Moving from IUI to IVF: what couples should know about the right time

If you’re sitting in my clinic asking, “How long should we keep trying IUI before moving to IVF?”, first — I hear you. That question carries money worries, calendar math, the pinch of age, and a whole lot of feeling. Let me give you a straightforward, doctor-y but very human answer: there is no single magic number for everyone, but there are clear rules of thumb and reasons to move on sooner rather than later.

Understanding pros and cons

In other words, guidelines and fertility experts all recommend trying IUI (intra-uterine insemination) a few times before going on to try IVF (in vitro fertilisation). The reason? Well, IUI is easier, simpler, and less expensive than IVF. For some couples, especially those who are younger and may be facing problems such as unexplained infertility or mild sperm issues, IUI can be effective. The European Society of Human Reproduction and Embryology (ESHRE) advocates IUI and ovarian stimulation in these cases.

How many cycles? A commonly used practical window is about three to four good IUI cycles. Many clinics counsel three cycles as a checkpoint: if pregnancy hasn’t happened by then, it is sensible to reassess. Some literature and reviews suggest trying up to six in selected situations, but the added benefit after around three to four cycles drops off for many couples — especially as age climbs.

Age and ovarian reserve

Age and ovarian reserve change the math. If you’re under 35 and tests look fine, trying three to four stimulated IUIs (with letrozole or gonadotropins as indicated) is reasonable. If you’re 35–40, most clinicians lean toward fewer IUI attempts — maybe two to three — because ovarian reserve and egg quality decline with time, and IVF gives a substantially higher per-cycle chance of a baby. If you’re over 40 or have poor ovarian reserve on testing, many doctors recommend moving to IVF sooner rather than later.

Of course, the key here is the cause. IUI isn’t the first-line step in cases with blocked tubes, severe male infertility, or any cause that indicates that the eggs cannot be retrieved or the sperm cannot achieve the necessary motility or penetration. In such cases, IVF (possibly with ICSI) appears as the first obvious solution. On the other hand, with couples having undergone several rounds or sessions with IUI with appropriate technique with no conception, that seems like the appropriate time.

Success rates

When it comes to success rates, there is a lot of variation in per-cycle chances with IUI, depending on factors such as age, sperm quality, drugs used etc., but cohort data and reviews put typical per-cycle live birth or delivery rates in the single digits to low teens; cumulative chances across a few cycles rise, but aren’t as high as IVF’s per-cycle success. That is why doctors balance cost, invasiveness, and time when advising couples.

Stay informed

In short: a thoughtfully-managed IUI treatment cycle series, typically three to four, if you are young, with no apparent contraindications may work. Following this, a conversation based on additional testing, as well as an open discussion about your financial, time, and emotional issues, is best. An assessment of whether additional IUIs are likely to succeed, based on scores, as well as state-of-the-art testing can be carried out. When factors such as age, tubal disease, severe issues involving men, and reduced ovarian reserve are a concern, IVF should be an earlier option.

(Dr. Sarina Vincent Arokia is a fertility specialist at Nova IVF Fertility, Vellore. sarina.arokia@novaivffertility.com)