Key facts about IUI

• Intrauterine insemination (IUI) is an artificial insemination procedure in which our doctor transfers sperm directly into a woman’s uterus to help her get pregnant.
• IUI is designed to make getting pregnant easier because it overcomes some causes of infertility by placing sperm near mature eggs during ovulation, rather than relying on sperm to reach the eggs after sexual intercourse.
• Ember recommends it for couples with infertility factors such as low sperm count, ovulation issues or unexplained infertility.
• We may also recommend IUI for those using donor sperm to achieve pregnancy, such as in cases of male infertility or as needed by LGBTQ+ couples or individuals.
• Risks for IUI are low and include infection from the procedure and multiple pregnancy (twins or more), if ovulation induction medicine is used.

What is IUI?

IUI, or intrauterine insemination, is a form of artificial insemination where sperm is placed directly into a woman’s uterus using a catheter. The aim is to help sperm reach and fertilize a mature egg in a woman’s fallopian tubes where fertilization occurs, increasing the chances of pregnancy.

The goal of IUI is to increase a woman’s chance of getting pregnant. This is because the sperm is placed in the uterus near the fallopian tubes, which is more conducive to fertilization than relying on sperm to make that journey on it its own after male ejaculation during sex.

Success rates for IUI vary widely, depending on the prospective parent’s age, health, issues affecting fertility, timing of the procedure and whether ovulation induction is used. Research shows that IUI is successful in 10.9% of cycles for women age 30-34. Patient age has a statistically measurable impact on IUI pregnancy rates, with the odds of success decreasing at a ratio of 0.933 per additional year of life.

The procedure can be particularly beneficial in certain cases, with the American Society for Reproductive Medicine noting, for example, that the pregnancy success rate for women with unexplained infertility doubles using IUI compared with no treatment at all. In addition, IUI’s success rates are significantly better when two IUI cycles are performed rather than one cycle. This is why we may suggest retrying IUI after an initial failure.

IUI is less invasive and less expensive than other procedures such as in vitro fertilization (IVF), but IVF does have higher success rates. Those considering either treatment should speak with a fertility specialist  to determine the best possible approach for their situation and diagnosis.

Conditions & causes of infertility IUI addresses

IUI is a noninvasive and relatively affordable fertility treatment. It is commonly prescribed in situations like:

• Unexplained infertility.
• Low sperm count or mobility.
• Mild endometriosis.
• Same-sex couples or individuals wanting to conceive with donor sperm.
• Concerns with the cervix or cervical mucus.
• Issues with erection or ejaculation.

IUI procedure

Before undergoing an IUI procedure, patients undergo pre-screening, which includes various tests and evaluations similar to those performed before IVF.

While specific tests may vary based on individual circumstances and clinic protocols, here are some commonly performed prescreening tests for IUI.

• Hormone testing: This involves bloodwork to evaluate hormone levels, including follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2). These tests help assess ovarian function, egg quality and the timing of the IUI procedure.
• Infectious disease screening: Both women and men are typically screened for infectious diseases such as HIV, hepatitis B and C, syphilis and other sexually transmitted infections (STIs). Ensuring a safe and healthy environment for the woman and potential pregnancy is crucial.
• Semen analysis: A semen analysis is performed for the male partner to assess sperm count, motility, morphology and other parameters that affect sperm quality. This evaluation helps determine the suitability of IUI as a treatment option and provides insights into the chances of success.
• Ultrasound: An ultrasound is often conducted for women to assess the condition of the uterus and ovaries. It helps identify any abnormalities, such as uterine fibroids, polyps or ovarian cysts, that may impact the success of the procedure.
• Ovulation monitoring: Close monitoring of the woman’s menstrual cycle through methods like ultrasound and hormonal assessments may be performed to track follicular development and determine the optimal time for the procedure, which is a crucial factor in its success.

In addition to pre-screening, medications may be prescribed before treatment. These medications can include letrozole, which helps stimulate the development of mature eggs, and a trigger medication, such as human chorionic gonadotropin (hCG), to precisely time the procedure around ovulation. Following IUI, hormonal support through medications like E2 and progesterone (P4) may be recommended to support the early stages of pregnancy.

IUI itself is a simple and painless procedure that can be performed in the doctor’s office. The woman will lie on an exam table with her feet in stirrups, similar to a routine gynecological exam. Our doctor will then insert a speculum into the vagina to visualize the cervix.

A thin, flexible catheter will then be inserted through the cervix and into the uterus. Specially prepared sperm will be injected into the uterus through the catheter. The procedure typically takes only a few minutes and does not require anesthesia.

Many individuals describe the experience of an IUI as similar to getting a Pap smear. Afterwards, most patients will lie down for 15 to 30 minutes and then resume normal activity.

Risks & side effects of IUI

Like any medical procedure, IUI carries some risks. The most common risks associated with the treatment include the following.

• Multiple pregnancies: IUI increases the chances of multiple pregnancies (twins or more), which can increase the risk of complications for mother and children such as premature birth and low birth weight.
• Infection: There is a small risk of infection during IUI, which can lead to pelvic inflammatory disease.
• Cramping and spotting: Some women may experience cramping and spotting after the procedure, which is usually mild and goes away on its own.
• Ectopic pregnancy: In rare cases, the fertilized egg may implant outside the uterus, which is an ectopic pregnancy that can be life-threatening and requires immediate medical attention.