IUI vs IVF- What's the Difference?


I remember it as clear as day.
It was February of 2018 and our doctor just told us that we would not be able to have children naturally. And I guess you could say that it was just like what you see in the movies. Our doctor handed us brochures and packets with all the information pertaining to infertility- what it meant and what our options were- and she encouraged us to "explore our options."
She grazed over the plan of starting with IUIs and if those were unsuccessful, moving on to IVF. As she was talking and going through all of this, I couldn't help but to think: "man, I sure hope Alex is paying attention because I have NO CLUE what she's talking about."
Infertility kind of has its own language, am I right?!
Yikes! At those first few appointments, they throw out these complex words and assume that you're just going to catch on and keep up. Well, eventually you do. But lemme just say, it's probably a lot easier to understand what the heck they're talking about from the get-go.
That's why I'm here!
Today, we're going to unpack these options together. I'm going to break it down for you in the easiest way possible and I'll even give you a few tips along the way. If you want to read more in depth information about either of these options, I encourage you to visit the blog archive and read through other posts pertaining to IUI and IVF.
IUI: What the heck is it?
Okay, if your doctor is talking to you about starting with an IUI, don't be nervous! I guarantee you it's not as bad or intimidating as you think it will be.
An IUI is an "Intrauterine Insemination." This means that they take your spouse's sperm and insert it into your uterus. It's a minor procedure and the pain level is that of harsh period cramps.
First of all, everything is based off of your cycle. SO KEEP TRACK. Based off of CD1 (cycle day one), your doctor will know the time frame for when to schedule your IUI. It usually falls about two-ish weeks after CD1.
What are the steps of an IUI?
  • Tracking Ovulation. There are a lot of different things you can do to monitor your ovulation. I know that some women use the Ava Bracelet to track their ovulation and I've heard great things (link provided). However, we went the old-fashioned way and I used daily ovulation test strips (link provided). Every morning and night, I would pee into a little cup and dip the strip into the cup. Then I'd tape it to a piece of paper where I could compare the darkening line to previous days.
  • Ovulation MedicationThey put me on a medication called Clomid, but I know there are other options available. Clomid is an estrogen modulator that helps stimulate ovulation. Basically, it blocks the estrogen receptors in your brain to trick your body into thinking that you're not making enough estrogen so that you produce MORE estrogen. Which is why people like to call this step, "The Clomid Crazies." It can drive you bonkers, y'all. Like one minute you're sitting there laughing and in the flip of a switch you're straight sobbing for no good reason. Other symptoms may include lashing out irrationally and overreacting. Think of your period hormones and double, no TRIPLE, it.
** TIP: This step really enhanced our communication as a couple. When I would feel these big emotions coming on, I would verbalize it to Alex before it had a chance to fully emerge unexpectedly. Just knowing that I was on this medication and knowing how it worked, I was able to assess myself during an argument. "Am I really upset about this or am I overreacting?" **
  • Ultrasound Monitoring. As you get closer and closer to the time frame for your IUI procedure, you'll start going in for ultrasounds. Heads up sister, this isn't a jelly on the belly ultrasound. They have a large ultrasound wand that they use to look at your ovaries and lining to see if you're ready for insemination. As you continue to go in, they will be looking at your follicles (eggs) to find a few dominant follicles that have the potential of dropping at ovulation. When you have a perfect measuring follicle (maybe two or even three), they will write you a prescription for your trigger shot and set up the date for your IUI.
** TIP: Take that prescription and call around to your pharmacies AS SOON AS YOU LEAVE to find a pharmacy that carries it. Not every pharmacy does and they can be tricky to find. Take the syringe home IMMEDIATELY and put it in your fridge. **
  • Trigger Shot. About 12 hours before your scheduled IUI, you'll have to administer your trigger shot. The shot must remain in the fridge until it's time to use it! Your doctor will tell you what time to do the shot and make sure you stay true to that time. Your trigger shot makes you ovulate about 12 hours later (your scheduled IUI time) so that the egg and sperm have an optimal chance to meet. The shot goes in your belly, and coming from someone who hates needles, it's not bad!
