IVF vs IUI: which is right for you?

IUI is a refinement of natural conception: sperm is washed and concentrated in the lab, then placed directly into the uterus timed to ovulation — often alongside oral ovulation-induction medication like letrozole. The procedure takes minutes, needs no anesthesia, and a cycle involves a handful of monitoring visits. Fertilization still happens inside the body, which means IUI can only help when the path from egg to embryo is fundamentally intact.

IVF replaces that path entirely: ovarian stimulation with injectable medications, egg retrieval under sedation, fertilization in the lab (with ICSI if needed), embryo culture, and transfer of an embryo to the uterus — with spare embryos frozen for later. It's a two-week clinical production with daily monitoring, and it works around blocked tubes, severe sperm problems, and fertilization failure in ways IUI simply can't.

Per attempt, IUI costs a small fraction of IVF — private IVF runs $13,000–$20,000 all-in per cycle, while an IUI cycle is typically priced in the hundreds to low thousands, plus modest medication costs. IUI is also physically gentler: no injections in many protocols, no retrieval, no anesthesia. The price of that gentleness is a substantially lower success rate per attempt, and IUI's odds decline faster with age than IVF's.

The honest framing isn't 'IUI is cheap and IVF is expensive' — it's cost per reasonable chance of a baby, on your timeline. Three or four failed IUI cycles cost real money and, more importantly, real months. For a 32-year-old with unexplained infertility, that gamble is often sensible. For a 40-year-old, the same months carry a steep biological price.

The daily-life burden differs too. An IUI cycle means a handful of monitoring visits and one brief procedure; an IVF cycle means injections at home, monitoring every day or two through stimulation, a retrieval under sedation with a recovery day, and a transfer. If work, childcare, or distance from the clinic make that schedule hard, say so at the consult — it belongs in the treatment decision.

IUI earns its place when the mechanics of conception are intact but need help connecting: unexplained infertility with open tubes and reasonable sperm parameters, mild male factor, cervical factor, and ovulation problems that respond to induction (common in PCOS). It's also the standard first-line approach for donor-sperm conception — single parents by choice and same-sex female couples make up a large share of IUI patients at Toronto clinics.

The usual clinical rhythm is to attempt a limited run — commonly around three cycles — before escalating, because most IUI successes happen in the first few attempts. Agree on the exit criteria with your clinic before cycle one: 'we'll do three, then move to IVF' is a plan; 'let's try again' repeated indefinitely is not.

Some diagnoses make IUI a detour rather than a step. Blocked or absent fallopian tubes: fertilization can't happen in the body, so IUI is pointless. Severe male factor: too few motile sperm for insemination to work — IVF with ICSI is the answer. Significantly diminished ovarian reserve, advanced endometriosis, or a need for genetic testing of embryos (PGT) all point directly to IVF as well.

Age is the other accelerant. Because IUI's per-cycle odds fall with age faster than IVF's, most REIs compress or skip the IUI phase for patients around 38 and older — the months spent on low-probability IUI cycles cost more in egg quality than they save in dollars. If you're in this group, ask your clinic to justify any IUI recommendation explicitly against going straight to IVF.

The Ontario Fertility Program treats the two treatments very differently: unlimited funded IUI cycles, but only one funded IVF cycle per lifetime. Medications remain out of pocket for both. That asymmetry makes funded IUI nearly free to attempt for eligible patients with an appropriate diagnosis — and makes the single funded IVF cycle a precious, spend-it-once resource.

Strategically: if you're a good IUI candidate, the funded cycles mean trying IUI first costs you little besides time — just budget that time honestly against your age. And whenever you use your one funded IVF cycle, use it at full strength: confirm eligibility, get the referral paperwork done early, and discuss with your clinic how to maximize what that cycle produces, since there is no funded second attempt.