What are infertility treatments? Comparing your options for timed intercourse, IUI & IVF

Part 5, Podium & Parenthood: Fertility & family planning webinar series

Updated September 27, 2026.

Presented by Markham Fertility Centre in partnership with Canadian Sport Institute Ontario (CSIO).

Infertility affects approximately 1 in 6 couples in Canada (Government of Canada, 2021), making it one of the most common reproductive health challenges faced today. The emotional, physical, and financial impact of infertility can be overwhelming, but the good news is that many effective treatment options are available to help individuals and couples build the family they dream of.

In this comprehensive guide, we will explore three of the most common infertility treatments used in Canada and around the world: Timed intercourse (TIC), intrauterine insemination (IUI), and in vitro fertilization (IVF). Whether you’re just beginning to seek answers or are already on your fertility journey, this resource will help you better understand the options, the processes involved, and what to expect every step of the way.

We will cover the following related to infertility treatments: 

1. What is infertility?
2. Infertility treatments: Why early evaluation matters
3. Timed intercourse (TIC)
4. Intrauterine insemination (IUI)
5. In vitro fertilization (IVF)
6. Emotional wellbeing and support
7. Cost: Financial considerations (Canada & Ontario) 
8. Comparing your options: Timed intercourse, IUI and IVF

See Part 1, Podium & Parenthood: Fertility 101

See Part 2, Podium & Parenthood: Fertility Preservation

See Part 3, Podium & Parenthood: Understanding the Menstrual Cycle

See Part 4, Podium & Parenthood: Third-Party Reproduction?: Egg donor, sperm donor, embryo donor & surrogacy

What is Infertility?

Infertility is defined as the inability to achieve pregnancy after 12 months of regular, unprotected sexual intercourse. For individuals over the age of 35, infertility may be diagnosed after just 6 months due to the natural age-related decline in fertility.

Infertility can be caused by factors involving:

• The female reproductive system (ovulatory disorders, blocked fallopian tubes, uterine issues)
• The male reproductive system (low sperm count, poor motility, structural abnormalities)
• Combined or unexplained factors (when no specific cause is identified)

In Canada, the Society of Obstetricians and Gynaecologists of Canada (SOGC) recognizes infertility as a significant reproductive health concern deserving timely evaluation and treatment (SOGC, 2020).

Infertility Treatments: Why Early Evaluation Matters

The earlier an infertility evaluation is done, the sooner a treatment path can be identified. This is particularly important because fertility declines with age, especially after 35 for women, and to a lesser extent for men.

A typical infertility assessment may include:

• Medical and sexual history
• Blood tests to assess hormone levels
• Ultrasound imaging of reproductive organs
• Semen analysis for male partners
• Specialized testing as needed (e.g., hysterosalpingogram or laparoscopy)

Infertility Treatment Pathways: An Overview

The three primary infertility treatment pathways most commonly used for infertility are:

1. Timed Intercourse (TIC)
2. Intrauterine Insemination (IUI)
3. In Vitro Fertilization (IVF)

Each treatment has specific indications, success rates, and considerations, which we will explore in detail.

Infertility Treatment: Timed Intercourse (Cycle Monitoring)

Timed intercourse is the least invasive and often simplest fertility treatment. It involves careful monitoring of ovulation to ensure that sexual intercourse occurs during the most fertile days of the menstrual cycle.

What is Timed Intercourse (TIC)?

Timed intercourse focuses on the fertile window—the 5 days leading up to ovulation and the day of ovulation itself. Since sperm can live inside the female reproductive tract for up to 5 days, and the egg survives for about 12–24 hours after ovulation, timing is critical.

This strategy is ideal for individuals or couples dealing with:

• Mild ovulatory issues (ie prolonged cycles)
• Irregular menstrual cycles

How Ovulation is Tracked: Key Definitions

1. Ovulation Predictor Kits (OPKs): These home urine tests detect the surge in luteinizing hormone (LH), which occurs 24–36 hours before ovulation. A positive test indicates the most fertile time for intercourse.
2. Ultrasound Follicle Tracking: In clinical settings, transvaginal ultrasound is used to track the size of ovarian follicles (fluid-filled sacs containing eggs). Follicles typically grow to 18–24mm before ovulation.
3. Hormone Bloodwork: Blood tests monitor estradiol, LH, and progesterone to confirm ovulation and assess cycle health.

