Having a baby isn’t always as simple as deciding you’re ready to get pregnant. But there are a lot of options for reproductive care, including intrauterine insemination (IUI) and in vitro fertilization (IVF).
The two procedures have been in the spotlight lately after vice-presidential hopeful Tim Walz suggested that his family used IVF to conceive his children, Hope and Gus.
“Even if we wouldn’t make the same choice for ourselves, there’s a golden rule: Mind your own damn business,” he said during his debut rally in Philadelphia earlier this month. “Look, that includes IVF. And this gets personal for me and my family.”
Walz, who is the vice presidential pick of Kamala Harris, later brought this up during his August 21 speech at the Democratic National Convention (where he officially accepted the VP nomination). "If you've never experienced the hell that is infertility, I can guarantee you, you know somebody who has," he said, noting that he and his wife spent seven years trying to conceive.
But the couple actually used IUI to conceive, not IVF, according to the New York Times.
The two procedures are often confused—even in those seeking reproductive care—so it’s understandable to have questions. Here’s experts say you should know about the difference between IUI and IVF.
Meet the experts: Pietro E. Bortoletto, MD, is the director of reproductive surgery at Boston IVF. Meleen Chuang, MD, is a clinical associate professor in the Department of Obstetrics and Gynecology at Family Health Centers at NYU Langone. Alex Robles, MD, a reproductive endocrinologist with Columbia University Fertility Center.
What is the difference between IVF and IUI?
IVF and IUI are commonly confused with each other, but they’re not the same thing.
With an IUI, healthy sperm from a partner or donor is placed in your uterus as close to the time of ovulation as possible, per American College of Obstetricians and Gynecologists (ACOG).
"IUI is more close to a natural conception, in which sperm is directly inserted into the uterus at the time of ovulation," explains Alex Robles, MD, a reproductive endocrinologist with Columbia University Fertility Center.
Doctors will may also use a medication like clomiphene to ensure that ovulation will occur, says Pietro E. Bortoletto, MD, director of reproductive surgery at Boston IVF. “We will use it sometimes, but not always,” he says.
IVF is a little more complicated, and it’s often done in cycles. During IVF, doctors will usually remove an egg from a patient or get one from a donor, per ACOG. The egg is then fertilized in a lab with sperm and given several days to grow. From there, the embryo is placed into the uterus, in hopes it will turn into a pregnancy, according to ACOG. Any healthy embryos that aren’t transferred during that procedure are often frozen and stored for future use.
Did Tim Walz and his family use IVF?
No—they used IUI, the New York Times reported on August 19.
"Like so many who have experienced these challenges, we kept it largely to ourselves at the time–not even sharing the details with our wonderful and close family," Walz's wife Gwen added in a statement to the Associated Press.
Gwen also shouted out her neighbor, a nurse who "helped [her] with the shots I needed as part of the IUI process."
Why do some people choose IUI over IVF?
There are a few reasons behind this. “IUI is often used for couples with less severe fertility issues, such as unexplained infertility or issues with sperm motility,” says Meleen Chuang, MD, a clinical associate professor in the Department of Obstetrics and Gynecology at Family Health Centers at NYU Langone.
But there are a few additional things to consider.
“IUI requires a woman to have an ovary, open fallopian tubes, and sperm,” Bortoletto says. “Some patients have blocked fallopian tubes or their partners have really bad sperm, so you can’t do IUI. Those are the patients that typically start with IVF over IUI.”
Meanwhile, single women using donor sperm or same-sex female couples using donor sperm will often start with IUI (provided the other health factors line up), he says.
“If someone is a good candidate for IUI, they should start with IUI,” Bortoletto says. “If someone can’t do IUI because of a medical reason, they should start with IVF. But they are drastically different in terms of cost and success.”
IUI typically costs between $1,500 and $2,500, while IVF can be anywhere from $15,000 to $25,000 per cycle, Bortoletto says.
However, IUI success rates are lower than those of IVF. There are a lot of factors that can determine whether someone will conceive with either procedure, but the IUI success rate is generally 10 to 15 percent per cycle, while the IVF success rate is around 40 percent.
"IVF, overall, has higher success rates and allows you to freeze embryos for future use—which increases the chances of having siblings in the future while also preserving your fertility if you are not interested in achieving a pregnancy right away," Robles says.
Ultimately, if you’re having trouble conceiving, Bortoletto recommends talking to your ob-gyn. They can make personalized recommendations about a potential treatment plan and refer you to a reproductive specialist, if needed.
