If you're having trouble getting pregnant, you're not alone — and there are a number of fertility treatments that may help. Options range from medications that stimulate ovulation to procedures like intrauterine insemination (IUI) and in vitro fertilization (IVF). The right treatment for you depends on what's causing your fertility challenges, as well as your age and family-building goals.
From fertility medications to IVF, here's what to know about your options — and how to find the right path for you.
How do I choose the right fertility treatment?
Start by familiarizing yourself with your options. Once you have a sense of which options might fit your situation, talk with your doctor to learn more about the treatments most likely to help.
Keep in mind when looking at costs that your insurance may cover some of the expense. This will depend on the state where you live, your specific insurance policy, and/or coverage that your employer may provide. Currently, 25 states require insurance plans to cover some form of fertility treatments.[1]
Get more expert advice and connect with other women with similar challenges and concerns on our free What to Expect app.
The following quick overview will get you started.
What is intrauterine insemination (IUI)?
With intrauterine insemination (IUI), a thin catheter is used to place sperm from your partner or a donor directly in the uterus during ovulation, upping the chances that sperm will meet egg.
If you’re ovulating normally, IUI can be done without any additional fertility drugs. If you’re having issues with ovulation, doing IUI with fertility drugs can boost your chances of getting pregnant.[2]
Can be good for: This procedure may be a good option for couples dealing with lower sperm counts or poor sperm motility (aka how well the sperm can swim), same-sex couples, or single women who want to become moms on their own. IUI is also a good first option for those with unknown fertility issues.
"I was diagnosed with unexplained infertility," says What to Expect Community mom bc1622. "I finally conceived from our third IUI."
Success rates: Using donor sperm for multiple cycles, one large study showed a live birth rate of:[3]
- 61.5% for women younger than 35 years old
- 48.9% for women 35 to 37
- 24.1% for women 38 to 39
- 11.8% for women 40 and older
For women using their partner's sperm, the numbers were lower:
- 27.6% for women younger than 35
- 22.96% for women 35 to 37
- 13.73% for women 38 to 39
- 6.9% for women 40 and older
"IUI worked for us (first try)," shares Community mom Sheena19. "It was minimally invasive (compared to IVF) and worked for us when trying naturally hadn't worked for over a year."
Average cost: $500 to $4,000 per cycle. That's a wide range, but the final price will depend on whether medication is used (and which kind), what testing and monitoring you'll need, and whether donor sperm is used.
Side effects or risks: There are no real risks to IUI, other than a rare chance of developing an infection, but the procedure won’t work for everyone. IUI is less likely to be effective for women over 40, as well as those with fallopian tube blockages, a history of pelvic infections, or significant endometriosis.
It also likely won’t work for male infertility problems, including very low sperm count or significant problems with sperm motility or morphology (the percentage of sperm that appear to be of normal shape and size). In this case, however, donor sperm may be used.
What is in vitro fertilization (IVF)?
During IVF, your eggs are fertilized by sperm in a laboratory or fertility clinic. One or more of the resulting embryos are then transferred to your uterus in hopes of achieving a pregnancy.[4]
Can be good for: Your doctor might recommend IVF if IUI hasn’t been successful for you. IVF can also be a good choice for those dealing with severe fallopian tube blockages, ovulation problems, diminished ovarian reserve, polycystic ovary syndrome (PCOS), endometriosis, or severe sperm factor.
"Three years and so many failed attempts at IUI. Finally have my daughter on my first IVF try," says Community mom Jenirose21. "A few years later I decided to try my only embryo left and had my second daughter at 36. Fast forward two years and at 38 ended up pregnant on my own with my son. Surprise!"
Same-sex couples, couples using donor eggs, or any couple that might need to use preimplantation genetic diagnosis or screening (PGD/PGS) to screen embryos for genetic disorders would use IVF, too.
"After two failed IUIs back-to-back and one medicated cycle that didn't work, we made the decision to move forward with IVF," says Community mom ukhtii. "After years of struggling with unexplained infertility, I finally feel like I can see a light at the end of the tunnel."
Success rates: Success rates for IVF vary depending on a woman’s age. According to the Society for Assisted Reproductive Technology (SART), the chance of a live birth doing IVF as a new patient in a clinic are:[5]
- 50.3% for women younger than 35
- 39.3% for women 35 to 37
- 27.2% for women 38 to 40
- 13.9% for women 41 to 42
- 4.1% for women 43 and older
Use the Predict Your IVF Success feature on SART's website to estimate your success rate based on your individual circumstances.
