IVF After IUI: When to Switch & What to Expect

You've been trying intrauterine insemination (IUI) for a while now, but it hasn't resulted in pregnancy. It's natural to feel uncertain about what comes next or whether in vitro fertilisation (IVF) might be the right step for you.

The good news is that many couples who don’t conceive with IUI go on to achieve pregnancy through IVF. Understanding when to consider this step – and what makes IVF different – can help you make informed, confident decisions about your next stage of treatment.

What is IUI?

Intrauterine insemination (IUI) is a fertility treatment where washed and concentrated sperm is placed directly into your uterus (womb) around the time of ovulation. This procedure helps the sperm get closer to your egg, increasing its chances of fertilisation.

IUI is commonly used for:

• Mild male infertility

• Cervical mucus problems

• Unexplained infertility

What is IVF?

In vitro fertilisation (IVF) is a more advanced fertility treatment compared to IUI. Unlike IUI, where fertilisation happens inside your body, IVF allows doctors to control and monitor each stage of the fertilisation process in a laboratory setting. 

IVF is recommended if you have:

• Fallopian tube blockage or damage

• Endometriosis

• Older age 

• Genetic concerns requiring embryo testing (through preimplantation genetic testing - PGT)

• Unexplained infertility after failed IUI attempts

While IVF offers higher success rates than IUI, it's more costly and requires a more complex treatment process with stronger medications and medical procedures.

When should you consider IVF after IUI?

Not everyone who undergoes IUI will need IVF, but in some situations, a different treatment may be more effective. If your IUI attempts haven’t led to a pregnancy, please remember this isn’t a reflection of anything you did wrong. IVF may provide another path forward by addressing challenges that IUI isn’t designed to overcome.

You should consider transitioning to IVF if:

• You've tried three to six IUI cycles without success

• You're over 35 years old

• You have low ovarian reserve

• You have blocked fallopian tubes

• You want genetic testing of embryos 

• You're seeking a faster route to pregnancy

Why IUI might not work for some couples

IUI doesn’t always lead to pregnancy, even after multiple attempts. Common factors include:

• Egg quality concerns:

  • As women age, especially after 35, their egg quality naturally declines, making fertilisation more challenging.

• Sperm-related issues:

  • A low sperm count or poor sperm movement (motility) can prevent successful fertilisation.

• Ovulation timing problems:

  • If ovulation doesn't occur as expected or the timing is slightly off, the sperm may not meet the egg.

• Unexplained infertility:

  • Sometimes, all tests come back normal, but pregnancy still doesn't happen.

• Uterine lining issues:

  • If the lining of the uterus (endometrium) isn't thick enough or has irregularities, the embryo may struggle to implant.

• Hidden fallopian tube problems:

  • Mild blockages or scarring in the fallopian tubes may not show up on standard tests but can still prevent pregnancy.

• Hormonal imbalances:

  • Conditions like polycystic ovary syndrome (PCOS) or thyroid disorders, if not properly managed, can affect ovulation and implantation.

Understanding these factors can help you and your doctor determine whether continuing with IUI or moving to IVF is the right decision.

If you're experiencing repeated IUI failures and feeling uncertain about the next steps, schedule an appointment with Thomson Medical. Our doctors can identify potential barriers and help you decide whether IVF is the right option for you.

How many IUI cycles should you try before IVF?

The recommended number of IUI cycles varies depending on your age and individual circumstances. However, most successful IUI pregnancies happen within the first three to four cycles.

General guidelines include:

• If you’re under 35 years old, try up to three to six IUI cycles.

• If you’re 35–40 years old, try three cycles, then evaluate IVF options.

• If you’re over 40 years old, many doctors recommend skipping IUI and going straight to IVF, or limiting IUI to a maximum of three cycles.

After three cycles, your chances of pregnancy don't increase much with additional attempts. Your fertility specialist can help determine the best timeline for your situation based on your specific circumstances.

Key differences between IUI and IVF

Moving from IUI to IVF involves several key differences in treatment approach and outcomes.

IVF after IUI: What to expect

If you decide to transition to IVF, understanding the process can help you prepare both physically and emotionally. The IVF process usually involves:

• Ovarian stimulation:

  • You'll take stronger fertility medications (gonadotropins) through daily injections to stimulate your ovaries to produce multiple eggs.

• Monitoring appointments:

  • You'll attend frequent blood tests and ultrasound scans to monitor how your follicles are developing.

• Egg retrieval:

  • Your doctor will perform this minor procedure under sedation to collect your eggs from the ovaries.

• Laboratory fertilisation:

  • Your eggs are fertilised with sperm in a laboratory, where specialists monitor the embryo's development over several days.

• Genetic testing (optional):

  • If you choose, your doctor can test embryos for genetic conditions through PGT before transfer.

• Embryo transfer:

  • One or two healthy embryos are transferred into your uterus.

• Two-week wait:

  • After the transfer, you'll wait approximately two weeks before taking a pregnancy test.

You may also choose to freeze remaining embryos for future use. Fertility treatment can be an emotional journey, but you don’t have to face it alone. With the right support and guidance, IVF can open new possibilities for growing your family.

If you're ready to explore IVF or want to understand more about what the process involves, schedule an appointment with Thomson Medical. Our team can walk you through each step and create a treatment plan tailored to your needs.

FAQ

Can I do IVF after IUI?

Yes. If you've tried multiple IUI cycles without success, IVF may offer better chances of achieving pregnancy.

How soon after a failed IUI can you try IVF?

You can begin IVF as soon as your next menstrual cycle starts. However, your doctor may sometimes recommend taking a short break to allow your hormones to return to baseline, especially if you've been on fertility medications for several cycles.

Should I skip IUI and go straight to IVF?

Which is more painful, IUI or IVF?

IUI is generally painless or mildly uncomfortable. IVF involves injections, egg retrieval (under sedation), and bloating, which may cause more discomfort but is usually manageable.

When should I switch from IUI to IVF?

How long does the entire IVF process take?

A complete IVF cycle – from initial consultation through testing, stimulation, egg retrieval, and embryo transfer – usually takes about three to four months. The actual treatment cycle takes about four to six weeks.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice based on your unique situations, please consult a specialist at Thomson Medical. Schedule an appointment with Thomson Medical today.

Citations

Knchua, & Knchua. (2025, May 6). Understanding the cost of IVF treatment. Alpha IVF Fertility Centre Singapore | IVF Clinic, IVF Specialist, Fertility Clinic. https://www.alphaspecialists.com.sg/1712/understanding-the-cost-of-ivf-treatment/

iMarketing. (2025, June 27). IUI vs IVF: Which Fertility Treatment Is Right for You? < Dr Law Wei Seng. Dr Law Wei Seng. https://www.drlawweiseng.com.sg/blog/iui-vs-ivf-which-fertility-treatment-is-right-for-you/