IVF and IUI: what actually happens

IUI first, usually

Intrauterine insemination is much the simpler of the two: prepared sperm is placed directly into the uterus around the time of ovulation, often alongside medication to encourage ovulation.

It is less invasive and considerably cheaper, which is why many couples start there. It also does less — it helps sperm get to the right place at the right time, and does nothing about fertilisation itself.

It is generally tried for a limited number of cycles before moving on, rather than repeated indefinitely. Ask at the outset how many cycles you would try before reassessing, so the decision to move on is one you made in advance rather than one you drift past.

What an IVF cycle is, in order

ASRM's five steps: ovarian stimulation, egg retrieval, fertilisation, embryo culture, and embryo transfer.

Stimulation means daily injections of fertility medication so that multiple eggs grow rather than the single one a normal cycle produces. ASRM's reason for wanting several is plain: some eggs will not fertilise or develop normally after fertilisation. It generally takes eight to fourteen days, with frequent scans and blood tests — the part that most disrupts working life.

Retrieval is a minor surgical procedure, done by transvaginal ultrasound aspiration in the doctor's office or an outpatient center, usually under sedation.

Fertilisation and culture happen in the laboratory over several days, and this is the stretch where you wait for phone calls and have nothing to do, which people consistently describe as the hardest part.

Transfer is quick: one or more embryos in a drop of culture medium are drawn into a thin catheter and placed in the uterus. It generally needs no anesthetic.

ICSI, and when it is actually indicated

In ICSI, a single sperm is injected directly into each mature egg rather than eggs and sperm being left to fertilise together.

ASRM names the indications: poor semen quality, and a history of failed fertilisation in a previous IVF cycle.

It is worth knowing those, because ICSI is sometimes offered routinely rather than for a reason. If it is proposed and neither indication applies to you, asking why is a fair question and a good clinic will have a specific answer.

The two risks to understand in advance

Ovarian hyperstimulation syndrome. ASRM: up to thirty percent of women undergoing ovarian stimulation have a mild case that can be managed with over-the-counter painkillers, and up to two percent develop severe OHSS with serious complications. Mild is common enough to expect; severe is uncommon and is why you are monitored so closely during stimulation. Know the symptoms your clinic tells you to report, and report them rather than waiting for the next appointment.

Multiple pregnancy. ASRM: the chance rises in all assisted reproductive technologies when more than one embryo is transferred. This is the actual content of the how-many-embryos discussion — transferring two is not simply two chances at the same outcome, it is also a materially higher chance of a twin pregnancy, which carries real risks for both you and the babies. Ask your clinic to give you their numbers for your situation rather than general ones.

Standard step or add-on

Fertility treatment has a large surrounding market of extras, and someone in the middle of this is the least well placed to evaluate them — which is precisely why they sell.

The question worth asking about anything proposed is the same one every time: is this a standard part of the protocol for my situation, what is the evidence it improves the outcome for someone like me, and what does it cost. A good clinic answers all three without irritation.

The same caution applies here as on the loss page. ASRM's updated guidance on recurrent loss recommends avoiding routine use of tests and treatments that lack strong evidence of benefit, and that principle does not stop at the clinic door.

Cost is a legitimate part of the decision and not a shameful one. Ask what a full cycle costs including medication, what is not included, and what happens financially if a cycle is cancelled — cancellation is a normal event, not a failure, and it is better to know the terms beforehand.