IUI at a glance
- Intrauterine insemination, often called IUI, is an office-based fertility treatment that inserts sperm directly into the uterus around the time of ovulation.
- IUI assists sperm in traveling to the egg for fertilization by placing it high in the uterine cavity, past the vagina and cervix.
- IUI is often the first treatment individuals and couples receive for infertility due to its ease, affordability and efficacy in treating several causes of infertility, including unexplained infertility, mild-to-moderate male factor infertility, mild endometriosis, and anovulation (the absence of ovulation) as well as for women wishing to use donor sperm to conceive.
- Reproductive endocrinologists can perform IUI in cases where a woman has produced eggs through her own menstrual cycle or with the help of ovulation inducing medications.
What is IUI fertility treatment?
Intrauterine insemination (IUI), sometimes called artificial insemination, is a procedure in which a sperm sample is prepared and inserted through the cervix into the uterus using a thin catheter.
The goal of IUI is to place a concentrated number of sperm within the uterine cavity. This decreases the distance and amount of time it takes for sperm to reach the fallopian tubes in order to fertilize an egg and potentially result in pregnancy.
Collecting sperm for IUI
Prior to performing an IUI, semen from a male partner or a selected sperm donor is collected by one of the following methods:
- Using a special collection condom during sex.
The sample is then “washed” in our lab in order to remove the seminal fluid, creating a highly concentrated sample of sperm to be used for the IUI procedure. The sperm sample can also be cryopreserved for later use in IUI or in vitro fertilization (IVF). If a sperm donor is being used, the sample will be thawed a few hours prior to the procedure and similarly processed.
A fast in-office procedure
The insemination process can be completed in an office setting in a matter of minutes. The procedure begins quite similarly to a gynecologic exam. The doctor will use a speculum to view the patient’s cervix, and insert a narrow catheter (tube) through the cervix into the uterus to inject the prepared sperm.
Some women experience light cramping or mild spotting after the procedure. There is no need to rest after the procedure. The patient can resume normal activity as soon as it is complete.
Natural cycle IUI
Natural cycle IUI is the term used when intrauterine insemination is performed using the naturally growing egg from the woman’s menstrual cycle. At the beginning of the patient’s cycle, the doctor will begin monitoring the growth of the follicle (which contains an undeveloped egg).
The doctor will assess follicle growth through the first half of the menstrual cycle, at which point a trigger shot of human chorionic gonadotropin (hCG) will be used to induce ovulation. The doctor will then perform the IUI procedure approximately 24-36 hours after the trigger medication is injected.
IUI with ovulation induction/controlled ovarian stimulation
Ovulation induction and medicated controlled ovarian stimulation are common treatments for infertility. Patients who do not ovulate regularly or produce mature eggs on their own may be able to achieve pregnancy with the help of oral and/or injectable drugs that promote the production of mature egg(s) by the ovaries.
These medications work to increase the level of the follicle stimulating hormone (FSH) and luteinizing hormone (LH), the hormones responsible for egg production and maturation.
Careful monitoring by ultrasound for follicle growth and possibly blood hormone levels help the doctor to optimize the timing of the hCG trigger shot and intrauterine insemination to improve the likelihood of achieving pregnancy.
If follicles are not growing, the provider may alter medication dosages or change medications. In cases where too many follicles develop, the provider may cancel the cycle due to the increased risk of multiple pregnancy (twins or more, which can be a health risk for the women and subsequent babies).
We may prescribe the following oral drugs
- Clomiphene citrate (Clomid, Serophene)
- Letrozole (Femara)
Injectable medications used for IUI may include the following gonadotropins:
The “trigger” shot typically used is a form of human chorionic gonadotropin (hCG) like Ovidrel, Novarel or Pregnyl.
How does IUI compare to IVF?
Intrauterine insemination and in vitro fertilization are the most common treatments for infertility.
One of the primary differences between the two is that with IUI, fertilization happens inside the body. During IVF the eggs are retrieved from the ovaries and fertilized in the lab.
This video from the American Society for Reproductive Medicine explains the difference.
IUI and IVF are used to treat different infertility conditions and patient circumstances. Though considerably more affordable, IUI may not always be the most effective option for obtaining pregnancy in particular cases. IVF is also used when intrauterine insemination has not been successful after several attempts.
Who should consider IUI for pregnancy assistance?
The use and success of IUI depends on the underlying cause of infertility. IUI is not an effective treatment in cases where the patient has bilateral (both) blocked fallopian tubes or in cases of severe male factor infertility.
Due to the ease and relatively lower cost of the procedure, IUI is frequently recommended for couples experiencing unexplained infertility, which is the diagnosis when fertility testing fails to identify a distinct cause of infertility in either partner. In these cases, IUI is most successful when combined with ovulation-stimulating medication or hormones.
Irregular or absent ovulation
Women who do not release an egg regularly may have difficulty timing intercourse with ovulation. IUI with ovulation inducing medications can make ovulation more predictable and increase the likelihood of becoming pregnant. Similarly, for women who don’t ovulate at all, ovulation induction with medications along with insemination can improve chances of pregnancy.
Male factor infertility
IUI is used when a male’s sperm is of modest quality (decreased counts or lower motility), when he has difficulty maintaining an erection, or when he has ejaculatory dysfunction.
Single women and couples who are using donor sperm to become pregnant can do so using IUI. The fertility specialists will evaluate the woman to determine if she is a good candidate for intrauterine insemination, with no underlying conditions such blocked fallopian tubes or uterine factors that would impact pregnancy.
Male fertility preservation
Men who are going to have a sterilizing vasectomy, chemotherapy or radiation treatment for cancer, or testicular surgery can freeze their sperm prior to treatment to be used in IUI or IVF later. Frozen sperm can be used with IUI or other fertility treatments after an indefinite period of time in storage.
Risks & side effects of IUI
The risks associated with the insemination procedure are relatively small.
They include minor abdominal cramping and light spotting for the woman post procedure. The risk of infection from IUI is very low.
There are risks associated with the use of fertility medications, such as an increased risk of a multiple pregnancy (twins or more). A multiple pregnancy presents a higher risk to both mom and baby. This includes an increased risk of obstetric complications, preterm labor, premature birth, and physical or developmental delays for the child.