5 Things to Consider When Choosing IUI or IVF as a Single Mother By Choice (SMBC)
Over the last year, I have received the same question over 100 times on my Instagram account @thesolomama–should I do IVF or IUI? Here is the answer (and you might not like it)…it depends.
Your doctor will have the best medical recommendation, but before you jump on that bandwagon, I highly recommend spending some time reflecting on the five areas below before signing on the dotted line.
Review your baseline testing results & consider your age
When you start the fertility process on the journey towards solo motherhood, the first thing the clinic you are working with is going to do is “baseline testing” on the third day of your period. Baseline testing is bloodwork and an exam to check that all of your hormone levels, weight, ovarian reserve (aka egg supply), and uterine lining are in a healthy range to conceive and carry a pregnancy to term.
If everything comes back positive, you will be approved to start IUI or IVF.
Just as a refresher, IUI or interuterine insemination is when one vial of sperm is used for insemination on the peak day of ovulation. IVF or in vitro fertilization is when your eggs are retrieved from your ovaries and fertilized outside of the body before transferring a viable embryo back into the uterus.
If your testing comes back with red flags (low ovarian reserve, hormone levels that are out of line or with issues in the uterine lining) IVF will most likely be the recommended protocol.
However, just because your levels come back “within range” does not mean you will get pregnant quickly or without any issues or delays. While doctors can draw conclusions based on baseline testing, there is not a test out there that can tell you the quality of your eggs. Even if your ovarian reserve (AMH level) looks average or above average, you could still have issues with egg quality. The best indicator of egg quality is your age and as we all know, there are always outliers to averages as well.
Here is what we know about age and fertility:
At 35: 35% of your eggs are abnormal
At 40: 65% of your eggs are abnormal
At 43: 80% of your eggs are abnormal
There is a huge misconception that a high AMH level equals great egg quality and it’s false. While it is an indicator of supply it is not an indicator of quality. There is absolutely no way to know if any of the eggs retrieved will be viable until they are fertilized.
If your tests come back “normal” and you are over 35, it is worth keeping these averages in mind as you make the decision to do IVF or IUI. I conceived two pregnancies out of 6 IUIs (one pregnancy loss and one sweet little girl who just turned 3) at 35 and 0 out of 6 IUIs at 38. Things change quickly as you age but every person is different so use the data as a guide but not as the end all be all answer for every single decision you make about your fertility.
If you have an aversion to IVF drugs and medical procedures:
If you are like me, and hate the idea of injecting drugs into your body, IUI may sound like an ideal option to try a few times before moving to IVF. The probability of success is significantly lower but if you have time to try, it could be worth it and put your mind at ease. If your baseline numbers are within range, there are no other fertility challenges and you are under 40 (but probably 38), IUI is a great option.
If you want more than one child as a single mom by choice (SMBC):
If you are 35+ and you anticipate that you may want to have another child in the future as a single mom by choice. IVF is a great option to preserve your eggs and/or embryos, and ensure that you can try for another baby in the future without worrying about a diminished egg reserve as you age.
When I went through this process at 34/35, I did not think I would want to have a second child as a solo mom. Now, at 38 (almost 39), I changed my mind. While my numbers are still in the average/above average range, I have had no success with IUI this round and will end up spending 2 to 3 times more money and time than if I had frozen embryos via IVF at 35. In the short run, IUI is a great option, but in the long run, IVF is often more cost effective and efficient.
With that said, I would never change a thing because IUI gave me my daughter but hypothetically speaking, IVF would have been great to consider the first time around even though I didn’t “need” it.
If you are calculating the total cost of IVF & IUI treatment correctly:
If you live in a state that covers fertility treatment (and work for an employer within that state with more than 100 employees) the cost of IUI or IVF may not matter much to you. However, if you are not covered or you are on private pay, the decision to do IVF can be a huge financial undertaking.
However, one major input I find people leave out of their math calculation between IUI and IVF is the cost of donor sperm. Regardless of where you live or if you are covered, a vial of donor sperm from a reputable cryobank is almost never covered under insurance and is averaging close to $1K per vial.
While IUI is generally a much more affordable procedure ($1K + cost of sperm), it usually takes 3-5 times to conceive and requires a new vial of donor sperm for each attempt.
IVF is typically significantly more expensive (ranging from 8K-30K + the cost of sperm) depending on the clinic and city you live in. CNY Fertility is the most cost effective option I have seen in the US. With IVF, one vial of donor sperm can generally be used 2-4 times. It is likely you may only need 1 vial of donor sperm for multiple egg retrievals and fertilizations.
Before you write off IVF as too expensive, I would recommend running the numbers with a probable scenario like this one:
IUI: 4 IUIs to conceive ($1K) + 4 vials of donor sperm ($1K) = $8K
You could also factor in pregnancy loss/starting over, and/or having another baby in the future which would double this cost to close to 16-20K at an affordable clinic (private pay).
IVF: One egg retrieval + meds ($8K) + 2 embryo transfers ($2K) to conceive + 1 vial of sperm ($1K) =$11K
If you factor in pregnancy loss and having another child (and you do not need to do a second egg retrieval, you probably will add another 3K-5K to this = 16K-20K at an affordable clinic (private pay).
If you end up experiencing pregnancy loss like 25% of women, or trying for a second child later on, the total costs may not be all that different but the time it takes to get pregnant could be shortened significantly.
If you have the time to spend a year trying to conceive via IUI:
IUI could take months (even years) to conceive (but so could IVF) and depending on your age, you may not have that time to waste. If you are 40, it would be unwise to spend two years attempting IUI at the peak of your fertility decline. IVF may be the best option to ensure you maximize your time and preserve your egg quality.
Trust your intuition and talk to your doctor:
The decision to pursue IUI or IVF is deeply personal and complex. There are so many different factors to consider and evaluate when making a decision. Remember that the majority of people who are working with a fertility clinic are struggling to get pregnant. This may or may not be your story. It is important to remind the clinic every single time you go in that you are pursuing single motherhood by choice. This will ensure they have a clear understanding of your profile. Every journey is different and I wish you the best of luck on whichever path you choose to take.
(And for the record, I am not a doctor, just a single mom by choice (SMBC) who has read, watched and listened to hours of content about this topic in preparation for motherhood.)