Medications for Timed Intercourse

Timed intercourse can be natural (unmedicated) or involve ovulation induction with medications such as:

• Letrozole (Femara): An aromatase inhibitor that stimulates ovulation by increasing Follicle Stimulating Hormone (FSH) production.
• Clomiphene Citrate (Clomid): An older oral medication that triggers ovulation by influencing the hypothalamus and pituitary gland.

These medications are particularly beneficial for individuals with irregular ovulation or conditions like Polycystic Ovary Syndrome (PCOS).

What Does the Process Look Like?

1. Initial consultation and cycle assessment
2. Baseline ultrasound and hormone testing
3. Daily monitoring of follicle growth
4. At-home OPK use or in-clinic confirmation of LH surge
5. Recommendations for timed intercourse (usually over 2–3 days around ovulation)

Success Rates for Timed Intercourse

• Women under 35: 10–15% chance of conception per cycle
• Success rates decrease with age
• Typically recommended for 3–6 cycles before escalating to other treatments

Pros and Cons

Pros:

• Low cost
• Non-invasive
• Natural or low-medication option

Cons:

• Lower success rates
• Requires regular monitoring
• Does not address more complex infertility issues

Infertility Treatment: Intrauterine Insemination (IUI)

What is Intrauterine Insemination (IUI)?

Intrauterine insemination (IUI) is a fertility treatment that involves placing specially prepared sperm directly into the uterus around the time of ovulation. It increases the number of sperm that reach the fallopian tubes and facilitates fertilization.

Who May Benefits from IUI?

IUI is commonly used for:

• Couples with mild male factor infertility
• Couples with coital factor infertility 
• Individuals using donor sperm
• Couples with unexplained infertility

The IUI Process

1. Cycle Monitoring: The cycle may be natural (unmedicated) or involve ovulation induction with medications such as Letrozole or Clomid.
2. Ovulation Trigger: A trigger shot of human chorionic gonadotropin (hCG) may be given to precisely time ovulation.
3. Sperm Preparation: On the day of insemination, a semen sample is collected and processed in the lab to isolate the highest quality motile sperm.
4. Insemination Procedure: A thin catheter is used to place the sperm directly into the uterus. This procedure is quick, typically painless, and performed in a clinic setting.
5. Two-Week Wait: A blood test confirms pregnancy approximately two weeks after the procedure.

Success Rates

IUI success rates vary but are generally:

• Under 35: 10–20% per cycle
• Over 35 or those with significant fertility challenges: Reduced success, but cumulative success improves over multiple cycles.

Definitions:

• Sperm washing: Laboratory process to separate motile sperm from seminal fluid and debris.
• Trigger shot (hCG): Mimics natural LH surge to trigger ovulation.

Pros and Cons:

Pros: Non-surgical, higher pregnancy rates than timed intercourse, suitable for various situations.
Cons: Lower success rates than IVF, requires multiple clinical visits.

Infertility Treatment: In Vitro Fertilization (IVF)

What is In Vitro fertilization (IVF)?

In vitro fertilization (IVF) is one of the most well-known and effective forms of assisted reproductive technology (ART). IVF involves retrieving eggs from the ovaries, fertilizing them with sperm in a laboratory, and then transferring a resulting embryo into the uterus.

IVF is often used when:

• Failed prior treatments: Other treatments such as timed intercourse or IUI have been unsuccessful
• There is severe male factor infertility
• There are blocked or damaged fallopian tubes
• Endometriosis or other pelvic factors are present
• Patients are using donor eggs, embryos, or surrogacy
• Advanced maternal age
• Recurrent pregnancy loss (RPL)

The IVF Process

IVF involves several key steps, which are carefully coordinated by a fertility clinic:

1. Ovarian Stimulation

Patients take injectable fertility medications for about 10–12 days to stimulate the ovaries to produce multiple eggs. Monitoring is done via bloodwork and ultrasound.

