Should you choose IUI or IVF when your partner has low sperm count?

If you’ve been trying to get pregnant for some time but have yet to see that much-desired positive pregnancy test, your experience is common: 1 in 8 couples experiences infertility by one estimate (1). Low sperm count and ovulation disorders are among the multitude of factors that could be thwarting your pregnancy hopes (2).

If your partner has a low sperm count, you might be considering options such as intrauterine insemination (IUI) or in vitro fertilization (IVF). In short, IUI is cheaper but less effective; IVF is more invasive and expensive but more effective (1). 

Here we’ll dive into both IUI and IVF in greater detail, including which might be the optimal choice if your partner’s swimmers need a little help. We’ll also explain why, with specific medical issues, the experts say to skip IUI and go straight to IVF.

What is IUI?

Intrauterine insemination involves inserting sperm directly inside your uterus near the time of ovulation (3). The idea is to overcome fertility problems related to the sperm’s journey to the egg that may interfere with your chances of conceiving, such as low sperm count, poor sperm motility, or hostile cervical mucus.  

To undergo IUI, you typically must have (3):

  • At least one open fallopian tube
  • No active infections
  • Enough motile sperm (Note: Small tweaks to your partner’s diet and lifestyle may help improve sperm quality. Read here for pro tips.)

While IUI is jokingly referred to as the turkey baster method, that’s misleading. The process is quite a bit more involved (and expensive) than the nickname suggests. Success rates for IUI are age-dependent but generally run between 5% to 15% per cycle, according to an analysis of 1,612 patients at a German fertility clinic (4). The cost of IUI ranges from a few hundred dollars up to $2,000 per cycle (3), depending on a few factors, which we’ll get to shortly. 

Who performs IUI?

Some OB/GYNs are trained to perform IUI, and might offer it in their offices (5). It’s also possible to work with a midwife who comes to your home, or to see a reproductive endocrinologist, an OB/GYN specializing in fertility (5). Check with your insurance to see which providers are covered, if any. 

What happens during IUI?

In the weeks before IUI, you may take fertility medications to help ensure that one or more eggs are ready (3). Once you detect a luteinizing hormone (LH) surge, your partner provides a fresh sperm sample (3), and your IUI provider processes the sperm to concentrate it to maximize the number of motile sperm (3). 

The sperm is injected into your uterus through a thin tube threaded through your cervix (3) during a brief insertion process. Sperm may reach your fallopian tubes in 5 minutes, but your provider will probably ask you to remain lying down for 10 minutes (3).

Sperm count is a critical factor in the success of IUI. A count greater than 5-10 million is associated with higher pregnancy rates, while samples with fewer than 3 million sperm have only a 1% chance per cycle of achieving a pregnancy (3). In these cases, your provider will likely recommend IVF.


What is IVF?

IVF is an established technique to combine the egg and sperm in a lab to create implantation-ready embryos to increase the chances of conception (6). The process, which can be emotionally taxing, invasive, and costly, involves (6):

  • Taking hormones or medications to make your body produce a batch of eggs at a specific time
  • Retrieving the eggs from your ovary with a thin needle
  • Adding sperm to the eggs to grow embryo(s)
  • Transferring healthy embryo(s) into your uterus with a tube threaded through your cervix

As many as 41% of women under age 35 become pregnant from a single IVF cycle (5), according to industry figures, but the success rate drops with age and is also influenced by other factors. (Find recent stats on IVF success rates by age here.)

Would I save more money starting with IVF? 

This is a complicated question with no easy answer — there’s the medical aspect and the cost to consider. The price of just one IVF cycle is steep: $10,000-15,000 (7). 

You’ll want to do your homework to find out whether your health insurance covers IUI or IVF. Right now, only 16 states require insurance coverage of infertility benefits by law (8). 

Even with coverage, you may need to go through some hoops. Your insurer may ask you to try IUI first before authorizing IVF. Knowing what’s covered will help you weigh the pros and cons of IUI and IVF.

As for the medical aspect, guidance from the Society for Assisted Reproductive Technology suggests leapfrogging straight to IVF with certain conditions, including (9):

  • Very low male sperm count or low motility
  • Blocked fallopian tubes from scarring or tubal ligation
  • Absence of ovulation
  • Advanced endometriosis
  • A partner with a history of a vasectomy
  • Few eggs and poor egg vitality


Scientifically speaking, if the first few cycles of IUI don’t work, research suggests your odds of conception plummet after the third IUI cycle (10). Your provider will probably recommend IVF at that point. 

In a nutshell, choosing between IUI or IVF depends on several factors including financial, medical and of course, what feels right for you and your partner. You may wish to consult with your doctor, or even several doctors to compare their suggestions and pricing.   

The fertility journey can be confusing and lonely. If you are looking for support and a community who knows what it’s like, there may be some groups your doctor can recommend or there are also online communities. If you would like to check out our Kindara community, our users write to us regularly on how helpful it was to them.

“I can't even fully explain how grateful I am for the community feature, which has also been invaluable. The ability to learn from others in my very same position, or see success in couples who made the same decision we did to bring a child into their lives.The support between the women on Kindara is a very much appreciated benefit to have during such a stressful, and sometimes confusing time. - Jennifer B.

Check out more Kindara stories here.


Photo by Pablo Heimplatz on Unsplash

References:

  1. https://resolve.org/infertility-101/what-is-infertility/fast-facts/
  2. https://www.acog.org/Patients/FAQs/Evaluating-Infertility?IsMobileSet=false
  3. https://www.uptodate.com/contents/procedure-for-intrauterine-insemination-iui-using-processed-sperm?search=iui&source=search_result&selectedTitle=1~48&usage_type=default&display_rank=1#H61118149 
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859121/
  5. https://resolve.org/what-are-my-options/treatment-options/what-is-iui/
  6. https://resolve.org/what-are-my-options/treatment-options/what-is-ivf/
  7. https://www.sart.org/patients/frequently-asked-questions/
  8. https://resolve.org/what-are-my-options/insurance-coverage/infertility-coverage-state/ 
  9. https://www.sart.org/patients/fyi-videos/the-difference-between-iui-and-ivf/
  10. https://www.ncbi.nlm.nih.gov/pubmed?term=20659733

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