Fertility treatment: Intrauterine insemination (IUI)

Varvara February 02 2022

Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm into a woman's uterus at the time of ovulation. IUI may be used to treat infertility when it has been diagnosed that the fallopian tubes are not open, sperm counts are decreased, or the male partner exhibits reduced motility of sperm.

Is IUI for me?

In combination with ovulation-stimulating medications, IUI can be used to treat infertility from a variety of causes. Women who have not conceived after 6 months of trying may benefit from this treatment. Women whose male partners have poor sperm quality or motility might also choose to use IUI to bypass the cervix. Other women may wish to use IUI for religious reasons since donor sperm is not used in this procedure.

How does an IUI work?

A woman begins taking medication (clomiphene citrate) 1-2 weeks prior to her scheduled date for ovulation induction and collection of eggs (see "Ovarian Stimulation" section below). The hormone medication stimulates the development of multiple eggs. Once the eggs are mature, they are collected and prepared for IUI. The partner is asked to provide a semen specimen on the morning of ovulation or after 2-3 days of abstinence. After sperm wash and concentration, a small catheter is placed through the cervix into the uterus under ultrasound guidance. A semen sample is then placed in the uterus using a syringe. Ultrasound monitoring is used every 15 minutes for 1 hour to check that placement has been successful and no leakage from around the catheter occurs.

The timeline for IUI treatment usually goes something like this:

  1. Ovulation is induced with fertility medications and monitored to determine the optimal time for IUI: Day 0-2 of the menstrual cycle
  2. Semen sample is obtained from male partner: On the morning of ovulation or after 2-3 days of abstinence
  3. Tubes are prepared for IUI by washing sperm and concentrating it: Day 1-4 of the menstrual cycle
  4. Catheter is inserted through the cervix into the uterus under ultrasound guidance: On the day of IUI
  5. Egg retrieval, fertilization, embryo culture, and selection occurs in the laboratory: Between days 3-6 following egg retrieval
  6. Embryo transfer takes place on or around day 5 post egg retrieval.

Who is a good candidate for IUI?

A woman who has ovulated in the past, either with or without drugs, is likely to respond well to IUI. Women whose male partners have poor sperm quality or motility might also choose to use IUI with cervical cap insemination. Other women may wish to use IUI if they are receiving donor sperm insemination. How long does IUI keep working?

IUI success rates depend largely on the female partner's age and the severity of fertility problems related to the male partner. Studies show approximately 10-20% per cycle pregnancy rates using intrauterine insemination for women under 35 years old, while older women have only 6-7 per cycle success rates. Couples may choose to try IUI for six cycles before pursuing other fertility treatment options.

Is it safe?

IUI is a fairly low-risk procedure, with risks including cervical damage during catheter placement; infection; mild cramping; and ovarian hyperstimulation syndrome (OHSS) in most patients using ovulation-inducing medications. Women who are at increased risk for OHSS include those who are carrying multiples (twins or more), are extremely overweight or have elevated estradiol levels. What happens after an IUI?

Semen samples must be frozen within 30 minutes of the collection after the frozen pellet has been thawed, washed, and concentrated according to instructions provided by the laboratory company.

Options for the next cycle:

If this is the first cycle attempting IUI, you can choose to try another IUI or wait until you receive your next period and continue with Clomid. Your RE will discuss your options with you.

Semen must be frozen within 30 minutes of the collection after thawing, washing, and concentrating according to instructions provided by the laboratory company. Once thawed, semen samples should not remain in storage longer than 2-3 days at most before they are used or disposed of (according to lab protocol).

Two weeks prior to ovulation induction additional medication known as gonadotropins may be started; they stimulate follicle growth and development of multiple eggs. On the day of ovulation, a small ultrasound-guided needle is used to retrieve the eggs from the ovaries. If sperm are available, they will be harvested for use in ICSI or IVF treatment immediately following fertilization of the eggs. Fertilization usually occurs in the lab, but sometimes it can take place inside your body (ICSI).

After three to five days of fertilized embryo growth, an embryo transfer is scheduled by your RE. During this time embryos remain frozen until transfer or cryopreservation. One or more embryos are thawed and placed into a catheter that has been inserted into your uterus through your cervix. This procedure usually lasts about 10 minutes. Your doctor may wish to perform an early pregnancy test prior to embryo transfer, especially if your expected period is late.

Two weeks after embryo transfer, you will receive a pregnancy ultrasound. This test helps determine whether the embryos are growing normally. If you do not become pregnant after three to five embryo transfers, there are other fertility treatments available to you, including IVF or donor eggs.

Are there any risks?

Several factors can increase IUI success rates, including cervical preparation; ovarian stimulation; and sperm selection for washing and concentration techniques. Overstimulation of the ovaries with drugs used to prepare them for IUI may result in ovarian hyperstimulation syndrome (OHSS), which causes nausea, abdominal pain, bloating, fluid accumulation in the abdomen or lungs, weight gain of at least 10 pounds within two weeks, shortness of breath, and/or low blood pressure. OHSS is not dangerous for most women but it can be uncomfortable.

Fertility medications may cause mild to moderate side effects, including bloating, mood swings, acne, breast tenderness, light spotting or bleeding between periods, weight gain, nausea, vomiting, abdominal pain, dizziness, headache. There are rare risks associated with fertility medications that include anaphylactoid reaction (swelling of the throat that makes breathing difficult), ovarian torsion (ovaries twist on the fallopian tubes causing severe menstrual-like cramping), rupture of membranes in the uterus which causes uncontrollable vaginal bleeding, and infection. Also, some women experience ovarian hyperstimulation syndrome (OHSS) which is a potentially life-threatening complication of fertility drugs that can cause severe abdominal pain, shortness of breath from fluid around the lungs, weight gain over 10 pounds in two weeks, nausea and vomiting, and bloating.

