IUI: Intrauterine Insemination Procedure, Risks and Success Rate

Doctor and patient before a IUI procedure.

What is IUI?

IUI (Intrauterine Insemination) is a fertility treatment that involves injecting sperm directly into the uterus of a woman. Also referred to as artificial insemination, this technique can increase the chances of a pregnancy for couples who are experiencing problems with fertility.

For natural pregnancy to occur, sperm need to travel from the vagina, through the cervix, then the uterus, and finally into the fallopian tubes. However, IUI places sperm that have been concentrated and washed directly into the uterus at the time the ovaries release one or more eggs for fertilization.  This improves the chances for pregnancy by reducing the distance and time it takes for sperm to travel to fertilize the egg.

IUI treatment can take place using sperm from either a male partner or donor. The ability of a couple to successfully conceive depends on numerous factors.

Women may need to take fertility medication that stimulate ovulation before having an insemination procedure, depending on the nature of the infertility.

The sperm is obtained from the semen sample of a partner or donor. It then undergoes a process referred to as “sperm washing” which retrieves a concentrated amount of healthy sperm from the sample.

A doctor will then inject the sperm directly into the woman’s uterus. Pregnancy occurs when the egg is fertilized by sperm and becomes implanted in the lining of the uterus.

The IUI is typically performed in a clinic or doctor’s office. The entire process takes about 15-20 minutes, but the actual IUI procedure itself only takes one or two minutes. Additionally, this technique does not require any anesthetic or pain medications.

IUI is a simple and inexpensive procedure. Although it can increase your chances of getting pregnant, each case is unique, and there is no guaranteed that IUI will work for you.

Who Is IUI For?

IUI is a relatively more affordable and less invasive procedure compared to fertility treatments like IVF (in vitro fertilization), which is both more invasive and expensive. For some couples, IUI is used as an initial treatment before moving on to IVF. Often, IUI is the only treatment required for a successful pregnancy.

These are the most common scenarios for using IUI:

  • Infertility due to unknown causes
  • Mild cases of endometriosis
  • Problems with the cervical mucus or cervix
  • Low sperm count
  • Low sperm motility
  • Abnormal sperm morphology
  • Erectile dysfunction or premature ejaculation
  • When using donor sperm.
  • To prevent the child from inheriting a genetic defect
  • Infertility due to ovulation problems
  • Allergy to semen

In certain situations, IUI may not be effective. These include:

  • Women who have moderate or severe endometriosis
  • Women who have had both of their fallopian tubes removed
  • Blockages involving both fallopian tubes
  • Severe disease affecting the fallopian tubes
  • Women who have experienced a number of pelvic infections
  • Men who don’t produce sperm (azoospermia).

IVF is an alternative treatment that may be recommended in situations where IUI is not possible. Your doctor will be able to help you decide the best course of action in these cases.

What Happens During The IUI Procedure?

Before The Procedure

Before the actual procedure, intrauterine insemination will require careful planning and coordination.

Women may be prescribed fertility medications to help their eggs mature before IUI. The insemination process will be performed by a doctor during ovulation when the eggs are released from the ovaries.

In some cases, hormones will be prescribed to induce ovulation. In order to maximize the chances of pregnancy, the doctor will pinpoint the exact time of ovulation in order to determine when the procedure should take place.

IUI can sometimes be done using a woman’s natural cycle, when no medication is used. The procedure is performed by a doctor during the window of time when the woman is ovulating naturally.

On the day of the IUI, a semen sample is provided by the male partner at the doctor’s office, or a donor’s sperm that was frozen is thawed and made ready.

Prior to insemination, the sperm are prepared by “washing”, which extracts a concentrated number of healthy sperm. Sperm washing helps eliminate substances in the semen that could cause reactions in the uterus that make it more difficult to become pregnant. Donor sperm that comes from a sperm bank is usually washed and prepared for IUI prior to it being sent to the doctor’s office.

After the ovulation time is determined, the majority IUIs are performed within 1-2 days. The doctor or fertility specialist will provide you with a detailed plan detailing the timing of the process and what to expect.