  • IUI DAY! Your hubby has to provide them with a sample of sperm. For us, there wasn't a place for him to do that at the office because we were going to my OB and not a fertility clinic. So, he did that before we left the house and we had to keep it warm until we got to the doctor's office. We were told to put the cup between my boobs or legs to help keep the sperm at body temperature. When you get to the doctor's office, they take the sperm and give it a good wash. This step may be optional for you depending on your diagnosis, but essentially they weed out the bad sperm so that only the good ones are put in your body. The wash takes about an hour and we were allowed to leave and come back, so we always went to get coffee and breakfast. When you go back for the actual procedure, it's no different than your annual exam. Feet up and legs wide. They put in a catheter for the procedure and a clamp on your cervix (these two SUCK, but it's about the equivalent of harsh period cramps). They bring in the sperm and tell you the diagnostics of how the wash went. Then the doctor takes the sperm and inserts it into your uterus! You have to lay on the table for about 15-20 minutes after the procedure and then you're free to go.
**TIP: We always, ALWAYS, planned something relaxing for the remaining day of the IUI and we encourage you to do this, too. Do something fun like book a hotel room at fancy hotel in town and lay by the pool. Be creative!**
  • The Two Week Wait. Yikes. These two weeks suck, that's about as good as I can word it. You don't drink or eat anything risky because, well, you could be pregnant. You analyze every little feeling- is that implantation? nausea? heartburn? It's a complex mix of emotions because you're glowing from happiness at the thought of being pregnant, but your insides are shriveling up at the thought of getting a negative test. I encourage you in these two weeks to find some serious positivity and get as much of it as you can. Spending time with friends/family, doing a devotion and praying...whatever positivity and peace looks like for you- DO IT and try your best not to worry. I know it's hard.
  • Test Day. Two weeks after your IUI you'll have to take a home pregnancy test. Some clinics have you come in for a blood test, but mine told me to take a home test and call them with results. If it's negative, you immediately start planning for the next month in hopes to do another IUI, if it's positive then- CONGRATS!
**TIP: Talk about your next steps before you know if it worked! There's a quick turnaround time if the IUI didn't work. You have to almost immediately start planning for the next month's IUI because your CD1 will come shortly after that negative test. Know your plan of action- will you do another IUI, skip the month, or move on?**
IVF: What the heck is it?
IVF, I want to say that it's not all that bad. I want to say that it's better than you think it will be. I want to say these things, but I don't know if I can. I think that a lot of it is based off of your perspective, but let's be honest- you can't control this stuff and sometimes shitty things happen and it doesn't make sense. But, I'm here to offer a guide for you. Some help so that you have a rough outline of what you're about to do and I hope you know that I am always here for you if you want to chat. Send me an email from my contact page or connect with me on Instagram.
IVF is "In Vitro Fertilization." That means that they collect your mature eggs and match them with your spouse's sperm in a lab. I'd be lying if I said this process is easy. Parts of this process and the process as a whole can really weigh on you. It takes about two months from start to finish and it truly does take over your life. Your OB should be able to recommend a good fertility clinic in your area to help you with your IVF cycle.
What I'm about to provide for you is a very brief overview of the IVF process. If you want to read more in depth about a specific part of IVF, I have each step broken down into its own blog post in the archive.
What are the steps of IVF?
  • Initial Appointment. This appointment will be long, so be prepared. For us, it took about two hours. Talk about overwhelming! You meet with the doctor of your clinic and they give you a folder FULL of all of the information you will need to know going forward. They get a baseline for where you're at, which means another ultrasound and a lot of blood work. They get you set up for an appointment with the IVF coordinator and schedule your next visit.