In vitro fertilization has been associated with the development of ovarian cancer. However, this risk decreases after approximately 1-2 years following childbirth or discontinuation of infertility treatments.

Are there alternatives?

Intrauterine inseminations are not recommended for women who have genital tract abnormalities, an incompetent cervix, or cervical factor infertility. Intrauterine insemination procedures may be less successful if you have mild endometriosis. Ask your doctor about natural methods to pregnancy chance such as lifestyle changes that may improve your chances of becoming pregnant.

How long does IUI take?

IUI depends on several factors: how long you have been trying to conceive, your age, and the number of previous IUI attempts. Some couples get pregnant after only one cycle of IUI while others may require three or more cycles before getting pregnant. It can take up to six months for some women to get pregnant using ovulation induction followed by intrauterine insemination.

How much does it cost?

The cost of an IUI procedure usually includes medications, semen collection and preparation, sperm analysis, the fertility monitor with an ultrasound machine, and an infertility specialist's time and office fees. The average cost of a single IUI is $200-600. Discounts: Ask about family planning services discounts if you are paying out-of-pocket. Some fertility centers offer discounts if you have a high FSH level, are undergoing egg donor treatment, or self-treatment with IUI. Insurance: Check your health insurance plan to see what infertility treatments it covers. If you want the procedure only and not medication, many insurers cover IUI under general anesthesia.

In most cases, intrauterine insemination is available at no charge, since the cost of this artificial insemination technique is incorporated into the fees for other services such as ultrasounds and sperm preparation. In some clinics, however, IUI may be offered separately from other methods at a cost ranging from $300-$500 per cycle.

How effective is it?

Artificial insemination success rates depend on the age of the female, the sperm count, and quality, as well as many other factors. In women younger than 35 years old undergoing intrauterine insemination with a partner's sperm, about 15 out of 100 will become pregnant each month. In couples where both partners are 35 or older, this number drops to 10 out of 100 monthly attempts.

What are the pros of IUI?

  1. There are no side effects associated with this fertility treatment.
  2. Artificial insemination treatments do not alter your hormones so they can be used when you have a low ovarian reserve or poor egg quality.
  3. This is a gentle fertility therapy that can be started immediately after other methods of assisted reproduction (such as IVF) fail.
  4. Intrauterine insemination is an effective second-line infertility treatment for couples who don't get pregnant during ovulation induction cycles, due to the presence of male factor infertility, unexplained infertility, or mild endometriosis.
  5. Intrauterine insemination is less expensive than in vitro fertilization (IVF) and it uses your partner's which means there was no third party involved.

What are the cons?

1. Intrauterine insemination does not always result in pregnancy.

2. This infertility treatment is useful only when combined with ovulation-inducing medications, which can cause unpleasant side effects such as mood swings and bloating.

3. IUI may be less successful for women who have mild endometriosis or an incompetent cervix.

4. Sometimes sperm quality can affect the chances of success after intrauterine insemination (IUI).

5. It depends on several factors: how long you have been trying to conceive, your age, and the number of previous IUI attempts;

6. There are different protocols that prescribe different times during the menstrual cycle to perform this procedure.

What are the side effects of IUI?

With Intrauterine insemination, there are no side effects because it doesn't use fertility drugs only sperm.

Are there other options to try before IUI?

Yes, other possibilities are intrauterine insemination with donor sperm, home insemination, timed intercourse, ovulation induction followed by intrauterine insemination or IVF.

How many cycles of IUI should be done until a patient becomes pregnant?

The average number of cycles needed to get pregnant is 5-6 : 3 if you have PCOS and blocked tubes or are under 40 years old. Two if you have endometriosis. One if you have normal fertility factors.

What are the advantages of IUI as compared with other assisted reproduction techniques such as IVF?

Intrauterine insemination is just one technique for getting pregnant. It works best when combined with ovulation-inducing medications. Other types of infertility treatment include Intrauterine insemination with donor sperm, home insemination, timed intercourse, and ovulation induction followed by intrauterine insemination and IVF.

When should I come back to repeat the procedure if it was not successful?

You should go for a control pregnancy test after 2 weeks of IUI conception. If you don't get a positive result then we recommend trying again (counting from the day your period starts). We usually suggest doing another IUI till you get pregnant or try any other infertility treatment.

How often can we continue with intrauterine insemination?

Intrauterine insemination is a fertility treatment that does not affect your health and it can be practiced for several years. However, the doctor will recommend stopping after 3-4 unsuccessful attempts and trying another infertility treatment such as IVF.

What are medical conditions which might prevent me from having intrauterine insemination?

Women who have severe endometriosis, severe male factor, tubal disease, or cervical scarring should look into alternatives such as IVF. Also, women over 40 years old should see if they're good candidates for egg donation/reciprocal IVF before doing intrauterine insemination.

Is IUI more effective than natural intercourse?

No, intrauterine insemination is just one way to get pregnant. It works best when combined with ovulation-inducing medications. Other types of infertility treatment include Intrauterine insemination with donor sperm, home insemination, timed intercourse, and ovulation induction followed by intrauterine insemination and IVF.

What are the chances of getting pregnant through intrauterine insemination?

The average pregnancy rate after three cycles is about 15%, but this depends on several factors including your age, how long you have been trying to conceive, what fertility problems you have, and the number of previous IUI attempts.

What will happen to my estradiol level after intrauterine insemination?

Estradiol concentration will not change because it is produced by the ovaries. Your doctor may measure the concentration of LH (luteinizing hormone) during this procedure.