Average cost: According to the National Bureau of Economic Research, a single IVF cycle can cost as much as $30,000.[6] While the typical cost per cycle is about $12,400, on average it takes 2.5 cycles to result in pregnancy. The price can climb with add-ons to a base price, such as medications, genetic testing, egg retrieval, and storage fees.
Side effects or risks: You’ll need to take hormone shots before your eggs can be harvested for fertilization, which can cause unpleasant side effects.
The procedure itself is invasive, and transferring more than one fertilized egg also makes you more likely to have twins or multiples, which ups the odds for possible complications. Plus, it can be very expensive if not covered by insurance.
"Despite how taxing it was on my body and how expensive it was even with insurance coverage, I would do it all over again in order to have my baby boy," says Community mom Ang-Olive. "We also have nine embryos in storage, so we'll be able to grow our family again."
How are donor eggs used?
The process involves fertilizing a donor egg with sperm and implanting it into your uterus, similar to IVF. The donor can be someone you know or someone you're matched with anonymously through an agency.
If you use donor eggs, you won't have a genetic connection to your baby, though you'll still carry the pregnancy and be your baby's legal parent.
To avoid any legal pitfalls, hire a lawyer early in the process to make sure you have a formal contract between you and your donor and/or the donor agency waiving all parental rights and outlining that any children born from the donated eggs are legally yours.
Can be good for: If traditional IVF cycles haven’t worked, donor eggs can be a next step. The procedure also might be right for women with a low egg count or poor egg quality, which is more likely after age 40.
Donor eggs are also an option if you have a genetic disorder or serious condition that you want to avoid passing on to your child.
Success rates: The live birth rate using fresh donor eggs is 36.6% per cycle, and the live birth rate using frozen donor eggs is 39.1% per cycle, according to SART.
Average cost: Donor eggs cost a minimum of several thousand dollars to over $30,000. IVF fees are added to this, plus additional costs such as medical care for your donor and legal fees.
Side effects or risks: Using donor eggs can be a lengthy and expensive process, and for some women, coming to terms with the fact that they won’t have a genetic link to their baby can be emotional. And with IVF, there’s a risk of multiples and related complications.
How is donor sperm used?
Using donor sperm means that you'll use donated semen, from a suitable sperm donor, for insemination via IUI or IVF. As with donor eggs, the donor may be someone you know or are matched with. Your clinic may have a sperm bank, or they can refer you to one.
If you're using your own eggs, you'll still have a genetic connection to your baby. The donor who provides the sperm will also be genetically related.
Can be good for: Single parents, same-sex couples, and couples challenged by male infertility.
Success rates: The success rates will be the same as those for IUI or IVF, depending on which you're using.
Average cost: The price varies according to the vial type and whether the donor is identified or not. For IUI use, the average price for a vial is $1,495 for nonidentified donors and $1,968 for identified donors. For IVF use, the average price for a vial is $1,245 for nonidentified donors and $1,789 for identified donors.[7]
Side effects or risks: There are no specific risks beyond those for IUI or IVF, as long as the donation comes from a suitable sperm donor.
What is a gestational carrier?
A gestational carrier (GC), also known as a gestational surrogate, carries a pregnancy for another woman or same-sex couple. In virtually all cases, the parents undergo IVF and the embryo is implanted in the carrier’s uterus. The embryo may come from one or both of the intended parents, from donated embryos, donated sperm, or both. The carrier does not have a genetic tie to the baby.[8]
Note: Traditional surrogacy, or genetic surrogacy, means that a carrier donates her egg and carries the pregnancy for another woman or same-sex couple. She does have a genetic tie to the baby. Genetic surrogates are much less common than gestational carriers today.
Can be good for: Using a GC can be a good option for couples who want a biological child but can’t carry a pregnancy. Same-sex couples or women who can’t sustain a pregnancy, don’t have a uterus, or have a medical condition that would make pregnancy dangerous or impossible might also consider GC.
Success rates: Rates are similar to rates of women using their own uterus and depend on the age of the woman whose eggs were used to create embryos.
Average cost: The average cost for a GC is between $30,000 and $100,000 or more. In addition to payment for the GC, you may also have (depending on the GC's insurance coverage and other factors):
- Pregnancy care and delivery costs
- IVF costs
- Agency fees
- Legal fees
Side effects or risks: Being a GC can be an intensely emotional process that can take 18 months or longer from matching to delivery. There are also major legal aspects to deal with. It’s in the best interest of parents and gestational carriers to have a contract spelling out details like parental rights and custody, as well as medical treatment during pregnancy and labor and delivery.
