What Is Intrauterine Insemination (IUI)?

IUI, or intrauterine insemination, is a relatively simple fertility treatment. It may be done with or without fertility drugs. The procedure itself involves transferring semen that has been washed and concentrated directly into the uterus via a thin catheter. IUI is done around the time of ovulation or in conjunction with fertility drugs to maximize the likelihood of conception.

When It's Used

IUI is used to treat many types of infertility and is often done in multiple cycles until pregnancy is achieved—or another treatment is tried. IUI is often the first procedure tried before moving on to more invasive options, such as in-vitro fertilization (IVF). Some insurance companies require a few cycles of IUI before paying for IVF.

Cycles of IUI may be recommended to treat any of the following infertility situations:

• Hostile cervical mucus
• If a sperm donor is being used
• If sexual pain makes intercourse not possible
• If treatment with fertility drugs alone is not successful
• Male infertility
• Unexplained infertility

Cost

When considering fertility treatments above and beyond taking fertility drugs, IUI is often the first tried because it's easier to do than assisted reproductive technologies like IVF. It also costs much less. Some insurance plans will cover IUI (and possibly other infertility treatments), while others do not. Check your coverage and all fees before getting started so that you can make a financially-informed decision.

According to a survey done by the nonprofit infertility association RESOLVE, the average IUI fertility treatment costs $895. The price, however, varies considerably from clinic to clinic, ranging from as low as $300 to well over $1,000.

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

Even so, IUI is still considerably cheaper than IVF, which costs between $10,000 to $20,000 or more for the first cycle.

Treatment Cycles

Your treatment cycle (and how many cycles you plan to do) will depend on why your doctor has recommended IUI and on whether you’re taking fertility drugs. Two common treatment cycles that do involve fertility drugs include:

Clomid or Letrozole with IUI

IUI may be added to a Clomid or Femara (letrozole) 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.

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, these tests are to confirm you’re not pregnant and don’t have any problematic ovarian cysts.)

The transvaginal ultrasounds will look for developing ovarian 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 to prompt the ovaries to mature and release an egg. Then, you will schedule the IUI procedure.

The Procedure

The procedure is simple and virtually painless, 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.) It doesn't require any medications or painkillers and takes just a few minutes to complete.

Semen Collection

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 to give a semen sample. The semen sample is achieved via masturbation, similar to how a semen analysis is done.

If your partner cannot produce a semen sample at the clinic, they may have the option of using a sterile home collection kit. Keep in mind that for this method, they will need to get the sample to the office within an hour of collection, and it must be kept at body temperature until they get there.

If your partner will be out of town, or if they had difficulty providing a sample in the past, they might be able to provide the semen sample before IUI day. In this case, the sample is frozen until it's time to thaw it out and be prepared.

Semen Washing

Semen contains more than just sperm. Your doctor will put the semen through a special “washing” procedure that removes impurities, leaving only what’s needed for conception.

IUI Procedure

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 test. The specially washed semen will then be transferred into your uterus via the catheter. Then, 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 in your fallopian tubes.

After the 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. They will check your progesterone levels, estrogen, and (maybe) hCG levels.

Your doctor may order a pregnancy blood test ten to 14 days post-IUI, or they might have you 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 having a multiple pregnancy or developing ovarian hyperstimulation syndrome (OHSS).

Multiples

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 at another time.

Ovarian Hyperstimulation Syndrome

If your doctor cancels your cycle because there are too many follicles (more than 20), they will also likely tell you to abstain from sexual intercourse. It is important to take this instruction seriously because the risk of OHSS is high. OHSS causes the ovaries to become painful and swollen. In severe cases, this condition can be life-threatening.

Potential Challenges

IUI has helped many women become pregnant, but it doesn't always work. In cycles where fertility drugs and IUI were combined, the pregnancy success rate can reach as high as 20%. These are per-cycle rates, meaning that the success odds are higher when looking at multiple cycles together. Often, it is recommended to commit to trying IUI for a minimum of three cycles.

In a study of about 1,000 IUI cycles, researchers found that the success rate per couple (over one or more cycles) was in large part dependent on the woman's age, medical history, and specific fertility issues.

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

• 55.6% for cervical factor infertility
• 47.4% for anovulation (problems with ovulation)
• 41.7% for male factor infertility
• 37.6% for oligospermia (low sperm count)
• 35.1% for unexplained infertility
• 13.4% for asthenospermia (poor sperm motility)
• 10.7% for endometriosis

Among those with unexplained infertility, just 4% of women got pregnant per cycle without fertility drugs.

A Word From Verywell

Deciding whether or not to pursue IUI is a personal choice. 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 your infertility. Another option to consider is mini-IVF.

Understand that while IUI can help you conceive, it also may not result in pregnancy. Be sure to tend to the emotional impact of infertility treatments while you consider your next steps. Speak to your doctor to understand all of your options to help you decide what's right for you.