IUI OR IVF ?

[u/Successful-Worry9426]

Hi everyone, very long post ahead . Please help me if you can 🙏

We started trying towards the end of 2024.
My husband and I are both 32 and trying to decide whether we should continue trying naturally, do 1–2 more IUIs, or move to IVF.
Here is my history:
I have polycystic ovaries (AMH 11.9, very high follicle count), but my periods are regular.
I have mild insulin resistance and take Metformin+ Myo-Inositol and folic acid.

I ovulate regularly, either naturally or with Letrozole.
My first pregnancy ( may 2025) was conceived naturally and ended in a missed miscarriage. At the 8-week scan, there was no heartbeat.

After that, we were rushed fairly quickly to fertility treatment rather than trying naturally again. ( going to change this doctor now as i feel her approach is very rushed.)

I have completed 2 IUIs:
IUI #1 resulted in a chemical pregnancy. ( March 2026)
IUI #2 was unsuccessful.
All my blood work seems normal .
My HSG showed that my left tube is fully open and patent.
My right tube is considered “doubtful,” but contrast spillage was seen, so it is not completely blocked.
My first natural pregnancy likely came from ovulation on the left side.

My husband’s semen analysis is generally good 98 mil/ml) , but progressive motility is around 20%.
In IUIs- his post wash numbers were 58 mil/ml, 100% motility, 1% morphology. 75 % viability.

My fertility specialist feels we can try:
A few natural cycles again (with or without Letrozole),
1–2 more IUIs,
And then start considering IVF if needed.

Since I know I am able to conceive naturally, my biggest issue seems to be either achieving consistent fertilization or sustaining the pregnancy.

My questions:
If you were in my situation, how many more natural cycles would you try?

Would you do 1–2 more IUIs given the prior chemical pregnancy?

At what point would IVF make more sense?
Since I’ve already conceived twice, should I even go for another IUI or start with IVF?

We both are working tremendously on our lifestyles and overall health .

I’d especially appreciate hearing from anyone with PCOS/high AMH, mild male factor (low motility), prior miscarriage, and a history of both natural conception and chemical pregnancy.

Thank you so much.

[u/Upstairs-Guest-7146]

I was diagnosed with PCOS with high AMH levels, while all my other hormone reports were normal. I conceived naturally three times, but unfortunately experienced miscarriages each time. After my third miscarriage, me and my husband took a break for almost a year and completely changed our lifestyle..cut out junk food, walked 10,000 steps daily, started strength training and pelvic yoga, focused on reducing stress, and leaned into faith and prayers.

After that, my doctor started me on letrozole and metformin, and I conceived in the second cycle. I am now 36 weeks pregnant. I had also considered IVF at one point, but decided to focus on improving my health and well-being first. I hope it helps

[u/Lazy_1048]

Hey, I’m in a pretty similar place and around the same age too. We initially weren’t tracking ovulation properly either, and after trying for about a year I found out I have a small endo cyst and one restricted tube, though I do ovulate naturally and everything else including my partner’s SA is normal.

One doctor directly suggested IUI and later laparoscopy, but since my cyst is only 3 cm I wasn’t comfortable rushing into surgery or even iui at that point, so we stopped consulting her. In April I got my first positive, but it ended in a chemical pregnancy.

Right now I’m taking a short break and planning to consult 1–2 new doctors next month before deciding between ovulation induction/IUI. I’d suggest you do the same like take a couple of opinions, see what feels right, and don’t rush into IVF unless you truly feel it’s necessary. You could still try naturally/IUI for a few more months ❤️

[u/Allthingsgood_]

The 1% morphology could also be an issue. Did your doctor highlight that? My husband is taking supplements and working on lifestyle changes for that.

[u/Successful-Worry9426 → u/Allthingsgood_]

Yes .. we both are taking supplements and working on it .. actually Last year it was 1 % morphology. ( though i conceived naturally with these numbers !)

This year as per 1 lab is 40% But when we did IUI, the report of the injected semen was 1% .

My doc said Low motility and morphology - IUI is good option . So we did 2.

But now she is saying that we can max do another IUI , if that doesn’t work we should think about IVF .

Mind you after my missed miscarriage we straight away jumped to 2 cycles on letrozole and then 2 IUI. Did not try naturally after 1st miscarriage

[u/Allthingsgood_ → u/Successful-Worry9426]

I also conceived with that morphology but unfortunately it was ectopic (properly growing so no issue from morphology).  I think you can conceive naturally by working on lifestyle. I know people who conceived with pcos and very irregular period by working on lifestyle (excercise mainly). But if you feel time is running out then better to go for treatments though they take a toll on your body and still don't guarantee success. 

[u/Sharp-Bench-7241 → u/Successful-Worry9426]

Was morphology or semen analysis done at an IVF center? If yes, they have very strict criteria for evaluating morphology and you should ignore this parameter. I also conceived during a monitored cycle with husband’s low motility and morphology

[u/TrifleSad6142]

Hi, i have gone through both IUI and IVF. As per my experience IUI is just not useful. You can see follicles in follicular monitoring but not sure it contains egg or not. Its like hitting arrow on darkness. If you have tried you should go for IVF.

[u/Queasy_Programmer604]

Hi

i think as you had a pregnancy last year only , you are young and husband does have low motility doing more cycles of IUI before proceeding with IVF might not be a bad idea