IUI or IVF? How we decide together

One of the most common questions in my consulting room: should we try IUI first, or go straight to IVF? The honest answer is that it depends, and the factors are worth understanding.

What each one actually is

IUI, intrauterine insemination, is the gentler intervention. Prepared sperm is placed directly into the uterus at the moment of ovulation. It shortens the journey sperm must travel, and it times everything precisely. It is quick, needs no sedation, and feels much like a regular gynaecological visit.

IVF moves fertilisation itself into the laboratory. It asks more of you: injections, monitoring, a retrieval procedure. In return, it gives us far more control and, for many situations, a meaningfully better chance per cycle.

When IUI makes sense first

IUI earns its place when the fundamentals are mostly working: at least one open fallopian tube, reasonable sperm parameters, and ovulation that responds to timing or mild stimulation. For unexplained infertility in younger couples, a few well-timed IUI cycles are often a sensible, affordable start.

When IVF is the wiser first step

Some situations tell us early that IUI is unlikely to repay the months it costs: blocked tubes, significant male-factor issues, endometriosis that has touched the tubes or ovaries, or simply age, because time matters and some journeys should not take the scenic route. In these cases, starting with IVF is not aggressive. It is kind.

How we decide, together

In practice the decision rests on four things: your test results, your age, how long you have been trying, and what you can sustain, emotionally and financially. I will always tell you plainly which option I would choose in your position, and why. Then the choice is yours, made with clear information instead of pressure.

Neither path is a failure and neither is a shortcut. They are different tools, and the right one is the one that fits your story.