IVF and IUI: The Process Step by Step

Getting pregnant can sometimes take longer than you expected, and that is very common. Assisted reproduction treatments now give millions of families the chance to have a child. This guide explains intrauterine insemination (IUI) and in vitro fertilization (IVF) step by step. The information is based on the NHS, the UK fertility regulator HFEA, NICE and the American College of Obstetricians and Gynecologists (ACOG). Every couple's treatment plan is different; your doctor always has the final say.

When should you seek help?

• The NHS recommends seeing a doctor if you have not conceived within 1 year of regular sex.
• ACOG and the American Society for Reproductive Medicine (ASRM) recommend seeing a doctor if you are 35 or older and have not conceived within 6 months, and an even earlier evaluation over 40. The NHS also recommends that women aged 36 and over seek help earlier.
• If your periods are very irregular, or you have known endometriosis, tubal problems, PCOS, or your partner has a known sperm problem, seek help without waiting.
• The first step usually includes hormone tests, an ultrasound, an X-ray that shows whether the tubes are open, and a semen analysis for your partner.

What is IUI? At the time of ovulation, sperm that has been washed and prepared in the lab is placed directly into the uterus through a thin catheter. It is a short, painless procedure; according to the NHS, it usually takes less than 10 minutes.
Steps:

• Checking that the tubes are open
• Medication to support egg development, if needed
• Monitoring with ultrasound
• A "trigger" injection to prompt ovulation
• Placing the sperm in the uterus
• A pregnancy test about 2 weeks later

Who is IUI suitable for? It can be tried in couples whose tubes are open, whose sperm counts are not very low and whose ovulation problem can be treated. It is of limited benefit for couples with blocked tubes, severe endometriosis or very low sperm counts. The chance of success is lower than with IVF; according to the HFEA, usually about a third of IVF's. In its 2026 update, the UK NICE guideline offers couples with 2 years of unexplained infertility either up to 4 cycles of medication-supported IUI before IVF, or going straight to IVF. Where public funding or insurance requires other treatments to have failed first, methods like IUI are often tried before IVF. Your doctor will decide the right path for you.

IVF step by step: According to the NHS and HFEA, one IVF cycle takes about 3-6 weeks, depending on the protocol.

• 1. Ovarian stimulation: Hormone injections are given every day for about 10-14 days. You can usually give them yourself at home.
• 2. Monitoring: Blood tests and ultrasound track the growth of the egg sacs (follicles).
• 3. Trigger injection: When the follicles are large enough, a final injection is given to mature the eggs.
• 4. Egg collection: About 1.5 days later, under light sedation or anesthesia, the eggs are collected through the vagina with a needle guided by ultrasound. The procedure takes about 20-30 minutes.
• 5. Fertilization: In the lab, the eggs are combined with your partner's sperm. If there is a sperm problem, a single sperm is injected into each egg (intracytoplasmic sperm injection, ICSI).
• 6. Embryo development: The embryos are monitored in the lab for 2-6 days.
• 7. Embryo transfer: The best embryo is placed in the uterus through a thin tube. It is usually painless and needs no anesthesia.
• 8. Support treatment: Hormone medicines (pessaries, gel or injections) are used to support the lining of the uterus.
• 9. Pregnancy test: According to the NHS, about 16 days after the transfer. Your clinic will give you the exact date; testing too early can give a false result.
• 10. Freezing: Remaining good-quality embryos can be frozen and used in later attempts.

How many embryos are transferred? In some countries, the number of embryos that can be transferred is limited by regulation, often depending on the woman's age and which attempt it is. The aim is to reduce the risks of twin and triplet pregnancies. Single embryo transfer is safer for both the baby and the mother. Ask your clinic which rules apply to you.

Success rates: The factor that affects success most is the woman's age. According to HFEA data for 2024, the birth rate per embryo transferred, for fresh and frozen transfers using the woman's own eggs, is:

• About 38% at ages 18-34
• About 8% at ages 43-44
• About 30% on average across all ages

These figures vary from clinic to clinic and person to person. Not succeeding on the first try does not mean failure; many couples get there after a few attempts.

Risks and things to watch for:

• Ovarian hyperstimulation syndrome (OHSS): An over-response to the medication can cause bloating and pain in the belly. If you have shortness of breath, chest pain, severe belly pain or are passing much less urine, contact your doctor or go to the ER right away.
• Multiple pregnancy: If more than one embryo is transferred, the chance of twins rises. Multiple pregnancies carry a higher risk of preterm birth and low birth weight.
• Ectopic pregnancy: Rare, but it can happen.
• Emotional load: Injections, waiting periods and uncertainty can be exhausting. Talking with your partner, loved ones or a psychologist is an important part of the process.

Legal framework: The rules on IVF differ widely between countries: who can access treatment, whether donor eggs or sperm are allowed, how long frozen embryos can be stored, whether storage must be renewed in writing, and what happens to embryos after divorce or the death of a partner. Freezing extra embryos usually requires both partners' consent. Check the rules that apply where you live with your clinic.

Funding and insurance: Coverage for IVF depends on your country, health system and insurer. Public funding or insurance often comes with conditions, such as limits on the woman's age, a minimum period of insurance, not already having a child from the current relationship, documented failure of other treatments, and a maximum number of funded cycles, sometimes with a co-payment. Because these conditions change, confirm the current rules with your insurer, health service or treatment center before you apply.

Take care of yourself during treatment: Eat a balanced diet, avoid smoking and alcohol, and take the folic acid your doctor recommends. Being at a healthy weight supports your chances of success. When choosing a clinic, consider its experience, how openly it shares its success rates and how much time it gives to your questions.

Dear mom-to-be, this journey takes patience and courage. You have every right to ask about each step, to understand it and to take a break when you need one. You and your partner are not alone in this; asking for support is not weakness, it is self-compassion.