All doctors and medical facilities have their own instructions regarding the procedure for IUI. However, a typical overview of the procedure for women undergoing IUI will often include the following:

  • During your period, you may need to schedule multiple appointments for bloodwork, ultrasounds and instructions for using medications.
  • If you are prescribed medication, you will typically begin taking them during your period.
  • Within a week or so of starting the medication, you will likely have another ultrasound and/or bloodwork.
  • Within 10-16 days after beginning medication, your doctor will use your test results to determine when you are ovulating and when you and your partner should come back for the procedure.
  • On the day of the IUI, the male partner will provide the semen sample to be used, or the donor sperm will be prepared.
  • The sperm will then be transported immediately to a laboratory for washing, in order to remove the seminal fluid or other substances which could cause irritation to the uterus.

During The Procedure

IUI is a relatively painless and noninvasive procedure and does not require anesthesia. It is performed on an outpatient basis and can be done in your doctor’s office or at a fertility clinic.

During the IUI procedure, the doctor slides a thin, flexible tube through the cervix into the uterus. The doctor will then use a small syringe to insert the sperm through the tube directly into the uterus. Pregnancy occurs if the sperm fertilizes an egg and the egg then becomes attached to the lining of the uterus.

The entire process only takes a few minutes. Although IUI is not usually painful, some women experience mild cramping.

Following The Procedure

You will remain lying down on your back for 10-30 minutes after the procedure. Following that, you are able to get dressed and continue with your daily activities.

Although the majority of women will notice little discomfort (if any), you may experience some light spotting and/or mild cramping for 1-2 days following the the procedure

In certain cases, a second IUI may be performed the next day. Additionally, medication may sometimes be prescribed for use until pregnancy has been achieved.

How Long Before The Results Are Known?

Typically, an at-home pregnancy test can be taken two weeks following the IUI. A test taken any sooner than that could lead to a false negative or a false positive.

Your doctor might schedule you to return for a blood test approximately two weeks after receiving your home kit results. This is because a blood test is a more accurate method for detecting pregnancy hormones.

If the IUI is not successful, you might consider giving it another try before switching to a different type of fertility treatment. In order to ensure the greatest chances for conceiving, it’s not uncommon to use the same therapy for 3-6 months.

What is the success rate for IUI?

Each couple will respond differently to IUI and predicting its likelihood of success can be difficult. The outcome of IUI depends on several factors, such as:

  • Age
  • Causes for the underlying infertility
  • Whether or not fertility medications are used
  • Other problems related to fertility

The success rate of IUI will vary depending on the individual reasons you are seeking fertility treatment. IUI success rates generally decline in women who are older than 40. They are also lower in women who have three IUI procedures without success.

To determine if IUI is a viable option for you, discuss your potential chances for success with a fertility specialist.

What Are The Risks Associated With IUI?

The risk of serious complications with intrauterine insemination are low and it is generally safe. Although rare, there are some risks:

  • Infection – There is a small chance of getting an infection from the procedure. However, infection is extremely rare as your doctor will only use sterilized instruments.
  • Vaginal Bleeding – Occasionally, light spotting may occur as a result of the catheter being inserted into the uterus. This normally has no affect on the odds of getting pregnant.
  • Multiple pregnancy – While IUI does not increase the odds of having twins, triplets, or more, multiple pregnancies are more likely when ovulation-inducing drugs are used. Multiple pregnancies are associated with higher risks than single births, such as the potential for early labor and a low birth weight.
  • Ovarian Hyperstimulation Syndrome – This is a condition where the ovaries overact to fertility medication (especially when using injections). It is possible for a large number of eggs to mature at once and be released. This could lead to an enlarged ovary, cramping, and fluid buildup in the abdomen. In extremely rare circumstances, it can cause fluid buildup in both the abdomen and chest, blood clots, problems with the kidneys, and an ovary becoming twisted.

You should immediately contact your doctor if you are currently on fertility medication for IUI and experience any of these symptoms:

  • Lightheadedness or vertigo
  • Nausea and vomiting
  • Difficulty breathing
  • Extreme pelvic or abdominal pain
  • Rapidly gaining more than 5 lbs. of weight
  • Sudden increase in the size of your abdomen

What is the Cost of IUI?

IUI costs vary depending on the type of insurance you have and your doctor’s fees. IUI is generally more affordable than other assisted reproductive technologies, such as IVF.

IUI costs typically can range anywhere from $460 to $1500. These prices do not include fertility drugs. Other costs can include blood work, semen analysis, and ultrasounds.

Some states have laws that require health insurance companies to partially or fully cover infertility treatment costs if they meet certain criteria. However, many insurance policies don’t provide any coverage for fertility treatment.

A billing or insurance specialist may be available at your doctor’s office. They will help you understand the costs and all payment options.

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