Intrauterine Insemination Explained

IUI is often the first fertility treatment tried. It’s less invasive and less expensive than IVF.

What Is IUI?

Intrauterine Insemination (IUI):

• Sperm placed directly into uterus during ovulation
• Bypasses cervix and vagina
• Gives sperm “head start” closer to egg
• Timed precisely with ovulation
• Quick, simple procedure

Also called:

• Artificial insemination
• Intrauterine insemination

How it helps:

• Increases number of sperm reaching fallopian tubes
• Places best-quality sperm closer to egg
• Overcomes cervical mucus issues
• Concentrates motile sperm

Best Candidates for IUI

Who Benefits Most

Unexplained infertility:

• All tests normal
• No identified cause
• Timing and number optimization

Mild male factor:

• Slightly low sperm count (at least 5-10 million after processing)
• Reduced motility (but some good swimmers)
• Morphology issues

Cervical mucus problems:

• Hostile cervical environment
• Antibodies against sperm
• Insufficient or too thick mucus

Mild endometriosis:

• Stage I or II
• After surgical treatment
• No tubal damage

Ovulation problems:

• Irregular ovulation
• Combined with ovulation medications
• PCOS with medication

Sexual dysfunction:

• Erectile dysfunction
• Ejaculation problems
• Painful intercourse
• Timing difficulties

Single women or same-sex couples:

• Using donor sperm
• Excellent success rates

Who Should Skip to IVF

IUI not appropriate if:

• Blocked or damaged fallopian tubes (need at least one open tube!)
• Severe male factor (count under 5 million after processing)
• Advanced maternal age (over 40)
• Severe endometriosis
• Multiple failed IUI cycles (usually after 3-6)
• Low ovarian reserve

HSG test required before IUI to confirm open tubes.

The IUI Process: Step by Step

Before Starting

Required tests:

• HSG test (Hysterosalpingogram) – MUST confirm at least one tube is open
• Hormone blood work
• Semen analysis
• Infectious disease screening

Without open tubes, IUI cannot work!

Step 1: Medications (Day 1-11)

Ovulation-inducing medications:

• Started Day 2-3 of your cycle
• Taken for approximately 11 days

Common medications:

• Clomiphene Citrate (Clomid) – oral pills
• Letrozole (Femara) – oral pills, especially for PCOS
• Gonadotropins (FSH injections) – more aggressive, multiple eggs

Goal:

• Stimulate 1-3 mature follicles
• More follicles = higher chance
• Too many follicles = cycle may be canceled (high-order multiple risk)

Step 2: Monitoring (Throughout Cycle)

Frequent appointments during stimulation:

Ultrasounds:

• Track follicle growth
• Measure size of each follicle
• Count how many are developing
• Ensure not too many

Blood tests:

• Estradiol (estrogen) levels
• Confirms follicle maturity
• Helps time trigger shot

Typical monitoring:

• Every 2-3 days during stimulation
• More frequent near ovulation
• Usually 2-4 monitoring visits per cycle

Step 3: Trigger Shot

When follicles are mature (18-20mm):

• hCG injection given
• “Triggers” final egg maturation
• Ovulation occurs 36 hours later

Timing is critical:

• Must be exact time as instructed
• Sets schedule for IUI
• Usually given at night

Step 4: Sperm Preparation

Day of IUI (Day 13-14 typically):

Partner provides sample:

• At clinic or brought from home (within 1 hour)
• Collected through masturbation
• 2-5 day abstinence period optimal

Lab “washes” sperm (1-2 hours):

• Separates sperm from seminal fluid
• Concentrates most motile sperm
• Removes dead sperm and debris
• Final sample has highest quality swimmers

Total motile sperm count after washing:

• Over 10 million: Good prognosis
• 5-10 million: Fair prognosis
• Under 5 million: Poor prognosis (may recommend IVF instead)

Donor sperm already prepared and frozen.

Step 5: IUI Procedure (Days 13 & 14)

Two inseminations typically performed:

• Day 13 and Day 14 after trigger
• Or Day 14 and Day 15
• Timing based on your cycle
• Increases chance of catching ovulation

The procedure (5-10 minutes):

1. You lie on exam table (like Pap smear)
2. Speculum inserted
3. Cervix cleaned
4. Very thin catheter inserted through cervix into uterus
5. Prepared sperm injected
6. Catheter removed
7. Rest 10-15 minutes

Pain level:

• Usually minimal discomfort
• Like mild period cramps
• Brief catheter insertion sensation
• Most women tolerate well

After procedure:

• Go about normal day
• No bed rest needed
• Can work, exercise lightly
• Intercourse okay (and encouraged!)

Step 6: Luteal Phase Support (Sometimes)

Progesterone supplementation may be prescribed:

• Vaginal suppositories or oral capsules
• Supports implantation
• Started day after IUI
• Continued until pregnancy test

Not always needed – depends on protocol and doctor preference.

