IUI (intrauterine insemination): what is it, process, cost, success rates

Infertility is a medical condition that can cause physical, psychological, and spiritual stress for everyone involved. It can affect the person attempting to get pregnant, and their partner and family.

It’s important for both partners involved to have a fertility workup since infertility can have both male and female contributing factors (Leslie, 2021). This process—from workup to treatment—can be quite confusing and stressful, but thankfully, there are many options available now for those struggling to have a child. 

One of the least expensive and invasive methods for managing infertility is intrauterine insemination (IUI). Because of that, it’s one of the most common fertility treatments used. Let’s explore IUI. 

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Intrauterine insemination (IUI) is a medical procedure where semen from the woman’s partner or a donor is introduced directly into the uterus (Ginsburg, 2020).

The IUI procedure was originally developed to help couples conceive when there was a severe male factor to infertility, such as an inability to have intercourse or very low sperm count. Nowadays, intrauterine insemination is common for (Ginsburg, 2020; Ombelet, 2015):

• Women in same-sex relationships

• Women without a partner

• Couples where one partner has a sexually transmitted illness and the other doesn’t

• Couples where the male partner has an inheritable illness linked to the Y-chromosome

Intrauterine insemination has been well-studied as a fertility treatment after decades of use. Every year, IUI results in thousands of pregnancies (Ginsburg, 2020; Leslie, 2021).

IUI is most successful when used to treat male factor infertility or when there is no male partner. It cannot help improve female factors such as blocked fallopian tubes or poor-quality oocytes (eggs) (Ginsburg, 2020; Leslie, 2021).

So, how exactly does an IUI work? If the image of a turkey baster comes to mind, think again—you wouldn’t be able to reach your uterus with a turkey baster, so an IUI procedure must be done in a fertility specialist’s office. Each reproductive health specialist will have their preferred protocols for IUI treatment, but most will follow a similar pattern.

Ovulation

The first step in intrauterine insemination is determining when you’ll be ovulating. You’re most likely to get pregnant in the 24–48 hours after the time of ovulation (when your ovaries release an egg). Your fertility specialist will determine the optimal time by either measuring the amount of luteinizing hormone (LH) in your urine or by inducing ovulation with medications (Sicchieri, 2018).

Medications commonly used to induce ovulation include (Sharma, 2021):

• Clomiphene citrate (Clomid)

• Tamoxifen

• Letrozole

• Cabergoline

• Metformin

• Gonadotropins such as HCG

Gonadotropin therapy is more intensive than other types of fertility medication and requires close monitoring with transvaginal ultrasounds (Walker, 2021).

Semen preparation 

You can obtain semen for intrauterine insemination in several different ways (Sicchieri, 2018):

• From a male partner

• A donation from someone known to the woman

• Using donor sperm purchased from a sperm bank

No matter where the semen comes from, the donor will be screened for sexually transmitted illnesses and other health issues. A lab will then prepare the semen sample. The lab will perform "sperm washing" with special chemicals that help remove dead cells, which leaves only the most active, healthy sperm. The semen is then placed into an insemination catheter for the procedure (Sicchieri, 2018; Leslie, 2021).

Insemination

During the IUI procedure, your provider will use a speculum to help visualize your cervix. They will then use an insemination catheter to insert the prepared semen directly into your uterus. You will likely have the insemination procedure performed twice for the best chances of successfully becoming pregnant—once on the day that you ovulate and once the day after (Sicchieri, 2018).

Post-procedure monitoring

After the intrauterine insemination procedure, you might experience some light spotting or mild cramping. You can resume most activities that day or the next. After about two weeks, you will take a pregnancy test to determine if the IUI procedure was successful.

The overall success rate for IUI cycles varies from 4% to 12.74% when used alone and under ideal conditions. Research shows that pregnancy rates increase when fertility drugs are used along with insemination (Leslie, 2021; Sicchieri, 2018).

More than 90% of the live births that happen with IUI are achieved within the first two cycles. The factors that affect the success rate of artificial insemination include (Leslie, 2021; Sicchieri, 2018):

• The age of the inseminated person

• The use of medications for ovulation

• The underlying causes of infertility

• The freshness of the semen being used

Intrauterine insemination is more likely to succeed when the woman is less than 35 years old. The chances of becoming pregnant are also greater for women without a history of endometriosis, blocked fallopian tubes, or pelvic inflammatory disease (Sicchieri, 2018; Choe, 2021).

All medical procedures come with some risks of unwanted side effects. IUI is no different, although it is typically considered a very safe procedure.

One potential risk of IUI comes from the medications sometimes used to induce ovulation. Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of ovarian stimulation. Most cases are mild but severe cases can potentially be fatal if untreated. The World Health Organization (WHO) estimates severe OHSS happens with 0.2 to 1% of stimulated cycles (Choe, 2021).

Pregnancy with multiples, such as twins or triplets, is another risk of IUI, especially when medications are used to cause ovulation. Carrying multiple fetuses can cause potential health issues for both the mother and the fetuses. The risks of a pregnancy with multiples include (Evans, 2020):

• High blood pressure (pre-eclampsia)

• High blood sugar (diabetes)

• Early labor

• Low birth weight

Women with underlying health conditions that could make carrying a pregnancy dangerous should not undergo IUI. Women who want to have a child but should not carry a pregnancy may have the option to undergo egg retrieval and use a surrogate. If you plan to become pregnant, talk to your healthcare provider to ensure you’re healthy enough to carry a pregnancy safely (Choe, 2021).

You may have to try three to four attempts at intrauterine insemination before you see success. If you're having trouble getting pregnant from IUI alone, your reproductive medicine specialist may recommend adding or changing medications used to stimulate ovulation. If IUI still isn’t helping you conceive, you may move on to try in vitro fertilization (IVF) (Leslie, 2021).

Your healthcare provider can help you review your treatment options and decide what assisted reproductive techniques are right for your unique situation.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

January 24, 2022

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.