And it’s important to note that state laws vary when it comes to gestational carrier pregnancy. In fact, some states are restrictive and/or don't recognize legal contracts. Be sure to check your state laws.
"Our process (despite successful egg retrieval and being a match with a surrogate within a month) took us exactly two years," says Community mom epistrong. "Our total expenses (including IVF) was about $130K."
How does egg freezing work?
Egg freezing involves retrieving a woman’s eggs in a procedure similar to IVF, then freezing and storing them. When you’re ready to have a baby, the eggs are thawed, fertilized, and implanted in your uterus. Medically, egg freezing is called oocyte cryopreservation.
Can be good for: Egg freezing might be worth considering if you know that you want children at some point but not for a while. It can also be a good option for women undergoing cancer treatment or those with a family history of early menopause, endometriosis, or ovarian cysts.
Success rates: Women in their 20s and early 30s have the best chance of retrieving, freezing, and storing healthy eggs. And those who freeze more eggs have the highest odds of successful fertilization later on. Here are the success rates for women who freeze at least 20 eggs:[9]
- 89% for women younger than 35
- 80% for women 35 to 37
- 73% for women 38 to 40
Average cost: The cost for one retrieval cycle runs between $10,000 and $20,000, which typically covers medication for hormone stimulation, the egg retrieval, and lab processing. But keep in mind that it may take more than one cycle to collect enough eggs.
You'll also need to add annual storage fees of between about $500 and $1,000 (depending on where you live). And — when you're ready to use the eggs — you'll have to pay for the thawing, as well as the cost of the IVF procedure to transfer the embryo to your uterus.
Side effects or risks: The majority of women who’ve frozen their eggs haven’t used them yet, and experts don’t know much about how long frozen eggs will remain viable in storage.
Also, as with traditional IVF, you have to take fertility drugs, which can have unpleasant side effects. And the procedure itself is invasive.
What are fertility drugs?
Fertility drugs are taken at the start of IVF, but you can also take them on their own for ovulation issues. For example:
- Oral meds like Clomid (clomiphene citrate) and Femara (letrozole). These are used to stimulate the ovaries and correct irregular ovulation. They work by suppressing estrogen production, which boosts the production of ovulation-stimulating hormones.
- Gonadotropins. If oral medications don't work, these hormone shots can be used to directly stimulate ovulation.
- Metformin. If your irregular ovulation is caused by PCOS, this drug may be another option. While it’s normally used to treat diabetes, Metformin works to sensitize insulin levels, which can help women with PCOS achieve more regular ovulation.
Can be good for: If IUI alone hasn't worked, combining it with fertility medications may improve your chances. You can also take fertility drugs while trying to conceive on your own without IUI or IVF.
"We moved to Clomid, and my ovaries responded great!" says Community mom Jelly_Belly_Bean. "Our first IUI took! It was a rough pregnancy, but we now have a beautiful year-old boy and are about to try IUI again this month to try for a sibling for the little guy!"
Fertility drugs can be a particularly good choice for women with ovulation issues related to PCOS. In fact, the American College of Obstetricians and Gynecologists (ACOG) recommends letrozole as a first-line treatment for PCOS-related infertility.[10]
Success rates: Successful pregnancy rates with fertility medications depend on the drug. Per cycle, live births occurred using:
- Gonadotropins: 35.5%
- Clomid (clomiphene citrate): 28.3%
- Femara (letrozole): 22.4%
"I was diagnosed with unexplained infertility after trying for over a year with our first," says Community mom huskypupmom. "We now have two healthy boys, both conceived with letrozole and timed intercourse cycles."
Average cost: Oral medications cost between about $30 and $130 or more per cycle for IUI. Injectable medications for IUI cost about $3,000 to $5,500 per cycle. IVF medications can range from $3,000 to $8,000 per cycle for injectable gonadotropins.
Side effects or risks: You might experience side effects such as bloating, nausea, headaches, mood swings, or breast tenderness. Hormone shots also come with a slight risk of ovarian hyperstimulation syndrome, where the ovaries become swollen and painful.
Fertility drugs increase the odds for multiples, too, since they could cause two or more eggs to be released at a time.
If you're exploring fertility treatment, talk with your doctor or a fertility specialist about your options. Together, you can weigh the benefits, risks, costs, and success rates to find the approach that best fits your medical needs and family-building goals.
"There's hope for unexplained infertility, and I'm proof that medically assisted conception works!" says Community mom ellenoduncan, who conceived her daughter via IVF.
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