What Is IUI?

Intrauterine insemination (IUI) is an assisted reproduction method that improves a woman’s chance to achieve pregnancy by placing sperm directly inside her uterine cavity. Albeit simple, this concept can be an effective way of circumventing male fertility problems such impotence, premature ejaculation, or low sperm count or motility. It is also widely used in cases of unexplained infertility, polycystic ovary syndrome (PCOS), anovulation, or absence of a male partner.

In comparison with sexual intercourse, during which sperm gets deposited into the woman’s vagina and cervix and must travel first through cervical mucus (which is nearly impenetrable on most days of the month), IUI surpasses this barrier and takes sperm much closer to the fallopian tubes, which contain the egg(s). This shortened path allows for a greater number of higher-quality sperm to vie for the chance of fertilizing an egg.

Prerequisites

Many clinics require that both partners be assessed in order to evaluate the viability of IUI as an option. For example, since the procedure will likely not be successful if the quality of sperm is poor, the male partner is expected to provide sperm sample for analysis. Blood sample for infectious disease testing may also be collected.

The female partner, on the other hand, will be subjected to hormone level blood testing and a general exam of the uterus. In addition, she may have to undergo laparoscopy to verify that at least one of her fallopian tubes is open. An evaluation of the woman’s egg reserve may also be performed.

Procedure Details

Partner’s or donor’s sperm is first washed (i.e., proteins are removed from the semen sample) and, while still fresh, placed in a syringe. The syringe is then attached to a catheter (a thin, flexible tube), which is inserted into a woman’s vagina and through her cervix for the purpose of depositing sperm directly into the uterus.

While the washing of sperm may take 2–3 hours, the IUI procedure itself lasts only a couple of minutes. It is fast, simple, and generally painless.

Types of IUI

IUI procedures can be broadly divided into two categories: natural (unstimulated) and medicated (stimulated). While the actual procedure for both is the same, the preparation differs significantly, and so do the cost and anticipated success rate of IUI.

Natural IUI

Women who have regular periods or have not been diagnosed as infertile may elect to have natural IUI. They do not take fertility drugs but merely track their ovulation with over-the-counter predictor kits or some other type of hormone level monitoring, such as vaginal discharge and/or basal body temperature tracking.

While some couples pursue natural IUI because of its relatively low cost, this option is particularly popular among lesbian couples and single women who want to become parents. As long as sperm is available and the IUI is performed within 36 hours of ovulation, these women have a good (i.e., average for their age group) chance of achieving pregnancy.

Natural IUI has three major advantages that make it an attractive option: no side effects from medications, minimal chance for multiple birth, and very low cost. Its success rate, however, is generally lower than that of medicated IUI.

Medicated IUI

During a medicated IUI treatment cycle, a woman takes a fertility drug to stimulate the production of one or more eggs. The ovaries are then monitored via ultrasound and/or blood work 2–4 times before the actual IUI procedure.

To help produce and ovulate a single egg, a woman is usually prescribed an oral medication such as Clomid (generic version: Clomiphene). When the blood work or imaging results indicate that the egg is mature enough, the woman receives a trigger shot of hCG, which forces ovulation to occur within 36 hours. Again, the IUI has to be properly timed.

Infertile women of advanced age, or those who do not respond well to Clomid, are often given injectable medications called gonadotropins instead. These medications stimulate the growth of multiple eggs, which upon reaching maturity are also ovulated with a trigger shot.

It is important to note that due to the higher number of eggs available for fertilization, the success rate of IUI increases with superovulation, but so is the risk of a multiple pregnancy.

Cost of IUI

As demonstrated in my post titled “IUI Cost,” the cost of IUI can vary from as little as $200 (for natural IUI) to more than $5,000 depending on a host of factors, such as type of medication, frequency of office visits, and availability of insurance coverage.

Although IUI is often touted as an inexpensive alternative to IVF, one must consider the possibility that multiple IUI attempts might be warranted. To gain some idea of how the cumulative cost of multiple IUIs compares with the cost of IVF, please visit my post “IUI vs. IVF: Cost Factor Revisited.”

Success Rate of IUI

On average, couples have about 20% chance of achieving pregnancy via unprotected sexual intercourse. All else equal, the odds steeply decrease with a woman’s age. The success rate of IUI follows a similar pattern.

Whereas a woman younger than 35 years is expected to have a 15-20% chance of a successful IUI, the odds for a woman over 40 plummet to a meager 5-6%. Still, if you are infertile and currently have close to zero chance of getting pregnant naturally, IUI (either natural and medicated) is a good first option to consider. Just keep in mind that it takes most women at least three IUI cycles to conceive.

If you are like me and have undergone four unsuccessful IUI procedures after years of infertility, it may be time to consider an alternative to IUI, such as in vitro fertilization (IVF).