‘I’m a Fertility Specialist. Here’s the Difference Between IUI and IVF Treatments’

The right to start a family through in vitro fertilization (IVF) is a topic close to many hearts—including that of Minnesota Governor Tim Walz. The Democratic party’s 2024 vice presidential nominee, and running mate to Kamala Harris, has spoken openly about he and his wife’s struggles with fertility, and how they used treatments like IVF to conceive their daughter, Hope.

This has been a major part of his platform, saying that national restrictions on the fertility treatment would be devastating for many Americans. He’s even pushed back on politicians who are against IVF—including Ohio Republican Senator JD Vance—saying, “If it was up to him, I wouldn’t have a family because of IVF,” per the Associated Press.

But on Tuesday, Walz’s wife, Gwen, put out an official statement saying it wasn’t IVF she’d undergone, but another fertility treatment called intrauterine insemination (IUI). Naturally, this had us—and likely others—wondering: What’s the difference between IUI vs. IVF?

More people likely recognize the term IVF. The treatment has been part of the larger conversation on reproductive rights this election year, and it accounted for more than 90,000 U.S. births in 2022 alone, per the American Society for Reproductive Medicine. But IVF is just one of several treatments that fall under the umbrella of assisted reproductive technology (ART). IUI—also known as artificial insemination—is lesser-known but is prescribed more frequently than IVF. It’s typically one of the first procedures offered to people dealing with infertility (either after or alongside fertility testing and drugs to support ovulation). In fact, of the people who received fertility treatments from 2017 to 2019, 14 percent got IUI, while only 2 percent underwent IVF, per the Pew Research Center.

To learn more about the ways that IUI and IVF are different, and whether IUI has been under the same threat of restriction as IVF, we spoke to Anate Brauer, MD, FACOG, a board-certified reproductive endocrinologist and fertility specialist based in New York City.

What is IUI?

IUI is a simple, safe procedure that’s less invasive and expensive than IVF, per the American Pregnancy Association. It boosts the chances of pregnancy by putting specially prepared sperm directly into the uterus via a thin tube, right around the time an ovary releases one or more eggs. The goal is for an egg and sperm to unite in the fallopian tube, leading to pregnancy, per the Mayo Clinic.

“It almost feels like having a pap smear,” says Dr. Brauer. She explains that there are two types of IUI—natural and medicated. With natural IUI, you’re not taking any medication and “we’re just following you throughout your natural cycle,” until eggs are mature and ready to be fertilized, she says. Medicated IUI, on the other hand, means you take a medication called Klomid months before the procedure to help mature more eggs. “It’s often used if you have unexplained fertility and have been trying to get pregnant for about 12 months,” she adds.

A few reasons why someone might opt for IUI treatment include the following, per the Mayo Clinic:

• Infertility related to endometriosis
• Mild male factor infertility (if couples have a hard time getting pregnant because of semen quality, IUI can help because it specially prepares and concentrates sperm for the procedure)
• Cervical or ovulatory factor infertility (i.e., problems with your cervix or ovulation)
• Semen allergy (while rare, people with a vagina can be allergic to semen when it touches their skin)
• Donor sperm (for couples or single people who need donor sperm to get pregnant, IUI is the most common way to achieve pregnancy)

About two weeks after getting IUI, you can take a home pregnancy test or go to the doctor for blood work to see if you’re pregnant. If you don’t get pregnant, the same process is tried for three to six cycles before moving on to another form of treatment, like surgery (to remove endometrial tissue if you have endometriosis, for example) or IVF, per the Mayo Clinic. In general, IUI costs anywhere from $300 to $1,000 without insurance, per Planned Parenthood.

“If you get a natural IUI for unexplained fertility, the success rate is about 3 percent per month,” says Dr. Brauer. “But if you combine medication with IUI treatment, that rate goes up to about 10 to 15 percent per month,” which can get you back to a natural rate, she adds. But factors like age, underlying health conditions, and the type of IUI you use can vary success rates.

The difference between IUI vs. IVF

IVF is more involved than IUI. “The two are totally unrelated to each other,” says Dr. Brauer. IVF starts by taking fertility medications (in the form of pills or injections) for several months, to help your body produce mature eggs. Your doctor then surgically removes those eggs and mixes them with sperm (from your partner or donor) in a lab, to create fertilized eggs called embryos—a process known as insemination, per Planned Parenthood.

About three to five days later, one or several embryos are placed in your uterus, in a procedure called an embryo transfer. To help increase the chances of pregnancy, doctors may prescribe you progesterone pills or injections for eight to 10 weeks after the procedure, per Planned Parenthood. If IVF doesn’t work on the first cycle, the process can be tried again.

“At the end of the day, IVF is much more successful because you can look at eggs under a microscope, grow out and monitor an embryo, and test it for certain genetics and chromosomes,” says Dr. Brauer. If genetic testing (a particular test called PGTA) is combined with IVF, and the variable of age is removed from the equation, “success rate is about 60 percent,” she adds.

While people typically seek out IVF for the same reasons as IUI, the procedures are much different. Embryos are harvested outside the womb with IVF (and can be frozen and stored for a couple’s use in the future), and success rate varies depending on your age and natural fertility status. IVF also tends to have more side effects than IUI—including bloating, cramping, spotting, and bruising from the hormone injections.

Plus, it can be more emotionally taxing for individuals and partners or their families, increasing the risk of depression and anxiety during treatment, per Planned Parenthood.

The costs and coverage for each treatment is different, too. Some insurance companies cover fertility treatments, while others don’t. The out-of-pocket cost for one round of IVF is about $15,000, per Planned Parenthood.

Is IUI in similar danger of restriction as IVF?

There has been some concern that treatments like IUI will face the same scrutiny as IVF has recently. But to date, IUI treatment is still widely and readily available to patients (despite insurance coverage variations).

“Because you’re not dealing with embryos, you’re just putting sperm into the uterus, no patients have expressed concerns to me over whether IUI will be restricted,” says Dr. Brauer. The issue of embryos being made outside the womb has sparked the larger political conversation.

The reason IVF has come under fire is because in February 2024, the Supreme Court of Alabama issued a ruling that declared all embryos made through IVF should be considered children. This ruling came after a clinic was sued under the state’s Wrongful Death of a Minor Act for accidentally dropping a couple’s frozen embryos on the ground, per Johns Hopkins Bloomberg School of Public Health. This doesn’t necessarily mean there will be national or other state restrictions on the procedure.