2. Trigger Shot and Egg Retrieval

When the follicles are mature, a trigger shot is given to prompt final egg maturation. Approximately 36 hours later, the eggs are retrieved during a short outpatient procedure performed under sedation.

3. Fertilization and Embryo Culture

The retrieved eggs are combined with sperm in the lab:

• Conventional IVF involves mixing eggs and sperm in a petri dish
• ICSI (Intracytoplasmic Sperm Injection) involves injecting a single sperm directly into each egg (used especially in male factor infertility)

Fertilized eggs are then cultured in the lab for 5–7 days to develop into embryos.

4. Embryo Transfer

A high-quality embryo is selected and transferred into the uterus using a thin catheter. The embryo transfer is usually painless and requires no sedation.

Some patients may opt for elective embryo freezing and transfer in a later cycle (known as a frozen embryo transfer or FET).

5. Pregnancy Testing

A blood test is performed about 10–14 days after the embryo transfer to confirm pregnancy.

Additional IVF Options

• Preimplantation Genetic Testing (PGT): Screening embryos for genetic conditions before transfer.
• Donor Egg or Sperm: Used when egg or sperm quality is severely compromised or absent.
• Gestational Surrogacy: When a surrogate carries the pregnancy using an embryo created from the intended parent(s).

Additional Options:

• Preimplantation Genetic Testing (PGT): Screens embryos for chromosomal issues.
• Egg/Sperm Donation: Used when needed for genetic or fertility reasons.
• Gestational Surrogacy: When the intended parent cannot carry a pregnancy.

IVF Success Rates:

• Under 35: 40–50% per embryo transfer
• 35–37: 35–40%
• 38–40: 25–30%
• Over 40: 10–20%

Source: Canadian Fertility & Andrology Society

Pros and Cons:

Pros: Highest success rates, genetic screening options.
Cons: Costly, physically and emotionally demanding, invasive procedures. invasive procedures.

Emotional Wellbeing and Support

The infertility journey often brings significant emotional stress, including:

• Feelings of loss or grief
• Anxiety about medical procedures
• Isolation or misunderstanding from others

Mental health support is crucial. Resources include:

• Fertility counsellors
• Peer support groups like Oasis Fertility Support Network and Informed Fertility
• Online communities and educational webinars

Financial Considerations (Canada & Ontario)

Infertility treatments in Canada are expensive. Costs include:

• Timed Intercourse: Minimal cost if unmedicated; low cost with medication.
• IUI: Approximately $1,560–$3,500 CAD per cycle.
• IVF: Approximately $10,000–$20,000 CAD per cycle in Ontario.

Public Funding:

• The Ontario Fertility Program (OFP) covers one funded IVF cycle per eligible patient but does not cover medications, donor gametes, or surrogacy costs (Ontario Ministry of Health, 2023).

Many insurance plans in Canada do not cover fertility treatment, making financial planning essential.

Comparing Your Treatment Options

Treatment	Best For	Involves Medication	Invasive?	Approx. Success Rate
Timed Intercourse	Ovulatory issues	Sometimes	No	5–15% per cycle
IUI	Mild male factor, donor sperm, cervical issues	Often	Mildly (catheter insertion)	10–20% per cycle
IVF	Severe infertility, older age, failed prior treatments	Yes	Yes	Up to 50% per transfer (under 35)

Infertility Treatments: Choosing the Right Fertility Treatment

The decision between timed intercourse, IUI, or IVF depends on a variety of factors including age, fertility diagnosis, treatment history, and personal preferences. It’s important to work closely with a fertility specialist to determine the right treatment path based on your specific needs.

Many individuals begin with less invasive treatments like timed intercourse or IUI before considering IVF. Others may go directly to IVF depending on clinical indications or time sensitivity.

References:

1. Government of Canada. “Infertility Awareness.” 2021.
2. Society of Obstetricians and Gynaecologists of Canada (SOGC). “Clinical Practice Guidelines.”
3. Canadian Fertility & Andrology Society (CFAS). “Fertility Statistics.”
4. Ontario Ministry of Health. “Ontario Fertility Program.”