** TIP: Bring a pad and pen! They go over EVERYTHING. Finances, genetic testing, success stories, IVF plan outline, what if scenarios, etc. I mean it when I say that it is overwhelming. Bring something to write down your own notes for your own understanding. **
  • IVF Coordinator. Just like with IUIs, IVF is all based off of your CD1. They will have you do a baseline ultrasound at this appointment and based off of your own specific situation, they will give you a calendar that maps out your IVF cycle and fill you in on what medications are being ordered for you.
  • IVF Medications. These are called STIMS and they stimulate your ovaries to make a BUNCH of eggs. Your medications will most likely come in the mail and let me warn you- don't be intimidated by the contents of your box! We chose to open ours at our drug administering appointment with our coordinator. I knew it would be overwhelming to look at on our own and I didn't want to get freaked out. We had an appointment specifically set up with the coordinator so that she could show us how to administer the medications. STIMS have to be mixed. You have a dry powder medication and a liquid medication that must be mixed together with syringes, but don't worry- your coordinator will help you to know what to do.
  • STIMS. You do STIMS shots every night for about two weeks. During STIMS, you'll have intermittent ultrasounds to check the growth of your follicles. As they grow, your doctors should be able to tell how they're growing and base your egg retrieval from that.
**TIP: Please keep in mind that every situation is different. I do know of some couples who have had to cancel their IVF cycle during STIMS due to elevated or low levels. Make sure you talk to your doctor about the chances of this happening with you.**
  • Egg Retrieval. This part was super intimidating for me, but looking back it wasn't nearly as bad as I was expecting it to be. Just like with IUIs, you'll have a trigger shot that you'll have to do the night before egg retrieval. At egg retrieval, they'll put you under anesthesia, or a "twilight sleep," and collect all of your eggs. They do this by inserting a large needle into your vagina and "syphoning" them out. You're knocked out, so you don't feel a thing! After retrieval, they bring you to the recovery area and hook you up to an IV and give you something to eat. You stay there for a little bit until you're feeling well enough to leave. They'll probably wheel you out to your car in a wheelchair just to be sure. But, good news! You should know how many eggs they got as soon as you're in the recovery area! YAY!
**TIP: When you leave the office from retrieval, GET SOME FOOD! Go through a drive thru and definitely make sure to get something on your stomach. It will really help you to feel better from the anesthesia. I promise, eating will help!**
  • Genetic Testing. You will be given the opportunity to decide if you would like to do genetic testing on your embryos. We chose to ask our doctor's recommendation and to go with that. We did not do genetic testing on our embryos, but I know a lot of couples who have. Do what's best for your family and talk to your doctor when trying to decide.
  • Embryo Updates and Egg Retrieval Recovery. The 5-6 days following retrieval, you'll be getting a phone call every day from your clinic with updates on your embryos! They'll talk you through what's a good embryo, the different stages, and how many have survived to the next day. As for your recovery, I highly suggest you get a heating pad and use it! Use the heating pad for cramping and try to drink as much water as possible. Taking a small walk each day helped me out significantly as well. A few days after retrieval, they will have you come back into the office to make sure you don't have OHSS (ovarian hyperstimulation syndrome), an exaggerated response to the STIMS.
**TIP: Prior to retrieval, you're going to have to fill out some paperwork and it's heavy, so I want to prepare you. It's like a will for the embryos that you will have after retrieval. It asks you questions about what to do with the embryos if you or your spouse die, what to do with the remaining embryos once you've finished building your family (donate to science, destroy, or embryo adoption), etc. HEAVY questions. Make sure you have this conversation sooner rather than later. A friend gave me a heads-up about it and I'm sure glad she did!**
  • The One Month Wait. After you know your total embryos and you've recovered properly, you may take a one month break. This break is for your embryos to freeze before embryo transfer. Some clinics do a fresh transfer (shortly after retrieval), but I'm personally not familiar with that. Our clinic recommended that we freeze our embryos for a month and allow my body the time that it needed to get back to normal from all of the hormone injections (STIMS).
