IUI is widely considered the “first step” when a couple begins fertility treatments beyond taking medications. I have had friends state that they are willing to try IUI, but draw the line there. They say that they won’t “go as far” as attempting IVF. This decision is, if I am being brutally honest (and I am), baffling to me. IUI is more affordable and less invasive, but there are definitely risks that often are not considered when someone decides that IUI is the better bet.
IUI is less effective meaning repeated tries are often necessary. When IUI is successful multiple births occur much more frequently than with IVF. The majority of multiples conceived via IUI are twins, but there is a significant incidence of triplets, quadruplets, and more. High order multiples can be dangerous for the mother and put the babies at risk of severe prematurity. Selective reduction is often advised to women who become pregnant with high order multiples, forcing the women who finally conceive to face horribly difficult decisions.
I actually consider that my husband and I were “lucky” to have our doctor suggest that we skip IUI and go straight to IVF. He did not think IUI would be successful in our situation and told us in simple terms that he thought it would be a waste of time and money. I have no way of knowing what the outcome would have been had we done IUI, but I do know that repeated failure to conceive would have been severely detrimental to my state of mind. I also could not imagine having to consider selective reduction, or raising triplets or more. For me, skipping that step was probably the absolute best decision. I was a complete wreck waiting for the results of our IVF and could not imagine looking at even worse odds and driving myself (and everyone around me) crazy through repeated IUI cycles and then IVF. I know that there are a lot of people who go through multiple IVF cycles without success, but there are even more who do IUI and do not conceive.
If our diagnosis had been different or if the doctor had said that he thought it was a good idea to give IUI a shot we probably would have tried it a few times. It does work for a lot of people, and is a great option to combat many fertility issues. There are many people though, like us, who realistically will not see much success with the procedure. These are the people who still try it either because of financial/insurance issues or because they fear the invasiveness and advanced nature of IVF. If IUI is recommended to you as a potentially successful treatment option or if it is all that your budget or insurance will allow then by all means I think you should do it wholeheartedly. If, however, your insurance doesn’t cover either procedure and your doctor tells you that he thinks IVF will have a better success rate then I would hope that you wouldn’t be afraid to move straight to IVF. IVF has a better success rate, much lower incidence of multiple births, and is more affordable as a first option rather than an option that is tried after multiple failed IUI attempts. The decision to try IUI or to move straight to IVF is ultimately one made between you and your doctor. I just see IUI touted as an easier, less drastic attempt and it is important to know that for some, the pros and cons list can actually come out in favor of skipping IUI and making IVF your first step.