For many patients, the path to parenthood starts with less invasive fertility treatments known as timed intercourse (TIC) and intrauterine insemination (IUI). Both treatments tend to be less expensive than IVF and require fewer medications and monitoring appointments. But the question is, what’s the difference between the two cycle types and how do I know what’s right for me?
TLDR: The two cycles are very similar, except at the end. During an IUI, an intrauterine insemination procedure is scheduled around ovulation; During TIC, patients plan to have intercourse around the time of ovulation.
What is Timed Intercourse (TIC)?
In a timed intercourse cycle, your doctor will prescribe medication, commonly Clomid or Letrozole (or sometimes gonadotropins), to help your body grow one or a few follicles in preparation for ovulation. Each follicle contains an egg that is maturing as the follicle grows in size.
After taking the medications that stimulate the follicles to grow, you’ll either be instructed to start using ovulation predictor kits (OPK) at home to detect ovulation or go into the clinic for ultrasound and bloodwork monitoring. Detecting ovulation helps you plan when to have sex to have the highest likelihood of fertilizing the egg(s) that is ovulating.
OPKs detect the surge of luteinizing hormone (LH) that triggers ovulation. Ovulation typically occurs 24-36 hours after the peak LH surge.
An example of an ovulation predictor kit (OPK)
When patients get a positive ovulation predictor kit (OPK) result, clinics typically recommend one of two options:
Have sex on the day of the positive test and again the next day, or
Have sex every other day for three days, starting on the day of the positive test.
In some treatment protocols you’ll be prescribed a progesterone medication that you’ll start after ovulation to help support the implantation and maintain the pregnancy. Two weeks after ovulation you’ll take a pregnancy test to see if the cycle worked.
Something to keep in mind when exploring your options is that each doctor and treatment protocol are different. Some doctors are relatively hands-off during TIC cycles, where little to no ultrasound monitoring takes place. Other doctors prefer to monitor progress through more frequent ultrasound and bloodwork appointments. The same goes for medications. Some TIC cycles simply involve an oral pill taken to stimulate follicle growth, where others require medication to stimulate follicles, a trigger shot to trigger ovulation, and progesterone medication after ovulation. Make sure to talk to your doctor about what type of monitoring and medications they suggest for you.
Who is Timed Intercourse For?
Timed intercourse is a great option for:
Someone who doesn’t ovulate regularly on their own (like PCOS)
Someone who has unexplained infertility
Someone with a normal semen analysis
Someone without structural abnormalities that interfere with fertilization or implantation (no fallopian tubes, blocked fallopian tubes, uterine abnormalities etc.)
Someone who doesn’t have pain or difficulty having sex
Timed intercourse is considered to be the least expensive and least invasive form of fertility treatment. Depending on your diagnosis, it might be a great place to start as you begin your fertility journey.
What does a timed intercourse cycle cost?
The cost of a timed intercourse cycle depends on what type of medication and how many monitoring appointments you will have during your cycle. All in all, you’ll likely pay between $1,000 and $2,000 per cycle.
What is an Intrauterine Insemination (IUI)?
An IUI cycle looks very similar to a timed intercourse cycle, but the key difference lies at the end. The IUI cycle usually involves the same medications, Clomid and Letrozole (or sometimes gonadotropins), taken around the same time, and either OPKs or ultrasound monitoring to detect ovulation. The difference between IUI and TIC comes after ovulation is either detected through OPK or triggered with a trigger shot. At this point in an IUI cycle, an intrauterine insemination procedure is scheduled rather than planned intercourse like in TIC.
The IUI is an in-office procedure where the best quality sperm are placed in the uterus 24-36 hours after detecting or triggering ovulation. In order to get the best quality sperm, a member of the andrology lab team will perform a sperm wash. The wash helps separate the best and most motile sperm to be used for the IUI.
During the IUI, the doctor will insert a speculum in the vagina to visualize the cervix. Then the doctor threads a thin, flexible plastic catheter through the cervical opening and injects the sperm through the catheter into the uterus. The IUI helps to put the best quality sperm into the uterus to increase the likelihood that at least one of those sperm can reach the egg in order to fertilize it.
After the IUI, your doctor may instruct you to take progesterone medication to support the pregnancy. You’ll take a pregnancy test 2 weeks after the IUI to see if the cycle was successful.
As with TIC, every doctor and every IUI protocol are different. Some IUI cycle protocols require more medications and more monitoring than others. You can discuss the options with your doctor and determine what will work best for you.
Did you know there are unmedicated treatment cycles?
If you ovulate regularly, you may be able to do a TIC or an IUI cycle without taking any medication to stimulate your ovaries to grow a follicle. During unmedicated cycles, you’ll monitor the growth of the follicle your body naturally selected to grow that month and possibly use a trigger to confirm ovulation. Then you’ll either time intercourse or plan the IUI procedure accordingly. Unmedicated TIC and IUI cycles may sometimes include progesterone medication to supplement the body’s natural progesterone production.
Who is IUI For?
IUI is a great option for:
Someone who doesn’t ovulate regularly on their own (like PCOS)
Someone who has unexplained infertility
Someone with a normal or mildly abnormal semen analysis
Someone without structural abnormalities that interfere with fertilization or implantation (no fallopian tubes, blocked fallopian tubes, uterine abnormalities etc.)
Same sex female couples or single mothers by choice (using donor sperm)
Someone who does not tolerate vaginal sexual intercourse
What does an IUI cycle cost?
The cost of an IUI cycle depends on what type of medication and how many monitoring appointments you will have during your cycle. Depending on the cycle type, you’ll likely pay between $500 and $4,000 per cycle.
Both TIC and IUI cycles are great options for those trying to conceive without jumping straight to IVF. They’re both less expensive, usually require less in-office monitoring, and tend to involve fewer medications than IVF. Your doctor can talk you through the pros and cons of IUI and timed intercourse cycles and help you decide which is the best for you.