IUI and IVF, step by step

Before either treatment

IUI and IVF usually come after a first evaluation of both partners. Before you start, a clinic will normally:

• review the tests for both partners, and check that at least one fallopian tube is open if IUI is planned
• test both partners for infections such as HIV, hepatitis B and hepatitis C
• explain the plan, the risks and the costs, and give you time to ask questions
• ask you to sign consent forms, including what should happen to any frozen embryos

Under the ART (Regulation) Act, 2021, clinics must take written informed consent before treatment. Counselling is often available, and it is reasonable to ask for it.

IUI: intrauterine insemination

In IUI, sperm is washed and concentrated in a laboratory, then placed directly into the uterus through a thin tube around the time of ovulation. It usually follows these steps:

1. Cycle start. IUI can be done in a natural cycle, or with tablets or injections to help one or two eggs develop.
2. Monitoring. Ultrasound scans track the growing follicles, so the timing is right and the risk of too many eggs is kept low.
3. Timing. Some people have a trigger injection to time ovulation; others use urine ovulation tests.
4. Sperm preparation. The male partner gives a sample on the day, or donor sperm is thawed. The lab separates the moving sperm from the rest of the semen.
5. Insemination. A speculum is placed, as for a smear test, and the sperm is passed into the uterus through a thin tube. It takes a few minutes, and most people feel only mild discomfort or cramping.
6. Waiting. A pregnancy test is usually done about two weeks later.

IUI may be suggested when there are ovulation problems that respond to medicines, mild male-factor concerns, unexplained fertility problems, or for people using donor sperm, including single women and female same-sex couples. It needs at least one open fallopian tube.

IVF: in vitro fertilisation

IVF usually follows these steps:

1. Stimulation. Hormone injections, often for around 10 to 12 days, encourage several eggs to develop. The exact length varies.
2. Monitoring. Ultrasound scans and sometimes blood tests track the follicles.
3. Trigger. A final injection matures the eggs.
4. Egg collection. About 36 hours later, eggs are collected through the vagina with a fine needle, under sedation.
5. Fertilisation. Eggs and sperm are combined in the lab. In ICSI, a single sperm is injected into each egg.
6. Embryo development. Embryos grow in the lab for three to five days.
7. Transfer. An embryo is placed in the uterus through a thin tube. This is usually quick and doesn't need sedation. Others may be frozen for later.
8. Waiting. A pregnancy test is done about two weeks later, on the day your clinic advises.

A rough IVF timeline

Stage	Roughly when	What you do
Stimulation	About 10 to 12 days, varies	Daily injections at home
Monitoring	Every few days during stimulation	Scans and sometimes blood tests
Egg collection	About 36 hours after the trigger	A day at the clinic, with someone to take you home
Embryo culture	3 to 5 days after collection	The lab updates you
Transfer	Day 3 or 5, or later as a frozen transfer	A short procedure
Pregnancy test	About 2 weeks after transfer	Blood or urine test, as advised

Single embryo transfer and freezing

Transferring one embryo at a time lowers the chance of twins or triplets, which carry higher risks for both the pregnant person and the babies. Good-quality embryos that aren't transferred can be frozen and used later in a frozen embryo transfer, which has its own guide.

Sometimes all embryos are frozen and none is transferred in the same cycle, for example to lower the risk of ovarian hyperstimulation.

Caution. IVF has risks, including ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy if more than one embryo is transferred. Egg collection also carries small risks of bleeding and infection. A clinic should explain these and how they reduce them.

Choosing between them

The choice depends on the cause of difficulty, age, how long you have been trying, and previous treatment. A doctor should explain why one is suggested over the other, and what each would involve and cost. How doctors weigh these factors is covered in a separate guide on IUI and IVF.

Optional add-ons

Some clinics offer extras alongside IVF. For many of these the evidence of benefit is limited. It is reasonable to ask what the evidence is for anything that is suggested.

Registration in India

Under the ART (Regulation) Act, 2021, clinics offering IUI must hold at least Level 1 registration, and clinics offering IVF need Level 2. You can check a clinic yourself with our ART registry check.

Choosing the sex of a baby is illegal in India, and a registered clinic will not offer it.

When to see a doctor

• You are considering either treatment. A first evaluation for both partners is the usual starting point.
• You have had several IUI cycles without a pregnancy and want to review the plan.

During or after treatment, contact your clinic straight away if you have severe tummy pain or swelling, feel breathless, are passing much less urine, have a fever, or have heavy bleeding. After a positive test, one-sided tummy pain or shoulder-tip pain needs urgent checking. If symptoms are severe or you feel faint, call 112 or go to the nearest hospital.