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.

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 (compared to $8,000 to $15,000 for IVF).

When Is IUI Treatment Used?

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:

What Does an IUI Treatment Cycle Look Like?

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.

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, 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.

They 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.

What Happens During the IUI 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 then 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 get up. They are transferred directly into your uterus. They aren't going anywhere but up, to a (hopefully) waiting egg!

What Happens After the IUI?

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!

What Are the Risks of IUI?

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 can be canceled and tried again another time.

How Successful Is IUI Treatment?

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

In cycles where fertility drugs and IUI were combined, the pregnancy rate was 8% to 17%.

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:

Infertility in Women. A.D.A.M. Healthcare Center. Accessed February 3, 2008.

Intrauterine Insemination: IUI. American Pregnancy Association. Accessed February 15, 2016. http://americanpregnancy.org/infertility/intrauterine-insemination/

The Costs of Infertility Treatment. RESOLVE: The National Infertility Association. Accessed February 3, 2008. http://www.resolve.org/family-building-options/insurance_coverage/the-costs-of-infertility-treatment.html

Continue Reading