IUI (Intrauterine Insemination)

Intrauterine insemination (IUI) is a fertility treatment where sperm is placed directly into your uterus.

During a natural conception, sperm has to travel from your vagina through your cervix, into your uterus and to your fallopian tubes. Once your ovary releases an egg, it travels to your fallopian tube. This is where the sperm and egg meet and fertilization occurs.

With IUI, sperm is placed directly into your uterus with a catheter (thin tube). This puts it closer to your fallopian tubes. IUI makes it easier for the sperm to reach an egg because it cuts down on the time and distance it has to travel. This increases your chance of becoming pregnant.

Healthcare providers often try IUI before other, more invasive and expensive fertility treatments. IUIs can be performed with your partner’s sperm or with donor sperm. You may need to take fertility drugs to make sure you ovulate.

Why is IUI performed?

People choose IUI if they have infertility and haven’t been able to get pregnant. It’s also an option when these conditions are present:

• Cervical mucus problems: Mucus produced by your cervix helps sperm travel. Thick mucus can make it hard for sperm to swim. With IUI, sperm bypasses your cervix and goes directly to your uterus.
• Low sperm count or other sperm problems: Semen analysis is part of infertility treatment. It may show that your partner doesn’t have much sperm or that the sperm is slow or oddly shaped. IUI helps increase the number of functional sperm available to fertilize the eggs.
• You’re using donor sperm: IUI is used when people use sperm from a person who isn’t the birth parent’s partner. This is called donor insemination (DI).
• Ejaculation or erection dysfunction: IUI can be used when one partner can’t get or sustain an erection or isn’t able to ejaculate.
• Semen allergy: In rare cases, people have an allergy to their partner’s semen. IUI can be effective because the proteins causing the allergy are removed during sperm washing.
• Unexplained infertility: This is when healthcare providers can’t find the cause of infertility.

How long is the process from beginning to end?

The timeline for the IUI procedure is about four weeks from beginning to end. It’s about the same length as a typical menstrual cycle.

• Before starting the IUI process, you (and your partner) will have bloodwork, semen analysis, ultrasound and other evaluations recommended by your health care provider.
• Some people take oral fertility medicine for five days or injectable medication for up to two weeks. This increases your chances of ovulation and releasing multiple eggs.
• Insemination is a quick process. It takes a few minutes to insert the sperm. Your healthcare provider may ask you to lie down afterward.
• You can take a pregnancy test two weeks after the insemination.

What do you do to prepare for IUI treatment?

Before starting IUI treatment, you’ll need a thorough medical exam and fertility tests. Your partner will be examined and tested, as well. This could include:

• A pelvic exam
• Ultrasounds of your uterus
• A semen analysis
• Screening for sexually transmitted infections (STIs) and other infectious diseases
• Blood tests for prenatal testing and possibly hormone testing
• An evaluation of your fallopian tubes, either by an X-ray test called hysterosalpingogram (HSG) or an ultrasound called hysterosalpingo-contrast-sonography (HyCoSy)

It’s a good idea to start taking prenatal vitamins about three months before you begin fertility treatment.

What are the steps of IUI treatment?

Every treatment plan and healthcare provider may have a slightly different process. IUI treatment typically includes the following:

Ovulation

• Your healthcare provider will need to know exactly when you’re ovulating. The timing of ovulation is critical to make sure sperm is injected at the right time.
• Determining the time of ovulation can be done using an at-home ovulation kit that detects luteinizing hormone (LH). Your healthcare provider can also detect LH in blood tests. They may also use transvaginal ultrasound to look for signs of mature eggs. IUI is often combined with fertility medications that stimulate your ovaries to produce and release an egg (or eggs).
• Insemination (inserting the sperm into your uterus) usually occurs within 24 to 36 hours after LH is detected, or after an injection of human chorionic gonadotropin (hCG).

Semen sample preparation

• Your partner provides a fresh sperm sample on the day of the IUI procedure. In some cases, your partner can provide the sample before, and your healthcare provider can freeze it until it’s time to be used. If you’re using a sperm donor, the sample will be thawed and prepared.
• Sperm is prepared for insemination through a process called “sperm washing” that pulls out a concentrated amount of healthy sperm. If you’re using donor sperm, the sperm bank usually sends sperm that’s already washed.

Insemination

• The insemination procedure is simple and takes just a few minutes. You’ll lie down on the exam table. Your healthcare provider will insert a speculum into your vagina. Next, your provider inserts a catheter into your uterus through your cervix. Finally, they inject the washed sperm into your uterus.
• You may be asked to lie down for 10 to 30 minutes after insemination. Pregnancy happens if sperm fertilizes an egg and the fertilized egg implants in the lining of your uterus.
• You may be given progesterone after IUI. Progesterone helps maintain the lining of your uterus and support early pregnancy.
• You can take a pregnancy test approximately two weeks after IUI.

Talk to your healthcare provider to get the best understanding of the IUI process and what to expect.

What can you expect after treatment?

There are some mild symptoms that you can experience after IUI, like:

• Mild cramping
• Spotting for one or two days

Most people will return to normal activities right away. You should avoid anything that makes you feel uncomfortable after IUI, but there usually aren’t any restrictions.

What are the most common side effects of IUI?

Some people experience mild side effects from fertility medications. The most common side effects after insemination are cramping and spotting.

IUI can be mentally and physically difficult. Talk with your healthcare provider if you’re feeling disappointed or overwhelmed so they can help you through the process.

What are the risks of IUI?

IUI is low risk compared to other, more invasive fertility treatments like IVF. Some of the risks of IUI are:

• Multiple births: You might release more than one egg if you take fertility medication. This increases your chances of becoming pregnant with twins, triplets or more. A pregnancy with multiple babies carries a higher risk of preterm birth and low birth weight.
• Infection: This is rare.
• Ovarian hyperstimulation syndrome (OHSS): A rare side effect of taking too much fertility medication.

How effective is IUI in getting pregnant?

The effectiveness of IUI is mostly dependent on the cause of infertility and the age of the mother. As you age, you have fewer eggs, and the quality of those eggs decreases. Success rates for IUI tend to be higher in people under age 38.

Most pregnancies achieved through IUI occur within the first three to four cycles. If pregnancy hasn’t occurred after this time frame, you may want to discuss further testing or alternative treatments, like IVF. Because there can be so many factors, it’s hard to say how long it may take for you or whether it’ll be successful. It’s best to talk with your healthcare provider about your unique circumstances.

How many cycles do you try before IVF?

Most healthcare providers recommend three cycles of IUI before moving on to IVF. In some cases (for example, if your partner has a very low sperm count or if you’re over 38 years old), going straight to IVF treatment and skipping IUI may be a better option for you. Other times, your provider may recommend up to six IUI cycles before moving to IVF.

It’s best to have these types of discussions with your healthcare team because they have the best understanding of your situation.

When should I contact my healthcare provider?

If you’re taking fertility medications for IUI, you should contact your healthcare provider if any of the following happen:

• Severe pelvic or abdominal pain
• Nausea and vomiting
• Shortness of breath
• Dizziness or lightheadedness

Is IUI better than IVF?

Most people will try IUI before IVF because it’s more affordable and less invasive. In some cases, your healthcare provider will decide IUI won’t work for you and recommend IVF. This can be due to age or the underlying reason for infertility. One treatment isn’t better than the other, but one may give you a higher chance of conceiving.