What Is IUI (Intrauterine Insemination)?
Intrauterine insemination (IUI) is a fertility treatment where sperm is placed directly into your uterus. During a natural conception, sperm has to travel from your vagina through your cervix, into your uterus and to your fallopian tubes. 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, sperm is placed directly into your uterus with a catheter (thin tube). This puts 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. You may need to take fertility drugs to make sure you ovulate.
Why Is IUI Performed?
People choose IUI if they have infertility and haven't been able to get pregnant. It's also an option when these conditions are present:
- Cervical mucus problems — Mucus produced by your cervix helps sperm travel. 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 problems — Semen analysis may show that your partner doesn't have much sperm or that the sperm is slow or oddly shaped. IUI helps increase the number of functional sperm available to fertilize the eggs.
- 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).
- 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. 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 of infertility.
- Mild endometriosis — Stage I or II endometriosis where the fallopian tubes remain open and functional.
- Cervical factor infertility — Problems with the cervix, such as scarring caused by a biopsy or other procedures, can make it harder for sperm to reach the egg. IUI bypasses the cervix entirely.
- Ovulatory factor infertility — IUI may also be done for people who have infertility caused by problems with ovulation, including a lack of ovulation or a reduced number of eggs.
How Long Is the Process?
The timeline for the IUI procedure is about four weeks from beginning to end. It's about the same length as a typical menstrual cycle.
- Before starting the IUI process, you (and your partner) will have bloodwork, semen analysis, ultrasound and other evaluations recommended by your healthcare provider.
- Some people take oral fertility medicine for five days or injectable medication for up to two weeks. This increases your chances of ovulation and releasing multiple eggs.
- Insemination is a quick process. It takes a few minutes to insert the sperm. Your healthcare provider may ask you to lie down afterward.
- You can take a pregnancy test two weeks after the insemination.
How 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 pelvic exam
- Ultrasounds of your uterus
- A semen analysis
- Screening for sexually transmitted infections (STIs) and other infectious diseases
- Blood tests for prenatal testing and possibly hormone testing
- An evaluation of your fallopian tubes, either by an X-ray test called hysterosalpingogram (HSG) or an ultrasound called hysterosalpingo-contrast-sonography (HyCoSy)
It's a good idea to start taking prenatal vitamins about three months before you begin fertility treatment.
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 Monitoring
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 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 of mature eggs.
- IUI is often combined with fertility medications that stimulate your ovaries to produce and release an egg (or eggs).
- Insemination usually occurs within 24 to 36 hours after LH is detected, or after an injection of human chorionic gonadotropin (hCG).
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's time to be used.
- 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.
- Next, your provider inserts a catheter into your uterus through your cervix.
- Finally, they inject the washed sperm 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 support early pregnancy.
What to Expect After 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.
IUI can be mentally and physically difficult. Talk with your healthcare provider if you're feeling disappointed or overwhelmed so they can help you through the process.
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 preterm birth and low birth weight.
- Infection — This is rare.
- Ovarian hyperstimulation syndrome (OHSS) — A rare side effect of taking too much fertility medication.
- Spotting — Sometimes, the process of placing the catheter causes a small amount of vaginal bleeding. This doesn't usually have an effect on the chance of pregnancy.
How Effective Is IUI in Getting Pregnant?
The effectiveness of IUI is mostly dependent on the cause of infertility and the age of the mother. As you age, you have fewer eggs, and the quality of those eggs decreases. Success rates for IUI tend to be higher in people under age 38.
Most pregnancies achieved through IUI occur within the first three to four cycles. If pregnancy hasn't occurred after this time frame, you may want to discuss further testing or alternative treatments, like IVF.
How Many Cycles Before IVF?
Most healthcare providers recommend three cycles of IUI before moving on to IVF. In some cases (for example, if your partner has a very low sperm count or if you're over 38 years old), going straight to IVF treatment and skipping IUI may be a better option for you.
Other times, your provider may recommend up to six IUI cycles before moving to IVF. It's best to have these types of discussions with your healthcare team because they have the best understanding of your situation.
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 won't 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.
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 happen:
- Severe pelvic or abdominal pain
- Nausea and vomiting
- Shortness of breath
- Dizziness or lightheadedness
A Note from Fishtail IVF
You aren't alone in your pregnancy journey. Many people struggle with infertility, spending month after month waiting for a positive test. Try not to lose hope. There are many advances in technology that help people achieve pregnancy. IUI may be one of those options.
You probably have lots of questions about the process, the timing and your chances of getting pregnant. Don't be afraid to ask our healthcare team all these questions. Our specialists at Fishtail IVF are here to work with you and determine the right fertility treatment to help you grow your family.
