Looks like I’ve arrived at a crossroad. To IVF or not to IVF? That is the BIG question.   

Why am I contemplating this option? After a recent break-up, I’ve returned to my original fertility plans only now I’m coming at the problem as a 35-year-old, not my oh-so-much younger 34-year-old days. Ah youth. What does the difference of a few months matter, you might ask? Well 35 is the big scary cut off point where female fertility starts to decline more rapidly. It’s also the point where pregnancies get called “geriatric” which, let’s be real, really just adds insult to injury.  

So little old geriatric me headed back to my fertility clinic to restart what I thought would be another few IUI rounds. Instead, my doctor recommended moving straight into IVF. I was on the borderline between needing to pull this trigger or sticking with IUI for a few more months. What tipped me over the edge was the offer of a free funded round.   

In Ontario, women under 43 can apply to receive one funded round of IVF from the government. Pretty cool, right? In most cases, you need to put yourself on a wait list for the funding which can be anywhere from a few months to a year and a half depending on your clinic. If you’re playing this fun game in your 30s, I’d recommend talking to your doctor about getting on the list even if you’re still at the IUI stage. You might never need the funding, but it’s better to have it when you need it than to start the process and have to wait when you’re feeling crunched for time.   

In my case, my doctor actually had funded rounds available in November and December (I was asking in September)and asked if I wanted one. The two-month delay to get restarted did freak me out, not gonna lie, but what sold me was the fact that any eggs harvested but not used could be frozen for future pregnancies. Meaning if I wanted two kids, this was probably my best shot without paying to freeze my eggs myself.   

Now there is a catch to the funded rounds. Well, several but let’s start with freezing. If you do a funded round, all your eggs will be fertilized by your donor. Meaning you can freeze the extras for future use, but they will all be fertilized embryos. If you opt for a non-funded round, you can choose how many eggs to fertilize and how many to leave as is in case you want to pursue a biological child with a partner in the future using his sperm.   

The other catch is that funding does not include medication or any extra fees such as genetic testing, embryo storage, transfer fees, or any other incidentals. Yes, you will save about 5-10K on a funded round, but do not make the mistake of thinking funded means free. IVF is not cheap. Repeat IT’S NOT CHEAP. Don’t go into this blindly or make the mistake of thinking this will be a few grand out of pocket not matter what song and dance your doctor gives you. (UPDATE: the process cost me about $13K not including optional genetic testing ($5k) or sperm purchasing ($1-5K)).   

I’ll create another post that goes more in depth into the IVF process itself, but for now, let’s just focus on the difference between IUI and IVF so you can make an informed decision. As always, remember to talk with a medical professional before you make a decision.  

What is IUI?  

Intrauterine insemination (IUI) is the process in which the sperm is placed directly into a woman’s uterus to spark conception. You might be used to hearing this called artificial insemination as it is a type of AI. Basically, this is the medical version of the turkey baster method.   

IUI does require some preliminary tests to ensure you meet the right criteria and don’t need more extreme intervention, such as IVF. Once you’ve done your testing and are a viable IUI candidate, the process itself is pretty simple. During your desired conception month, you’d report the first day of your period to your clinic and the clock starts from there. You’ll be called in for cycle monitoring which will include blood work and multiple trans-vaginal ultrasounds to track your progress. As you get closer to your best IUI date, those tests can become daily. You may also be on medication depending on your fertility plan.   

Around day 7-14 when your tests suggest you’re getting close to the right window, you’ll be asked to take a trigger shot. Trigger shots are done with a human chorionic gonadotropin (hCG) injection. You’ll do this about 12 hours before your IUI procedure. Warning, this medication can send your hormones out of whack. I may or may not have cried at salad, just saying. 

On the day of your IUI, you’ll go in for the procedure which will be a quick process. It feels very similar to a pap smear. You’ll be up in the stirrup, starting at the ceiling, while a nurse uses a speculum and a long tube to introduce your purchased sperm sample directly into the uterus.   

From there, conception is much the same as if you’d had unprotected sex. You’re hoping the sperm fertilizes the egg on its own and implants in the endometrium or lining of the uterus. You’ll be asked to take progesterone suppositories to help with the implantation and 14 days later, you’ll be called back for a blood test to see if you’re pregnant.   

All in all, it’s a pretty easy and painless process. Little to no medication is required depending on your requirements and the cost associated with an IUI round is really just the sperm sample (which could be $500-$1500K depending) and maybe a few hundred dollars for meds (for the lightest version).   

What is IVF?  

In vitro fertilization (IVF) is the nuclear option of infertility. It’s a complex series of procedures where mature eggs are harvested and fertilized in a lab then reintroduced back into the uterus at a later date.   

Much like IUI, you’d start with your preliminary fertility tests to ensure you’re a good candidate. Then on your starting month, you’d report the first day of your period and the show begins from there. One thing I didn’t realize is IVF basically creates its own cycle based on your natural one. So don’t freak out if your app says you’re about to get your period or you’re missing your best date to conceive. Everything is monitored based on the medication you’ll be injecting on a daily basis.   

The goal is to stimulate the production of eggs in your cycle to collect as many mature eggs as possible. You’ll be monitored throughout your harvest month to track the growth of your egg follicles. When they hit a certain size, or you reach a certain point in the medicated cycle, your egg retrieval will be scheduled.   

The retrieval process is not as simple as IUI is and you’ll need to be consciously sedated for the procedure. Don’t plan on working the same morning as your retrieval, in other words. You’ll go into an OR where a doctor will put you up in stirrups and get up in there to sort of vacuum out the viable eggs.   

Once collected, they’ll be fertilized within 3 or 5 days. From there you can decide to proceed with genetic testing or schedule your transfer date which will move a single embryo into your uterus with hopes of it implanting. The transfer process requires meds of its own and this is the step most women associate with the painful part of the IVF process. Progesterone oil is no one’s friend and those needles are large as fuck. More on that later.   

Which one do I need?  

The decision between IUI and IVF is one you’ll need to make with your doctor and with your budget. IUI is by far the cheaper choice, but it’s more so meant for women with minor to no fertility issues. IVF, on the other hand, is for women when all other options have failed and is drastically more expensive. Single mom’s by choice tend to fall somewhere in the middle. I don’t have severe infertility issues, for example, but I’m at the age where time matters and I don’t have a partner at home to try naturally every night so it’s science or nothing for me. Do not make this decision lightly or quickly. Do your research and make an informed choice about what’s right for your body and your goals. And learn from someone who’s been there – ask all about costs upfront then verify the numbers you are told.