IUI (Intrauterine Insemination)

What is IUI (intrauterine insemination)?

Intrauterine insemination (IUI), a type of artificial insemination, is a fertility treatment where sperm is placed directly into a person’s uterus.

During a natural conception, sperm has to travel from your vagina through your cervix, into your uterus and to your fallopian tubes. Only 5% of the sperm are able to travel from your vagina to your uterus. 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, the sperm is collected, washed and concentrated so that only high-quality sperm remain. This sperm is placed directly into your uterus with a catheter (thin tube), putting 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. A person may take fertility drugs to ensure eggs are released during ovulation.

Why is IUI performed?

People choose IUI for many reasons, such as infertility issues, or as a reproductive option for same-sex female couples or females who wish to have a baby without a partner, using a sperm donor.

Intrauterine insemination (IUI) may be used when these conditions are present:

• Cervical mucus problems or other problems with your cervix. Your cervix separates your vagina and uterus from each other. Mucus produced by your cervix helps sperm travel from your vagina, through your uterus and to your fallopian tubes. 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 impairments. Semen analysis is part of infertility treatment. It may show that your partner’s sperm is small, weak, slow or oddly shaped, or that your partner doesn’t have much sperm. IUI can help these problems because only high-quality sperm is selected and used in your treatment.
• 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). DI is done when one partner has no sperm or when the sperm quality is so low that the sperm can’t be used. Single women or same-sex female couples who wish to conceive can also use donor sperm.
• 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. It can cause burning, swelling and redness in their vagina. 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 for infertility.

How long is the IUI process from beginning to end?

The timeline for the IUI procedure is approximately four weeks (around 28 days) from beginning to end. It’s about the same length as a regular menstrual cycle.

• Before starting the IUI process, you (and your partner) will have a thorough examination that could include bloodwork, semen analysis, ultrasound and other diagnostics.
• Some people are given oral fertility medicine for five days or injectable medication for up to two weeks. This increases your chances of ovulation and releasing multiple eggs. Not all people require these medications.
• Insemination is a quick process. It takes a few minutes to insert the sperm. Your healthcare provider may ask you to lie down for around 15 minutes afterward.
• You can take a pregnancy test two weeks after insemination.

Does IUI work?

The success varies depending on the underlying cause of infertility. IUI works best in people with unexplained infertility, and people with cervical mucus issues or issues with ejaculation. There are certain conditions like fallopian tube disorders, endometriosis or severe sperm impairment where IUI won’t work well. Treatments like IVF (in vitro fertilization) may work better for these issues.

What is the difference between IVF and IUI (intrauterine insemination)?

Intrauterine insemination (IUI) is different from in vitro fertilization (IVF) because fertilization occurs inside of your fallopian tube in an IUI procedure. A sperm sample is collected and washed so that only high-quality sperm are left. This sample is inserted into your uterus with a catheter during ovulation. This method helps the sperm get to the egg more easily in hopes fertilization will happen. With IVF, the sperm and egg are fertilized outside of your body (in a lab) and then placed in your uterus as an embryo. IUI is less expensive and less invasive than IVF. IUI has a lower success rate per cycle.

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 prediction 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 mature eggs. Sometimes, you’re given an injection of human chorionic gonadotropin (hCG) or other fertility medications to make you ovulate one or more eggs. Ovulation typically occurs around 10 to 16 days after the first day of your period.
• Insemination (inserting the sperm into your uterus) usually occurs within 24 to 36 hours after LH is detected (either in your blood or urine), or after the hCG injection.

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 is 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 — similar to what happens during a Pap test. Next, a catheter is inserted through your cervix into your uterus. Finally, your healthcare provider injects the washed sperm sample 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 can improve the chances of implantation.
• You can take a pregnancy test approximately two weeks after IUI.

Please consult with your healthcare provider to get the best understanding of the IUI process and what to expect.

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 uterine exam.
• Ultrasounds of your uterus.
• A semen analysis.
• Screening for sexually transmitted infections (STIs) and other infectious diseases.
• Blood tests.

Your healthcare provider may recommend taking folic acid (included in most prenatal vitamins) at least three months before conception (or IUI treatment).

What can you expect after IUI treatment?

