The short answer
There is no single right order for every couple. IUI makes sense first only when certain basic conditions are met. If they are not, IUI may cost time without giving a real chance.
The decision rests on four things: the woman's age, her egg reserve, whether the tubes are open, and the semen report. Your doctor weighs these after tests.
How IUI works
IUI stands for intrauterine insemination. Washed and concentrated sperm are placed directly in the uterus around the time of ovulation. Fertilisation then happens naturally inside the fallopian tube.
The woman may take mild tablets or injections to help one or two eggs grow. Ultrasound scans track the follicles. The procedure itself takes a few minutes and needs no anaesthesia. Read more on our IUI treatment page.
How IVF works
In IVF, the ovaries are stimulated with injections to grow several eggs. The eggs are collected under short anaesthesia and fertilised with sperm in the lab. One embryo is then placed in the uterus.
Because fertilisation happens outside the body, IVF bypasses blocked tubes. With ICSI, a single sperm is injected into each egg, which helps when sperm counts are low. Extra good embryos can be frozen for later. See our IVF treatment page for the full process.
IUI and IVF side by side
| Point | IUI | IVF |
|---|---|---|
| Where fertilisation happens | Inside the body, in the tube | In the lab |
| Tubes must be open | Yes, at least one | No |
| Sperm needed | Reasonable count and movement | Can work with low counts, especially with ICSI |
| Medicines | Mild tablets or low-dose injections | Daily injections for about 10 to 12 days |
| Egg collection | Not needed | Yes, under short anaesthesia |
| Embryos can be frozen | No | Yes |
| Typical cost per cycle | ₹10,000 – ₹25,000 | ₹1,60,000 – ₹3,56,000 |
| Time per cycle | About 2 weeks | About 4 to 6 weeks |
When IUI first is reasonable
- The woman is younger and her egg reserve is normal.
- At least one fallopian tube is open on a tube test.
- The semen report shows a fair count and movement after washing.
- Ovulation problems, such as in some women with PCOS, need a gentle push.
- Unexplained infertility has lasted a shorter time.
In these cases, a limited number of IUI cycles is a common plan. Your doctor sets that number with you, based on your tests.
When going straight to IVF makes sense
- Both tubes blocked or damaged. Sperm and egg cannot meet in the tube, so IUI cannot work.
- Low sperm count or poor movement. IVF with ICSI needs only a few healthy sperm.
- Falling egg reserve or age in the late thirties. Time matters, and IVF gives more information per cycle.
- Moderate or severe endometriosis. It can affect the tubes and egg quality.
- Several failed IUI cycles. Repeating the same step rarely changes the result.
For tube problems, see our guide to blocked fallopian tubes and IVF.
Cost is not just the price per cycle
IUI costs far less per attempt. But if your chance per IUI cycle is low, several cycles may add up in money and months. For an older woman, those months can also reduce her chances later.
IVF costs more at the start. Frozen embryos from one cycle may allow a later transfer without a fresh stimulation. Think of cost per realistic chance, not cost per attempt.
Before any treatment, you get a written itemised estimate. The full IVF breakdown is on our IVF cost page.
Tests that help you decide
- AMH and ultrasoundThese show the woman's egg reserve.
- Tube testAn HSG or similar test checks whether the tubes are open.
- Semen analysisThis shows count, movement and shape of sperm.
- Hormone and thyroid testsThese check ovulation and general health.
Many of these tests can be done in your own city. The reports can be reviewed on WhatsApp before you travel to Delhi.
Questions to bring to your consultation
- Based on our reports, is IUI a realistic option for us?
- If we try IUI, how many cycles before we review the plan?
- Would IVF give us more useful information about eggs and embryos?
- Will we need ICSI if we choose IVF?
- Can extra embryos be frozen for a later attempt?
Write down the answers and discuss them together at home. A clear plan with a review point helps you avoid drifting through many cycles without a decision.
Age changes the balance
For a woman in her twenties or early thirties with normal tests, a short trial of IUI is often reasonable. Time is on her side.
From the mid-thirties onwards, egg numbers and quality fall faster. Spending many months on IUI can mean starting IVF later with fewer eggs. This is why doctors often move to IVF sooner for older women.
Risks to know about
Both treatments carry a risk of twins or more when several eggs grow. IVF stimulation can rarely cause OHSS, where the ovaries swell. Ectopic pregnancy can occur with either. Your doctor monitors you to lower these risks.
Success with either treatment depends mainly on age, egg reserve, sperm quality and embryo quality. Consult your doctor for the plan that fits your reports.