Before IUI or IVF: Have You Looked at the Biology First?
A recent Washington Post article stopped me in my tracks.
It described American couples traveling to Europe for IVF because fertility treatment has become so expensive in the United States that, in some cases, couples can travel overseas, receive treatment, and still spend considerably less than they would for IVF at home.
One couple featured in the article had been quoted $40,000 for one round of IVF in Florida. They ultimately traveled to Greece, where they reported spending about $12,000 on treatment, excluding travel expenses.
The article also cited a recent estimate of more than $29,000 for a single IVF cycle in the United States, with additional expenses potentially pushing the cost considerably higher.
As someone who has personally gone through infertility treatment and IVF, I understand the desperation behind those numbers, my fertility journey totaled $90,000+ about 10years go without any help from insurance.
When you want a baby, you'll do anything. And I want to make something very clear: I am not anti-IVF. IVF is an incredible fertility advancement that gave me my family but it is not always the first answer when you can't conceive.
There are situations where IVF is absolutely necessary and where delaying treatment to pursue months or years of alternative approaches would not be appropriate.
But this article reminded me of one of the biggest reasons I created Vital Fertility.
Before we spend tens of thousands of dollars trying to overcome a fertility problem, I want to make sure we've thoroughly investigated the biology that may be contributing to it because in the long run your biology and genetics gets passed on to your offspring and who doesn't want healthy offspring?
What if IVF or IUI is already the right next step?
Then I want to help create the healthiest biological environment possible going into treatment.
Vital Fertility Is the Step Before, or Alongside, IUI and IVF
I don't see functional fertility care as a replacement for reproductive endocrinology. I see these two types of care as doing different jobs.
A reproductive endocrinologist is incredibly skilled at reproductive technology.
They can stimulate the ovaries, monitor follicle development, retrieve eggs, fertilize eggs in a laboratory, create embryos, perform embryo transfers, and use assisted reproductive technology to help overcome barriers to conception.
My job is different.
I want to understand the biological environment those eggs, sperm, embryos, and eventually pregnancies are developing within.
- Why isn't ovulation happening consistently?
- Why is progesterone low?
- How is the thyroid functioning?
- What is happening with insulin and blood sugar regulation?
- Is inflammation elevated?
- Are there nutrient deficiencies or insufficiencies?
- What does the semen analysis actually show?
- And if the basic semen analysis looks reassuring, is there a reason to investigate sperm DNA fragmentation or other aspects of male fertility?
- Is the vaginal microbiome supportive?
- Are there signs that endometriosis, uterine factors, tubal factors, or other structural issues need further evaluation?
- And when the foundational work looks good but pregnancy still isn't happening, are there deeper factors worth investigating?
Functional fertility medicine means starting with the foundation, identifying what actually deserves attention, addressing what is modifiable, and then deciding whether we need to look one layer deeper.
What Does a Complete Fertility Workup Actually Include?
Before talking about “root causes,” I think it's important to make sure the conventional fertility evaluation has actually been completed.
Depending on the individual or couple, that may include evaluation of:
- Ovulation and menstrual-cycle patterns
- AMH and ovarian reserve
- FSH, LH and estradiol
- Thyroid function
- Prolactin
- Progesterone at the appropriate point after ovulation (usually 7 days after your ovulation).
- Semen analysis and male-factor fertility
- Fallopian-tube patency, often evaluated with an HSG when indicated
- Pelvic or transvaginal ultrasound when appropriate
- Uterine abnormalities
- Hysteroscopy if indicated
- Endometriosis or other pelvic pathology when symptoms or history warrant further evaluation
Some of these evaluations may be ordered or reviewed through my practice, while imaging, procedures, and specialist evaluations are coordinated with the appropriate reproductive endocrinologist, OB-GYN, urologist, radiology center, or other specialist.
Because functional medicine shouldn't replace an appropriate medical fertility workup. What it does is help us make that workup more complete!
What About IUI?
IUI deserves a little nuance. Intrauterine insemination can be helpful for selected couples, including some cases involving mild male-factor infertility, especially where motility is an issue and unexplained infertility.
For couples with unexplained infertility, the American Society for Reproductive Medicine recommends a typical initial course of three or four cycles of ovarian stimulation with oral medication plus IUI before moving to IVF if those attempts are unsuccessful. ASRM does not, however, recommend natural-cycle IUI for unexplained infertility because evidence suggests it is likely no more effective than expectant management.
But here's the distinction I want my patients to understand: IUI is a treatment. It isn't necessarily an explanation.
