Intrauterine Insemination (IUI)

IUI is a relatively noninvasive and less-expensive fertility treatment compared to more invasive and costly treatments such as in vitro fertilization (IVF). In some cases, couples may begin with IUI before progressing to IVF if needed. IUI may be the only treatment needed to achieve pregnancy.

IUI can be performed using a male partner’s sperm or donor sperm. IUI is most commonly used in these scenarios:

• unexplained infertility
• mild endometriosis
• issues with the cervix or cervical mucus
• low sperm count
• decreased sperm motility
• issues with ejaculation or erection
• same-sex couples wishing to conceive
• a single woman wishing to conceive
• a couple wanting to avoid passing on a genetic defect from the male partner to the child

IUI isn’t effective in the following scenarios:

• women with moderate to severe endometriosis
• women who have had both fallopian tubes removed or have both fallopian tubes blocked
• women with severe fallopian tube disease
• women who have had multiple pelvic infections
• men who produce no sperm (unless the couple wishes to use donor sperm)

In situations where IUI isn’t recommended, another treatment such as IVF may be helpful. If you wish to discuss options for conceiving, your doctor can help determine the best course for you.

IUI is a relatively painless and noninvasive procedure. IUI is sometimes done in what is called the “natural cycle,” which means no medications are given. A woman ovulates naturally and has the sperm placed at a doctor’s office around the time of ovulation.

IUI can also be combined with ovarian stimulation. Medications such as clomiphene citrate (Clomid), hCG (human Chorionic Gonadotropin), and FSH (follicle stimulating hormone) may be used to prompt the ovaries to mature and release an egg or multiple eggs. Ovulation with more than one egg usually increases chance of pregnancy.

Each medical facility and doctor will have their own specific instructions for the IUI procedure. After your initial consultation, when you and your physician have determined that IUI is the best course to pursue, a typical timeline may include the following:

• You may have several office visits while on your period for bloodwork, ultrasounds, and medication instructions.
• If medications are prescribed, you’ll usually start taking them while on your period.
• About a week after starting the medication, you’ll likely have another ultrasound and possibly bloodwork.
• Depending on your test results, your doctor will determine when you’re ovulating, and you and your partner will return to the clinic. This is typically 10 to 16 days after starting the medications.
• Your male partner will provide a semen sample the day of the procedure, or the donor sperm will be thawed.
• The sperm will immediately be taken to a lab where they will be “washed.” This is a process where the seminal fluid and other debris are removed so that the sperm is very concentrated and unlikely to irritate the uterus.

IUI is quick and typically painless and does not require anesthesia.

• You’ll lie on an exam table and your doctor will use a speculum (the same tool used in a Pap smear) to gently open the vagina and visualize your cervix.
• The sperm will be passed through the cervix and placed into the uterus using a long, very thin tube.
• You’ll remain reclined on the exam table for 10 to 30 minutes following the insemination.
• Most women experience little to no discomfort, although some women may experience mild uterine cramping or vaginal bleeding following the procedure.
• Some practices perform a second insemination the following day.
• Some practices also prescribe progesterone to take after the procedure and through the early stages of pregnancy if pregnancy is achieved, while others do not.
• You can take a pregnancy test two weeks after the IUI procedure.

There is a small risk of infection following the IUI procedure. Your doctor will use sterile instruments, so infection is very rare.

If medications are used to induce ovulation, there is a risk of pregnancy with multiple babies. Since fertility medications increase the likelihood that more than one egg will be released, they also increase the likelihood of pregnancy with multiples. Your physician will try to balance the amount and type of medication, along with bloodwork and ultrasound monitoring, to prevent too many eggs from being released at one time.

Sometimes the ovaries over-respond to fertility medications (particularly the medications given as injections) and a condition called ovarian hyperstimulation syndrome may result. A large number of eggs may be matured at one time and possibly released. This can result in an enlarged ovary, fluid buildup in the abdomen, and cramping. In very rare cases, ovarian hyperstimulation syndrome can result in fluid buildup in the chest and abdomen, kidney problems, blood clots, and twisting of the ovary.

If you’re currently taking fertility medications for IUI and experience any of the following symptoms, you should call your doctor immediately.

• dizziness or lightheadedness
• sudden weight gain of more than 5 pounds
• shortness of breath
• nausea and vomiting
• severe abdominal or pelvic pain
• sudden increase in abdominal size

Every couple will have a different response to IUI, and it can be difficult to predict its success. A number of factors affect the outcome, including:

• age
• underlying infertility diagnosis
• whether fertility drugs are used
• other underlying fertility concerns

Pregnancy rates following IUI are varied based on your reasons for needing fertility treatment. Success rates for IUI tend to decrease in women over the age of 40, and in women who have not gotten pregnant after three cycles of IUI. You should discuss your predicted success rate with your fertility specialist to see if this a good option for you.

The cost to pursue IUI treatment can vary based on your location and specific needs.

The University of Wisconsin Hospitals and Clinics states that the cost of IUI typically ranges from $460 to $1500. This does not include the cost of fertility medications. Additional costs may include ultrasounds, lab testing, and semen analysis.

Some insurance companies will cover portions of the cost for fertility treatments. You may be able to speak with a billing or insurance specialist at your physician’s office. They can help you understand all of the costs and payment options.

Intrauterine insemination is a relatively low-risk treatment that can be a wonderful option for many women or couples trying to conceive. If you have had difficulty conceiving or have questions about your options for conception, speak with your OB-GYN or a fertility specialist. Your doctor can help determine the best course to help you achieve pregnancy, and IUI may be an effective route.