  • Embryo Transfer Prep. After about a month, when your cycle starts again, you will contact your clinic to set up and discuss embryo transfer. You'll start going in for baseline ultrasounds periodically during your cycle to figure out the perfect transfer date and during this time, you're going to be on a LOT of medication (again) to make sure your body is ready for your baby! The medications are different this time- it's like estrogen patches, etc. It preps your body to receive an embryo!
  • Fresh Transfer vs Frozen Transfer. A fresh embryo transfer is when they transfer the embryo into your uterus after day five or six of it being monitored in the embryologist lab. If the cells are dividing properly and the embryo has a good rating, they will do the transfer. A frozen embryo transfer includes the one month wait. Your embryo is frozen for one month (or as long as you wish) after day five or six. The transfer protocol is totally based off of your personal health history, clinical recommendation, and personal choice. Explore your options here!
**TIP: There were a lot of medications surrounding the transfer and they needed to be taken in different doses at different times. I wrote the medication, dose, and time on our bathroom mirror to make sure I took everything when I needed to!**
  • Embryo Transfer. What an amazing day it is! In fact, it's really similar to an IUI. You get a picture of your embryo for transfer before you go in to the room and they will talk to you about how well the embryo responded to the thawing process. When you go into the room, they get you all set up- feet up, legs wide- by hooking up a catheter and setting up a jelly on the belly ultrasound. The embryo transfer is ultrasound led and you can watch on the monitor as they place your baby in your body. It's absolutely amazing and I highly encourage you to soak it all up! Transfer itself is not painful, just as with an IUI, it's similar to harsh period cramps as they attach the catheter and insert the embryo.
**TIP: You have to have a FULL bladder for transfer! This creates a dark space on the ultrasound monitor so that the doctor can accurately know where to go with the embryo. Drink lots of water before transfer.**
  • The Final Wait. Many clinics are different and I don't want to steer you astray. Some clinics say to wait 8 days, some say 10. We had to wait 8 days before doing our blood pregnancy test and it was the longest 8 days of my life. During this time, I really encourage you, again, to find all of the positivity that you can. Whatever that looks like for you- DO IT. Prayers, walks, time with family/friends. Whatever brings you peace and comfort, make sure you're filling your cup every day with happy things and not worry.
**TIP: I implore you- please, please, please do not test early. Please, please, please do not look up symptoms of an early pregnancy. I didn't have ANY symptoms and had I googled what they "may be," I would've lost my mind and been worried for nothing. EVERYONE IS DIFFERENT. EVERY PREGNANCY IS DIFFERENT. Please don't give yourself unnecessary worry and doubt. I know the wait is hard, but it's better to fill yourself with positivity than worry in this time!**
  • Test Day. After our 8 days, I went to our clinic for a blood pregnancy test and I was told that I would receive a call with our first set of beta numbers within a few hours. Betas are good and you want them to be high! This means that your embryo has attached and is growing! You'll go back a few days later for a check on beta numbers to ensure that they are still growing, meaning that YOU'RE PREGNANT!
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I know this may come across as overwhelming at first, but I promise you get the hang of it. When we first found out about infertility, I thought I would NEVER understand all of these little pieces and details, but now it's like second nature- a second language almost. You adapt to the situation at hand and eventually, you do understand it all and you do become comfortable with it.
Like I said before, I believe that perspective is HUGE. What's your perspective as you enter this new season of your life? Are you entering it begrudgingly or excited? Nerves and worry and fear and doubt are all totally normal. I'm not asking you to be happy all day every day. That's simply out of the question. All I'm asking you to do is to look for the good in your situation, because I guarantee you there's always a silver lining.
I'm not a doctor. I'm not a nurse. I'm simply here to be a reference and a resource for you. I wish I could've read something like this going into our diagnosis and that's why I've created this for you. To be a helpful guide on what to expect from another person's experience.
Please do not take our journey and our experience to be your groundwork. Every cycle, situation, clinic, and body is different. Please work with your own clinic and doctor to know what's best for you.
But please know that I am here for you if you need someone to talk or vent to. We've been through a lot and we want to use our experience to help others. You're not alone in this, friend. We're here for you and we wish you the best of luck!