IUI can increase the number of motile sperm reaching the uterus at the appropriate time, and when combined with ovarian stimulation, it can increase the number of available eggs.
What it doesn't necessarily tell us is why pregnancy hasn't happened.
And for a couple who has been diagnosed with “unexplained infertility,” that's an important distinction.
When Everything Is “Normal,” but You're Still Not Pregnant
This is one of the groups of patients I feel most passionate about helping, because this was me!!
- You've been trying.
- You've had the basic fertility workup.
- You're ovulating.
- At least one fallopian tube is open.
- The semen analysis is considered adequate.
- Nothing obvious explains why pregnancy isn't happening.
And now you're being presented with the next steps:
IUI → IUI → IUI → IVF.
There is nothing inherently wrong with that treatment pathway. In fact, ASRM's evidence-based recommendations support ovarian-stimulation IUI followed by IVF for many couples with unexplained infertility.
But “unexplained” doesn't necessarily mean there is nothing contributing.
Sometimes it means the standard evaluation hasn't identified an explanation.
That's where I think there's room for another conversation.
- Are there modifiable factors we haven't investigated?
- Is there something affecting egg or sperm health?
- Is metabolic health optimized?
- Are there thyroid or nutrient issues?
- Is there significant inflammation?
- Are there clues in the menstrual cycle?
- Does the male partner need a more comprehensive evaluation?
- Is there a reason to investigate the vaginal microbiome?
- Does the history suggest endometriosis or another condition that deserves specialist evaluation?
- And if the foundational pieces have already been addressed, is there a reason to investigate deeper?
Sometimes we find something meaningful. Sometimes we don't.
And sometimes the conclusion after doing this work is: IVF really is the best next step. That's valuable information too.
Functional Fertility Care Shouldn't Keep You From IVF
This is extremely important to me. I never want functional medicine to become another endless detour for someone trying to have a baby.
- Time matters in fertility.
- Age matters.
- Ovarian reserve matters.
- Tubal status matters.
- Severe male-factor infertility matters.
- Certain reproductive diagnoses matter.
There are situations where I would absolutely encourage someone to establish care with a reproductive endocrinologist rather than spend months trying supplements, diets, or alternative treatments hoping to avoid IVF. The goal isn't to avoid IVF at all costs. The goal is to use it thoughtfully when it's needed.
If IVF Is the Right Next Step, Let's Prepare for It
There is another group of patients I work with who already know IVF is their next step.
- Maybe both tubes are blocked.
- Maybe there is severe male-factor infertility.
- Maybe age or ovarian reserve makes time particularly important.
- Maybe previous treatments have failed.
- Maybe genetic testing requires IVF.
- Or perhaps they've already decided that IVF is simply the path that makes the most sense for their family.
For those patients, my role changes slightly but not much because at the root of my care I will always try to optimize and build resilience in the body... so I'll ask:
“How can we support your health and fertility going into IVF?”
That may mean looking at metabolic health, thyroid function, nutrient status, inflammation, sperm health, lifestyle factors, sleep, environmental exposures when relevant, and other modifiable pieces of the fertility picture.
None of that guarantees that an IVF cycle will work.
There is no supplement, diet, functional laboratory test, or “perfect” protocol that can promise a healthy embryo or successful pregnancy.
But when someone is preparing to invest enormous financial, physical, and emotional resources into fertility treatment, I believe it is reasonable to make sure we're paying attention to the health of both partners and addressing meaningful modifiable factors where we can.
And Yes, We Need to Talk About the Cost. This brings me back to that Washington Post article.
Americans are traveling internationally for fertility care because the financial burden of IVF in the United States has become extraordinary.
The article describes growing interest in countries such as Greece and Spain and highlights not only the potential savings, but also some of the logistical and regulatory challenges that come with receiving fertility treatment abroad.
That shouldn't make anyone feel guilty for needing IVF. And it certainly shouldn't suggest that spending money on functional medicine first guarantees you'll avoid it. It doesn't.
But it does reinforce something I believe deeply:
Before making one of the largest medical investments of your life, you deserve to understand as much as reasonably possible about your fertility.
Not just hers. His too.
Not just whether you're ovulating. But how well.
Not just whether sperm are present. But whether they are optiized for fertilization to occur.
Not just whether your labs fall inside a reference range.
But whether there are clinically meaningful patterns worth addressing.
And not endless testing for the sake of testing.
The right testing, for the right person, at the right time.
There Are Really Three Paths
When couples come to me, every fertility roadmap is different and individualized.
