Intrauterine insemination – IUI

The granddaddy of all fertility treatments, artificial insemination dates back to the late 18th century. In those days, the method involved healthy sperm and something like a turkey baster. Today, sperm is “washed” and carefully placed in the uterus, using a procedure called intrauterine insemination, or IUI.

Is IUI for me?

IUI can help you conceive if your partner has a low sperm count or poor sperm motility. (Poor motility simply means that sperm has a hard time reaching an egg.)

IUI also helps if you’re taking medication to ovulate or produce extra eggs and insemination is timed to boost your chance of pregnancy.

Other fertility problems treatable with IUI include:

  • Unexplained infertility
  • Cervical scarring or cervical mucus abnormalities
  • Severe pain during sex
  • Problems with ejaculation or developing an erection
  • Sexually transmitted disease, such as HIV or hepatitis (in either partner)
  • Semen allergy

IUI can also help when a woman uses donor sperm to conceive a child, or when a man who had his sperm frozen before cancer treatment is ready to have a baby.

What’s the treatment for IUI?

IUI requires ovulation, at least one open fallopian tube, and a semen sample with healthy sperm. Each IUI treatment is referred to as a “cycle” – the time from the first day of your period to ovulation and insemination and then a pregnancy test two weeks later.

The timeline for IUI treatment usually goes something like this:

  • Egg production. The ovaries produce eggs for fertilization in a couple of ways. Your doctor may recommend an “unstimulated,” or natural, IUI cycle, meaning no fertility drugs are used. Or a doctor may give you a fertility drugat the beginning of your period to stimulate the ovaries to produce several mature eggs. (Women typically release only one egg a month.)
  • Tracking the eggs. An ovulation detection kit can help you pinpoint ovulation, which is necessary for timing insemination. When an egg bursts from its follicle, the kit shows a telltale surge in luteinizing hormone, and insemination usually happens the next day. Your doctor can also figure out when ovulation occurs by doing an ultrasound.
  • Washing the sperm. Once you ovulate, it’s time for your partner to produce a sperm sample, which is then “washed.” This process concentrates the hardiest sperm into a small amount of fluid.
  • Insemination. Your doctor uses a thin, long tube (a catheter) to put the concentrated sperm directly into the uterus through the cervix. The procedure is usually painless, but some women feel mild cramping.
  • Testing for pregnancy. A pregnancy test is done about two weeks after insemination.

How long does IUI take?

Insemination takes only a few minutes, but you may be on fertility drugs for about a week before you ovulate. Depending on the cause of your fertility problem, you may have three or four IUI cycles before getting pregnant or trying another treatment, such as in vitro fertilization (IVF).

Some doctors are now advising women in their late 30s and older to try IVF even sooner – either as a first-line treatment or after just one or two unsuccessful IUI cycles.

What’s the success rate for IUI?

Success rates depend on a couple’s fertility problem and age. Studies have found that for couples with unexplained infertility, the pregnancy rate for each natural IUI cycle is about 4 to 5 percent, and when fertility drugs are used, the pregnancy rate is about 7 to 16 percent. There are no national statistics on live birth rates.

What are the pros of IUI?

  • For many couples, IUI is the first step in treatment because it’s less invasive and less expensive than other assisted reproductive technology (ART) treatments, such as IVF.
  • Couples with male fertility problems have an easier time conceiving through IUI than just by timing intercourse.
  • Couples with unexplained fertility problems generally have better results with IUI than with fertility drugs alone.
  • This procedure allows fertilization to occur naturally inside your body.

What are the cons of IUI?

  • You and your partner have to go to the doctor’s office as soon as you produce an egg. You usually have only 24 to 36 hours notice before you ovulate.
  • Because the timing of insemination is so crucial, your partner must be able to produce a sperm sample by masturbating into a cup at the doctor’s office or clinic on short notice.
  • Taking fertility drugs is linked to a greater chance of conceiving two or more babies, and carrying multiples is considered a high-risk pregnancy. If you use a fertility drug (such as clomiphene citrate) to induce ovulation before IUI, your chance of having twins is about 10 percent. If you usegonadotropins to produce multiple eggs, your chance of conceiving multiples is about 30 percent.
  • With gonadotropins, there’s a 10 to 20 percent chance of developing a mild form of ovarian hyperstimulation syndrome (OHSS), a condition in which the ovaries become temporarily enlarged and fluid leaks into the abdomen. This may feel uncomfortable but usually goes away quickly without treatment. Gonadotropins cause a severe form of OHSS in 1 percent of cycles. These cases usually require hospitalization.

Details about success rates with IUIs at different ages and fertility situations

For a couple with unexplained infertility, female age under 35, trying for 2 years, and normal sperm – we would generally expect about:

  • 10% chance per month of getting pregnant and having a baby with artificial insemination and Clomid for up to 3 cycles (lower success after 3 attempts)
  • 15% chance per month of getting pregnant and having a baby with injectable FSH medication (e.g. Follistim, Gonal-F, Bravelle or Menopur) and IUI for up to 3 cycles
  • 55% chance of conceiving and having a baby with 1 IVF cycle

Chances for success in women over 35 drop off, and for women over 40 they are much lower. For this reason, we are more aggressive in older women.

IUI with Clomid or injectables

Many studies have shown that insemination with drugs to stimulate multiple eggs to ovulate gives a higher success rate than doing IUI without drugs, called natural cycle IUI.

How many inseminations to try before doing IVF?

  • The short answer is to move on to IVF after 3 failed IUIs
  • If the female is age 40 or older, or ovarian reserve low, consider IVF earlier
  • In vitro fertilization has a significantly higher success rate as compared to IUI
  • More on when to move from IUIs to IVF

Cervical vs. intrauterine insemination

IUI is more effective than ICI, intracervical insemination. By placing the sperm higher in the female reproductive tract, more sperm will get to the area in the fallopian tube where they might have a successful date with the egg(s).

How important is timing of the IUI? Any insemination should be carefully timed to occur at or a little before the time of ovulation. We know that in some couples, sperm can remain viable in the female reproductive tract and result in fertilization of an egg for five days (after having sex).

Eggs are fertilizable for only about 12-24 hours (maximum) after ovulation. Therefore, IUIs must be properly timed so that sperm show up for the date while the eggs are still viable.