Medication, IUI or IVF — how do they differ?
The short answer
Roughly in order of intensity: ovulation medication with timed intercourse, IUI usually with medication, then IVF. Which one is recommended depends on what your evaluation found, not on how long you've struggled.
What to know
- Blocked tubes or a significant sperm issue usually point to IVF directly.
- No ovulation usually starts with medication such as letrozole.
- Unexplained infertility usually starts with medication plus IUI for a few cycles.
- Ask the number of attempts before reassessing — that's the question people forget.
- Costs differ by an order of magnitude between IUI and IVF, and coverage differs even more.
What you can do now
- Ask for success rates for your age, per cycle. Not clinic averages.
- Prepare both bodies over the three months before. How to prepare.
- Strong evidence If you have PCOS, ask whether letrozole comes first. First-line for ovulation in the 2023 international guideline.
Read the full explanation
Three main options, increasing in intensity, cost, and effectiveness.
Ovulation medication with timed intercourse
Oral medication (letrozole or clomiphene) taken for five days early in the cycle to stimulate ovulation, with monitoring and timed intercourse. Used mainly when ovulation is irregular or absent. Lowest cost and intensity.
IUI (intrauterine insemination)
Washed, concentrated sperm placed directly into the uterus around ovulation, usually combined with the oral medication above. Requires at least one open tube and a reasonable semen analysis. Success per cycle is modest (often cited around 10 to 20 percent, depending on age and diagnosis), which is why it's usually planned as a series of three to four cycles. Cost is typically in the hundreds to low thousands per cycle.
IVF (in vitro fertilization)
Eggs are retrieved after stimulation, fertilized in the lab, and an embryo is transferred to the uterus. It bypasses the tubes entirely and allows testing of embryos. The most effective option per cycle and the most demanding. Cost is often $15,000 to $25,000 or more per cycle including medication.
Which is discussed when
Blocked tubes or a significant sperm issue usually point to IVF. Absent ovulation starts with medication. Unexplained infertility usually starts with medication plus IUI. Age shortens the number of simpler attempts a doctor will suggest before IVF.
What the research shows
Not rated, deliberately. This page explains how something works rather than claiming a treatment helps, so a rating would mean nothing. Everything traces to the sources below.
Questions for your doctor
Edit any of these before you add it — they're yours. Your list stays in this browser, and you can print a one-page sheet from it.
- Why this option first for me, and what would you move to if it doesn't work?
- What are the success rates for someone my age with my diagnosis, per cycle and cumulatively?
Sources
- ASRM, Evidence-based treatments for couples with unexplained infertility: a guideline (2020)
- ReproductiveFacts.org (ASRM patient resources)