Sometimes our work leads to:
- Path 1: Try naturally a little longer.
We identify and address meaningful factors, improve the foundational biology, and there is a reasonable window to continue trying naturally.
Sometimes it's:
- Path 2: Optimize while pursuing IUI or IVF.
Treatment makes sense, and our work happens alongside the fertility clinic rather than instead of it.
And sometimes it's:
- Path 3: Don't wait.
The history, age, ovarian reserve, tubal status, sperm parameters, diagnosis, or other factors tell us that reproductive technology deserves to move to the front of the plan.
That is what individualized fertility care should look like.
Maria's Clinical Insight
I've experienced infertility from both sides of the exam room.
I know what it's like to be the patient who wants answers.
I know what it's like to spend an enormous amount of money trying to build a family and put off vacations, remodels, new cars, etc.
And now, as a functional clinician, I also understand how many different systems can influence reproductive health.
That's one of the reasons I created Fertility Jumpstart and Fertility Mastery.
I wanted to create the type of care I wish I'd had before and during my own fertility treatment.
Not someone promising me that I could avoid IVF.
Not someone telling me IVF was my only option without asking any additional questions.
But someone who could stand in the middle and say:
Let's make sure we've looked at the whole picture.
If there's something meaningful and modifiable, let's address it.
If you need IVF, let's support you going into it.
And if your reproductive endocrinologist and I need to work alongside one another, even better.
Vital Fertility is not the alternative to IUI or IVF.
We are the step before it, or the support alongside it.
And after reading about couples traveling across the world because IVF at home has become so expensive, I couldn't help thinking:
Maybe Europe still gets to be part of your story. I just hope it gets to be the babymoon instead.
Frequently Asked Questions
- Should I try functional fertility care before IVF?
It depends on your individual situation. For some couples, there may be time to investigate and address modifiable fertility factors before pursuing assisted reproductive technology. For others, age, ovarian reserve, tubal disease, severe male-factor infertility, genetic considerations, or another diagnosis may make it important to involve a reproductive endocrinologist promptly.
Functional fertility care can also be used alongside IVF preparation rather than instead of IVF.
- What should be checked before IVF?
An appropriate pre-IVF evaluation depends on your history and diagnosis. Foundational areas may include ovarian reserve and ovulation, thyroid and metabolic health, nutrient status, semen parameters and male fertility, uterine and tubal factors, and other testing indicated by the couple's history.
Additional functional testing should be individualized rather than automatically ordered for every patient.
- Is IUI only helpful for male-factor infertility?
No. IUI may be used for mild male-factor infertility and is also commonly combined with ovarian stimulation for unexplained infertility. ASRM recommends a typical course of three or four cycles of ovarian stimulation with oral medications and IUI for many couples with unexplained infertility before moving to IVF if unsuccessful.
- Can functional medicine improve IVF success?
Functional fertility care can identify and address potentially modifiable aspects of health, but it cannot guarantee IVF success. IVF outcomes are influenced by many factors, including age, embryo genetics, ovarian reserve, sperm factors, reproductive diagnoses, and chance/alignment. The goal is to identify clinically meaningful factors that can reasonably be addressed, not to promise an outcome.
- Do you work with couples after failed IUI or IVF?
Yes. In fact, this can be an important time to pause and take a more comprehensive look at the fertility picture before moving directly into another treatment cycle. An unsuccessful IUI or IVF cycle doesn't necessarily mean something was done wrong, and unfortunately, even well-planned fertility treatments don't guarantee pregnancy. But it can give us an opportunity to ask whether there are modifiable factors that haven't been fully evaluated or addressed.
The Bottom Line
IUI and IVF are incredibly valuable tools.
Sometimes they are exactly what a couple needs.
But assisted reproductive technology and investigating fertility biology don't have to be opposing approaches.
You can investigate before treatment.
You can optimize alongside treatment.
And you can move to IVF when IVF is the right tool.
My goal isn't to keep you out of the fertility clinic.
It's to help make sure that when you walk into it, we've asked the questions worth asking first.
Not Sure What Your Next Step Should Be?
If you've been trying to conceive, your basic fertility workup hasn't provided enough answers, you're considering IUI or IVF, or you want to prepare your health before your next fertility treatment, this is exactly where Vital Fertility fits.
The Fertility Foundational, Jumpstart and Fertility Mastery programs were designed to investigate foundational and, when appropriate, deeper factors affecting fertility for both partners, before treatment or alongside your reproductive endocrinologist.