What is an intrauterine insemination (IUI)?
IUI (Intrauterine Insemination) is a low intervention option that is often the first step into fertility treatment. An IUI consists of a doctor using a thin, flexible plastic catheter to place a concentrated semen sample into the uterus at the time of ovulation.
The goal of an IUI is to:
Concentrate a semen sample down to the best quality sperm
Use medication to induce ovulation in patients that do not ovulate on their own
Time the addition of sperm alongside ovulation
Shorten the distance the sperm have to swim to reach the egg
An example IUI catheter.
How does the process work?
There are two types of IUI, natural and medicated. Based on your medical history and whether or not you ovulate regularly, your doctor will let you know which cycle works best for you.
Natural Cycle IUI
A natural cycle IUI is an IUI that’s timed alongside natural ovulation. This means that no medications are used to grow a Follicle. Depending on your clinic, the steps to a natural IUI usually look something like this:
Common steps in a natural IUI cycle.
During the natural IUI, some clinics have you use Ovulation Predictor Kit (OPK) at home to check for ovulation, while other clinics prefer that you come in for ultrasound and bloodwork monitoring. Some clinics like to do both. (Your clinic will provide you with instructions based on how they function.) The timing of the start of OPK or ultrasound monitoring is all based on your natural Menstrual Cycle length, which means it will vary from person to person. Once ovulation is detected, the clinic will help you schedule your IUI the following day.
Medicated IUI
A medicated IUI is an IUI that uses a medication to help one or more follicles to grow to maturity. The most common medications are taken orally and are called Clomid and Letrozole (Femara). Oftentimes, an injectable medication called Ovidrel is used to trigger the eggs to ovulate once they’re mature.
Some medicated IUI cycles are done using injectable medications known as gonadotropins. These medications tend to be reserved for patients that do not respond well to the oral options. Gonadotropins (commonly used in IVF) are also considerably more expensive than Clomid and Letrozole.
Want to know more about injecting the Ovidrel and other subcutaneous injections? Click here.
The IUI is then scheduled the day after administering the Trigger Shot. The medicated IUI process usually looks something like this:
Common steps for a medicated IUI cycle.
Who is a candidate for IUI treatment?
Because IUIs are low intervention and low cost, it’s often a good way to start fertility treatments. IUIs are typically a first step for patients with unexplained infertility, those who are non-ovulatory with a normal ovarian reserve, people with polycystic ovarian syndrome (PCOS), and patients using donor sperm.
Some insurance policies require a certain number of unsuccessful IUIs prior to covering an IVF cycle. Check with your policy to confirm if this is a requirement for your coverage.
IUIs are not right for everyone. Some patient demographics that are not good candidates for IUI are:
patients with severe male factor infertility
patients who are over 40 years old
patients with very low ovarian reserve or poor egg quality
patients with blocked or removed fallopian tubes
patients looking to genetically test their embryos
IUI is a common type of fertility intervention that requires less money, less time, and less medication than IVF. It’s often the recommendation for many patients to get started in fertility treatment
Are there any risks associated with IUI?
IUI is generally considered to be a safe procedure, but there are two main risks to keep in mind.
The first and most common risk is getting pregnant with multiples (twins, triplets, etc.). The higher risk of multiples is associated with the medicated IUI in particular. When you take the medication to stimulate your ovaries to grow an egg to maturity, oftentimes the body will respond by growing a few mature eggs. Because multiple eggs are present and being ovulated, there is a chance that more than one egg could fertilize and implant to create a pregnancy of twins, triplets, or higher order multiples.
The risk of a twin pregnancy is about 10 percent when using oral medications like Clomid during an IUI cycle, according to Shady Grove Fertility. The risk is slightly higher at just over 14 percent if injectable gonadotropin medications are being used to grow follicles during the IUI.
It’s best practice for your doctor to counsel you about your personal risk for multiples before you start your treatment, as well as when to cancel the cycle if the risk of multiples becomes too high. In this scenario, the ovaries would create too many follicles to safely proceed with IUI without a very high risk of multiples.
The second risk of IUI is infection. Because the catheter is inserted through the vagina and cervix and into the uterus, there is a chance that some bacteria can be introduced. There is also a small chance that bacteria can be contained within the sperm sample itself and can cause infection. Either way, the chances of infection are less than 1 percent, according to UCSF Health.
How much does IUI cost?
The cost of IUI varies widely. According to FertilityIQ, the cost can range from $150 to $4,000. At the low end, the fees cover only the in-office insemination. At the high end, the cost covers injectable ovarian stimulation medications, monitoring, a trigger shot, and the in-office insemination. Your expected out of pocket cost will vary depending on your medical history, the treatment protocol chosen for you by your doctor, and the fees set by your clinic.
Be sure to check with your insurance benefits provider to see if IUI is covered under your existing plan or if you have the opportunity to enroll in fertility coverage through your employer.
What are the success rates of IUI treatment?
In general, the success rate of IUI is between 10% and 20%. The reason there is a percentage range is that there are many factors that influence the success of the IUI, like egg quality, maternal age, anatomy of the uterus and fallopian tubes, and number of eggs ovulated.
The success rate of an IUI is similar to the success rate of a non-infertile couple attempting to naturally conceive each month (20%).
After learning these details about an IUI procedure, cost, and risks, you can determine if it may be the right next step for you.
If you want to know if an IUI might be recommended for you, take our quiz here to receive a free, personalized treatment guide!
Sources:
UCSF Health. n.d. “Intrauterine Insemination (IUI).” Ucsfhealth.org.
FertilityIQ. n.d. “The Cost of IUI.” FertilityIQ.