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

• 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. A pregnancy test can be taken around two weeks after IUI.

How painful is IUI treatment?

Anesthesia isn’t required for IUI and the procedure shouldn’t be painful. However, you may have mild cramping and discomfort during and right after insemination.

What medications are used during IUI?

IUI is often combined with fertility medications that stimulate your ovaries to produce and release as many eggs as possible. However, it’s not always needed. Some common medications are:

• Clomiphene citrate (Clomid® or Serophene®).
• Letrozole (Femara®).
• hCG (human Chorionic Gonadotropin).
• FSH (follicle-stimulating hormone).
• Prenatal vitamins (recommended for all pregnancies).

Your healthcare provider will determine if fertility drugs will be used as part of your IUI treatment.

How much does IUI cost?

The cost of IUI varies depending on the fertility clinic you use, your health history, use of medications and diagnostic testing. It’s less expensive than other infertility treatments like IVF. You can expect to pay between $300 and $4,000 per cycle without insurance. Some states have laws that require insurance companies to cover part of the costs of infertility treatment.

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 premature labor and low birth weight.
• Infection: This is rare.
• Spotting: The procedure can cause a small amount of vaginal bleeding.
• Ovarian hyperstimulation syndrome (OHSS): A rare side effect caused by taking too much fertility medication. OHSS causes your ovaries to become painful and swollen.

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. Couples or individuals suffering from infertility issues and pursuing assisted reproductive technologies often struggle with depression. Talk with your healthcare provider if you’re feeling disappointed or overwhelmed so they can help you through the process.

How effective is IUI in getting pregnant?

IUI can be highly effective, especially when fertility drugs are used. The pregnancy rate for IUI when fertility drugs are used can be as high as 20%. The effectiveness of IUI is mostly dependent on the underlying cause of infertility and the age of the birth parent. The IUI fertility rate is about the same as a normal conception (around 20%), which means IUI helps bring people’s chances up to a more typical success rate.

How long does it take to know you are pregnant after IUI?

You’ll know if you’re pregnant approximately two weeks after IUI. It takes about that long for human chorionic gonadotropin (hCG) to be detected in blood or urine. Your healthcare provider will let you know if you should return for a blood test to detect pregnancy or if you can use an at-home urine test.

How many cycles of IUI do you try before IVF?

Most healthcare providers recommend three cycles of IUI before pursuing another reproductive treatment, like IVF. If you’re over the age of 40, some healthcare providers recommend just one cycle of IUI before moving on to IVF. This is because the success rates for IVF are higher for that age group and timely treatment is important.

In some cases, going straight to IVF treatment and skipping IUI may be better for you. This is the case if you have a condition like endometriosis, fallopian tube damage or advanced maternal age.

If you haven’t gotten pregnant after three cycles of IUI, your healthcare provider will discuss the next steps with you.

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 happens:

• Severe pelvic or abdominal pain.
• Nausea and vomiting.
• Shortness of breath.
• Sudden weight gain.
• Dizziness or lightheadedness.

Is there anything I can do to increase my chances of pregnancy with IUI?

Several factors can determine the success of IUI. These factors include:

• Age.
• If you use fertility drugs.
• Health conditions.
• Your cause of infertility.

Your healthcare provider will work with you to determine how to increase your chances of becoming pregnant using IUI.

What is the success rate of IUI?

Other than the reason for infertility, age is the most important factor in determining the success of IUI. Most healthcare providers will recommend IUI before turning 40 to increase your chance of becoming pregnant.

As a person ages, they have fewer eggs and the quality of those eggs decreases. The pregnancy rate for IUI by age is:

• Age 20 to 30: 17.6%
• Age 31 to 35: 13.3%
• Age 36 to 38: 13.4%
• Age 39 to 40: 10.6%
• Over 40: 5.4%

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 will not 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.

Can I have sex after IUI?

Yes, you can have sex before and after IUI. You’re increasing your chances of becoming pregnant by having sex the day of IUI or the day after.

A note from Cleveland Clinic:

If you’re having difficulty conceiving, speak with your healthcare provider. Many people struggle with infertility, and there are options to help you. IUI may be one of those options. Your healthcare provider will work with you to determine the right fertility treatment to help you achieve a successful pregnancy.