What to Expect During IUI (Intrauterine Insemination)

The IUI Procedure + When It's Used + Success Rates + Cost

Female doctor talking to patient and using laptop in exam room, discussing IUI procedure
The IUI procedure can be done in your fertility clinic's office. Todd Pearson / Photodisc / Getty Images

IUI, or intrauterine insemination, is a relatively simple fertility treatment. It may be done with or without fertility drugs. The procedure itself involves transferring specially washed semen directly into the uterus via a thin catheter.

You may know of IUI by the more commonly used term artificial insemination (AI). IUI and AI are one and the same.

Indications

IUI treatment may be recommended for any of the following situations:

Some insurance companies require a few cycles of IUI before paying for IVF treatment.

IUI is not recommended for those with:

Cost

When considering fertility treatments above and beyond fertility drug use, IUI may be the first tried. It's easier to do than assisted reproductive technologies like IVF. It also costs much less.

According to a survey done by RESOLVE, the average IUI fertility treatment costs $895. The price, however, varies considerably from clinic to clinic.

What you pay will depend on your insurance coverage, and whether the price quoted by the clinic is only the procedure itself or also includes fertility drugs, blood work, and ultrasound monitoring.

When all is said and done, one IUI cycle may cost you $3,000. Be sure you understand the price before you start treatment.

Even so, IUI is still considerably cheaper than IVF, which on average costs $19,000 for the first cycle.

Treatment Cycles

Your cycle will depend on why your doctor has recommended IUI and on whether you’re taking fertility drugs.

Clomid or Letrozole with IUI: IUI may be added to a Clomid or letrozole (Femera) treatment cycle.

In this situation, as soon as your next period starts, you’ll have a blood test. You may also have an ultrasound. This is to confirm you're not pregnant and don't have any ovarian cysts.

Assuming everything looks good, you’ll start taking the oral fertility drugs on the days prescribed by your doctor. You may or may not have ultrasound monitoring and more blood work as the cycle progresses.

If your doctor is monitoring your cycle, she will schedule the IUI procedure for just before ovulation.

Or, your doctor may ask you to use an ovulation predictor test at home. When the test indicates ovulation is near, you’ll call your doctor’s office to schedule blood work, possibly an ultrasound, and the IUI procedure.

Gonadotropins with IUI: Gonadotropins are injectable fertility drugs, including FSH, LH, hMG, and hCG. Brand names you may recognize are Gonal-F, Follistim, and Ovidrel.

When you get your period, you’ll call your doctor to schedule a baseline ultrasound and blood work. (As mentioned above, this is to confirm you’re not pregnant and don’t have any problematic ovarian cysts.)

You’ll start giving yourself injections according to your doctor’s instructions. Every so many days, you’ll have transvaginal ultrasounds and/or blood work.

The transvaginal ultrasounds will look for developing follicles. The ultrasound tech will look to see how many are there, how quickly they are growing, and whether they are nearing maturity.

The blood work will measure estradiol (E2), LH, and progesterone.

Your medications may be adjusted based on your hormone levels and the size and number of follicles growing on your ovaries.

When one or more follicles reach maturity, your doctor will schedule a trigger shot of hCG and schedule the IUI procedure.

The Procedure

The procedure is pretty simple, though it’s normal to feel nervous about it. It will be done in your fertility clinic. (You don’t need to go to the hospital for the procedure)

If you’re using a sperm donor, the donor sperm will be thawed and prepared.

If not, your partner will come into the clinic that day with you and give a semen sample. The semen sample is achieved via masturbation. (Similar to how a semen analysis is done.)

If your partner will be out of town—or, if he had difficulty providing a sample in the past—your partner may provide the semen sample before IUI day. In this case, if the sample is frozen, it will be thawed and prepared.

Semen contains more than just sperm. Your doctor will put the semen through a special “washing” procedure. This takes out the impurities and leaves only what’s needed for conception.

For the procedure itself, you will lie down on a gynecological table, similar to the ones used for your yearly exam.

A catheter—a small, thin tube—will be placed in your cervix. You may have some mild cramping, similar to what you might feel during a pap smear.

The specially washed semen will then be transferred into your uterus via the catheter.

The catheter is removed, and you’re done!

Your doctor may suggest you remain lying horizontally for a short while after the procedure, or you may be able to get up right away.

In either case, you don't need to worry about the sperm falling out when you stand up. The sperm are transferred directly into your uterus. They aren't going anywhere but up, to a (hopefully) waiting egg!

What to Expect Post-Procedure

After the IUI procedure, you may be prescribed progesterone. This is usually taken via a vaginal suppository.

About a week after the IUI, your doctor may order blood work. He will check your progesterone levels, estrogen, and (maybe) hCG levels.

Ten to 14 days post IUI, your doctor may order a pregnancy blood test. Or, he may tell you to take an at-home test.

Waiting to find out if the treatment was successful can be very stressful. Take good care of yourself!

Risks

IUI is a relatively low risk procedure.

There is a very small risk of infection.

Some of the biggest risks come from the fertility drugs used.

If you’re using gonadotropins, you may be at risk for developing ovarian hyperstimulation syndrome (OHSS).

Your risk of conceiving multiples (twins, triplets, or even more) is higher when taking gonadotropins. This is why monitoring is important.

If there are too many potential follicles, the cycle may be canceled and tried again another time.

If your doctor cancels your cycle because there are too many follicles, he will also likely tell you to abstain from sexual intercourse. It is important you take this instruction seriously.

Some couples are hesitant to "throw away" the cycle. However, if you have sex and conceive, you put yourself and your future babies at risk. Don't do it. 

Success Rate

In cycles where fertility drugs and IUI were combined, the pregnancy rate was 8 percent to 17 percent. These are per cycle rates, meaning that the success odds are higher when looking at multiple cycles together.

Your personal success rate will vary depending on the cause of your infertility and your age.

In a study of about 1,000 IUI cycles, researchers found that the success rate per couple (over one or more cycles) depended on their age and cause of infertility. 

Success rates per couple (over more than one cycle) in this study were...

  • 55.6 percent for cervical factor infertility
  • 47.4 percent for anovulation (problems with ovulation)
  • 41.7 percent for male factor infertility
  • 37.6 percent for oligospermia (less than 20 million sperm per ml)
  • 35.1 percent for unexplained infertility
  • 13.4 percent for asthenospermia (poor sperm motility)
  • 10.7 percent for endometriosis

In a review of studies on IUI and unexplained infertility, just 4 percent of women got pregnant per cycle without fertility drugs.

Though IVF success rates per cycle are much higher, IUI is significantly less expensive. The procedure is also easier and less invasive.

If IVF is out of your price range, multiple IUI cycles might be the better choice, depending on the cause of infertility. Another option to consider is mini-IVF.

Speak to your doctor to understand all your options and risks.

Sources:

Merviel P1, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. "Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature." Fertil Steril. 2010 Jan;93(1):79-88. doi: 10.1016/j.fertnstert.2008.09.058. Epub 2008 Nov 8.

The Costs of Infertility Treatment. RESOLVE: The National Infertility Association.

Continue Reading