Step 7: The Two-Week Wait

14 days after IUI:

• Waiting to test
• Most stressful part
• Symptoms or no symptoms both normal
• Don’t test too early!

Blood pregnancy test:

• Done at clinic
• Approximately 14 days post-IUI
• More accurate than home test

Success Rates

Per Cycle Success Rates

Varies widely based on factors:

By age (using partner sperm):

• Under 35: 10-15% per cycle
• 35-40: 8-10% per cycle
• Over 40: 2-5% per cycle

By diagnosis:

• Unexplained: 10-15%
• Mild male factor: 8-12%
• Ovulation disorders: 12-15%
• Endometriosis: 5-10%

With donor sperm (younger donors):

• Higher success rates
• 15-20% per cycle

Cumulative Success Rates

Success increases with multiple cycles:

• After 3 cycles: 30-40% cumulative
• After 6 cycles: 40-50% cumulative

Most pregnancies occur within first 3-4 cycles.

Factors Affecting Success

Better success with:

• Younger age
• No tubal damage
• Good sperm count after processing
• Multiple mature follicles (2-3)
• Unexplained infertility
• Timing of insemination

Lower success with:

• Age over 37
• Severe male factor
• Endometriosis
• Only one follicle
• Previous failed cycles

How Many Cycles to Try?

Typical Recommendations

3-6 IUI cycles:

• Most doctors recommend 3-4 cycles minimum
• Up to 6 cycles before moving to IVF
• Diminishing returns after 4-6 attempts

If not pregnant after 3-4 cycles:

• Reassess treatment plan
• Consider IVF
• Additional testing
• Change medications or protocol

When to Move On Sooner

Consider IVF after 1-2 failed IUIs if:

• Age over 38-40
• Very low ovarian reserve
• Time is critical
• Male factor worsening
• Financial considerations (IVF may be more cost-effective)

Discuss with your doctor based on your specific situation.

Risks and Side Effects

From Medications

Ovulation medications cause:

• Bloating
• Mood swings
• Hot flashes
• Breast tenderness
• Headaches

Rare but serious:

• Ovarian hyperstimulation syndrome (OHSS)
• Usually with injectable medications
• Severe bloating, pain, fluid accumulation

Multiple Pregnancy Risk

IUI increases chance of twins or more:

• Stimulating multiple eggs
• Risk: 10-20% twins, 1-3% triplets
• Higher with injectable medications
• Cycle canceled if too many follicles (usually >4)

Multiple pregnancy has risks:

• Preterm birth
• Pregnancy complications
• Higher c-section rate

Doctor monitors to minimize risk while optimizing success.

From Procedure Itself

IUI procedure risks (very rare):

• Infection (less than 1%)
• Spotting (common, not concerning)
• Cramping (common, normal)
• Allergic reaction to washing medium (extremely rare)

Very safe procedure overall.

What to Expect Emotionally

The Roller Coaster

Each cycle brings:

• Hope at the start
• Anxiety during wait
• Anticipation approaching test
• Joy if positive
• Crushing disappointment if negative

This emotional cycle is exhausting.

Coping Strategies

Take care of yourself:

• One cycle at a time mindset
• Plan distractions during two-week wait
• Support system activated
• Self-care priorities
• Allow yourself to grieve failures

When to Take a Break

It’s okay to pause:

• After multiple failures
• Financial strain
• Emotional exhaustion
• Need to regroup
• Physical break from medications

Taking a break doesn’t mean giving up.

Improving Your Chances

Before IUI

Optimize your health:

• Maintain healthy weight
• Take prenatal vitamins
• Folic acid daily
• Stop smoking
• Limit alcohol
• Reduce stress

During Treatment

Support your cycle:

• Take medications exactly as prescribed
• Attend all monitoring appointments
• Follow trigger shot timing precisely
• Stay hydrated
• Get adequate rest

After IUI

No special restrictions:

• Normal activities okay
• No bed rest needed (doesn’t help)
• Sex is fine (may even help!)
• No specific diet required
• Avoid excessive exercise

Implantation happens 6-12 days after IUI – what you do immediately after doesn’t affect it.

Questions to Ask Your Doctor

Before starting IUI:

✓ What are my chances with IUI vs. IVF?

✓ What medication protocol do you recommend?

✓ How many follicles are we aiming for?

✓ What if I have too many follicles?

✓ How many cycles should we try before moving to IVF?

✓ When will I know if it worked?

✓ What’s the plan if this doesn’t work?

Remember

IUI is a simple, relatively low-tech intervention that helps many couples conceive. While success rates are modest per cycle, cumulative rates over multiple cycles are encouraging.

IUI is a reasonable first step for many couples.

Success rates are modest but real. Many babies born through IUI.

If it doesn’t work, you haven’t wasted time – you’ve gained information.

IUI often leads to IVF, which has higher success rates. Each step is progress.

Stay hopeful but realistic. Be patient with the process and yourself.