How do you know whether to start with IUI or IVF when using a sperm donor?
—TTC without a map
This is such a great question, because the decision-making process when using donor sperm is complex.
First, I want to acknowledge that sometimes people don’t have a choice. There are some fertility challenges that make conception through IVF essential and can only be diagnosed by a doctor. This decision may also be influenced by your insurance company — some companies require that people do a certain number of IUIs before moving to IVF.
For people navigating this choice outside of medical or insurance constraints, I have four initial questions that may help:
1. What kind of donor sperm are you using?
The question of what type of donor sperm you’re using is important because the type of donor sperm (and how it’s processed) impacts success rates as well as the cost associated with at-home insemination or IUI. For people who are using a directed (known) donor close to them and not paying for banked sperm, starting with at-home insemination or IUI may be ideal. But for those who have a limited number of vials of banked sperm, especially with possible fertility challenges or at an advanced age, considering IVF may make financial and medical sense.
2. How much medical intervention do you ideally want?
I work with some LGBTQ+ people without fertility challenges who are clear that they want to stay outside the medical system for as long as possible, even if it takes them longer to get pregnant, and others who want to expedite the conception process as their number one priority and don’t mind medications, doctor appointments, and potentially invasive fertility procedures. Getting a sense of where you fall on this spectrum can be helpful in determining if you want to start with IUI or IVF, because IUI is less medically intensive than IVF but also has lower success rates per attempt.
3. How old are you?
Most of us are aware that age affects people’s fertility. Overall, people have higher pregnancy success rates under the age of 35, and the older you get, the more likely that you’ll need some fertility support in your conception process. Most providers don’t recommend IUI as an effective strategy for people over 43 years old, and many recommend considering using donor eggs for IVF cycles if you are between 43 and 45 years old.
4. What’s your ideal family size?
If you know that you want one child, your family-building process may look different than if you’re confident you want, say, three or four children. When factoring in the costs of donor sperm and fertility treatments along with their predicted success rates, you may discover that doing IVF from the get-go is more cost-effective than starting with IUI.
There’s no one right answer for everybody, but hopefully these questions help clarify whether or not it makes sense to begin with IUI or IVF as you embark on growing your family.
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