rollercoaster of hope, anxiety, and potentially disappointment.

Potential for Ovarian Hyperstimulation Syndrome (OHSS). 

The medications used to stimulate egg production can sometimes cause OHSS, where the ovaries become painfully swollen and fluid accumulates in the abdomen. While most cases are mild, severe OHSS can require hospitalisation. Good monitoring helps minimise this risk, but it's something to be aware of.

IUI vs IVF: What to Choose After All

Ideal Candidates for IUI Treatment

IUI works best for particular situations. It's often perfect for couples with unexplained infertility who just need a little help getting the sperm closer to the egg. It's also excellent for those with cervical issues, mild male factor infertility, or women using donor sperm. The simplicity and lower cost make it an appealing first step for many on their fertility journey.

Ideal Candidates for IVF Treatment

I typically recommend IVF procedure for specific circumstances. It’s for women with blocked or damaged fallopian tubes, cases involving severe male factor infertility, diminished ovarian reserve, or advanced maternal age. It's also the go-to option for those with genetic disorders they wish to avoid passing on, and for same-sex couples and single intended parents who might need egg donation and gestational surrogacy as part of their family-building plan.

Factors Guiding the Decision: Diagnosis, Age, Prior Treatments

In my consultations, I focus on three key factors that typically guide which path makes the most sense:

Your specific diagnosis often points clearly toward one approach or the other. For example, if you have blocked fallopian tubes, IVF is necessary because the egg and sperm simply cannot meet naturally.

Age matters tremendously in fertility treatment. For women over 35, especially those over 40, time becomes precious. The higher success rates of IVF might outweigh the benefits of trying multiple IUI cycles first.

Your medical history also guides recommendations. If you've already tried several IUI cycles without success, it might be time to consider moving to IVF.

The Importance of Consulting a Specialist

Approaches to fertility significantly impact the surrogacy process. And they are best made in partnership with a reproductive endocrinologist who knows your specific medical situation. You have expert guidance—you have the most appropriate treatment path based on your unique medical history and personal circumstances. The Surrogacy Insider is here for you to provide much-needed guidance.

FAQ

Is IUI painful?

IUI is quite tolerable for most women.  The process is like a pap smear; maybe some minor cramps during the therapy, but nothing major.  Afterwards, some have mild cramps; usually, this passes quickly.  Most women go right back to their regular activities.

Is IVF painful?

IVF carries more possible pain than IUI.  At the sites of the daily hormone injections, bruising and soreness can result.  Since the egg retrieval is done under sedation, you won't feel anything during the operation.  Thereafter, you might have cramps and discomfort for one or two days.  Like an IUI surgery, the embryo transfer itself is usually comfortable.

How many IUI cycles should be tried before IVF?.

Before discussing a move to IVF, most doctors advise 3–4 IUI cycles.  Of course, if there are no other circumstances suggesting IVF should be tried first. Age, diagnosis, and individual situation all affect this advice.  While women over 40 might consider IVF after fewer failed IUI attempts, younger women with unexplained infertility might try more IUI cycles.

Does age affect IUI and IVF success rates?

After 35, especially, IUI and IVF success rates drop with age; after 40, the drop is more pronounced.  Older patients might be advised to move to IVF sooner since IVF success rates often vary less than IUI success rates based on age.

Can I choose between IUI and IVF myself?

Although patient preferences are important, fertility treatment choices are best when they are made in concert with a doctor.  Based on a particular diagnosis, age, and other considerations, the doctor will make recommendations.  Some disorders just won't respond to IUI, thus IVF is the only realistic path for success.

What are the success rates? Comparing IUI vs IVF outcomes

Usually, between a 5-20% success rate per cycle, IUI varies greatly depending on age and diagnosis.  For women under 35, IVF provides far better success rates—between 40 and 50% per cycle—but this drops with age.  These figures help to explain why many doctors advise IVF for women with limited time to reach pregnancy or with a specific diagnosis.

Are there risks with IUI or IVF?

Both procedures carry some possible complications.  IUI may result in mild spotting or cramps later.  Though rare, infection is theoretically possible.  Fertility drugs raise the risk of multiple pregnancy.  IVF is more complicated, thus it carries more possible risks.  These include possible OHSS, infection, bleeding, multiple pregnancies, should more than one embryo be transferred, and risks related to the egg retrieval process.