IUI or IVF? How doctors decide which to suggest

Two different approaches

IUI (intrauterine insemination) and IVF (in vitro fertilisation) are often talked about as if one is simply a stronger version of the other. They work quite differently.

• IUI places washed, concentrated sperm inside the uterus around ovulation. Fertilisation still has to happen naturally, inside the fallopian tube.
• IVF collects eggs from the ovaries, fertilises them in a laboratory, and places an embryo in the uterus. It bypasses the fallopian tubes.

Because of this, some situations suit IUI, some need IVF, and some could reasonably go either way.

The factors doctors look at

The fallopian tubes

IUI needs at least one open, healthy fallopian tube, because the egg and sperm meet there. If both tubes are blocked or badly damaged, IVF is usually the option that makes sense. A test of the tubes, such as an HSG (an X-ray dye test) or a similar ultrasound test, is often done before IUI for this reason.

Sperm results

IUI can help when sperm results are mildly below the usual reference values, because washing concentrates the moving sperm. When sperm numbers or movement are much lower, IVF with ICSI (injecting a single sperm into each egg) is often suggested instead. The male partner's results matter as much as the female partner's tests.

Age and egg reserve

As the person providing the eggs gets older, egg numbers and quality tend to fall. Some doctors may suggest moving to IVF sooner for people in their late thirties or older, or when tests suggest a lower egg reserve. This is a judgement, not a fixed cut-off.

How long you have been trying

When no cause has been found (unexplained infertility), guidelines differ. Some, including ESHRE's 2023 guideline on unexplained infertility, support IUI with medicines to stimulate the ovaries as a first option. Others have leaned towards moving to IVF after a longer period of trying. Your doctor should explain which approach they follow and why.

Ovulation

If the main issue is irregular or absent ovulation, for example with PCOS, the first step is often medicines to help ovulation, sometimes combined with timed sex or IUI. IVF is usually considered if these do not work.

Previous treatment

If several IUI cycles have not led to a pregnancy, many doctors suggest discussing IVF rather than continuing with more IUI.

Cost, time and preference

IVF costs considerably more than IUI and involves more visits, medicines and procedures. IUI is simpler but may take several cycles. Your finances, time, work, and how you feel about each process are valid parts of the decision.

A side-by-side comparison

	IUI	IVF
Where fertilisation happens	Inside the body	In a laboratory
Needs open fallopian tubes	Yes, at least one	No
Medicines	None, tablets or low-dose injections	Daily injections for around 10 to 12 days
Procedure	Short, done in clinic, no sedation	Egg collection under sedation, then embryo transfer
Suits severe sperm problems	Usually not	Yes, often with ICSI
Embryos can be frozen for later	No	Yes
Clinic registration in India	ART Level 1 or above	ART Level 2
Relative cost	Lower	Higher

Good to know. Starting with IUI does not rule out IVF later, and going straight to IVF is not "giving up" on a simpler option. The aim is the approach that fits your situation.

Questions to ask your doctor

• Why are you suggesting this option for us, rather than the other?
• Have both partners been fully tested? Are the tubes known to be open?
• How many cycles of this would you suggest before we review the plan?
• What medicines are involved, and what are the risks, including multiple pregnancy?
• What would each option cost in total, including scans, medicines and lab fees?
• Is the clinic registered under the ART (Regulation) Act, 2021, at the right level?

You can use our appointment questions tool to prepare a list, and our ART registry check to look up a clinic.

Caution. Be wary of anyone who promises a pregnancy with either treatment. No honest clinic can promise a result.

When to see a doctor

See a fertility specialist to talk through IUI or IVF if you have been trying for 12 months (or 6 months from age 35), sooner if you know of a tube, ovulation or sperm problem, or if previous treatment has not worked. If you are not sure what kind of doctor to see, our specialist checker can help.