Fertility treatment: Intrauterine insemination (IUI)

The granddaddy of all fertility treatments, artificial insemination dates back to the late 18th century. In those days, the method involved healthy sperm and something like a turkey baster. Today, sperm is "washed" and carefully placed in the uterus, using a procedure called intrauterine insemination, or IUI.

illustration of intrauterine insemination
Photo credit: Jonathan Dimes for BabyCenter

Is IUI for me?

IUI can help you conceive if your partner has a low sperm count or poor sperm motility. (Poor motility simply means that sperm has a hard time reaching an egg.)

IUI also helps if you're taking medication to ovulate or produce extra eggs and insemination is timed to boost your chance of pregnancy.

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Other fertility problems treatable with IUI include:

  • Unexplained infertility
  • Cervical scarring or cervical mucus abnormalities
  • Severe pain during sex
  • Problems with ejaculation or developing an erection
  • Sexually transmitted disease, such as HIV or hepatitis (in either partner)
  • Semen allergy

IUI can also help when a woman uses donor sperm to conceive a child, or when a man who had his sperm frozen before cancer treatment is ready to have a baby.

How does IUI work?

IUI requires ovulation, at least one open fallopian tube, and a semen sample with healthy sperm. Each IUI treatment is referred to as a "cycle" – the time from the first day of your period to ovulation and insemination and then a pregnancy test two weeks later.

The timeline for IUI treatment usually goes something like this:

  • Egg production. The ovaries produce eggs for fertilization in a couple of ways. Your doctor may recommend an "unstimulated," or natural, IUI cycle, meaning no fertility drugs are used. Or a doctor may give you a fertility drug at the beginning of your period to stimulate the ovaries to produce several mature eggs. (Women typically release only one egg a month.)
  • Tracking the eggs. An ovulation detection kit can help you pinpoint ovulation, which is necessary for timing insemination. When an egg bursts from its follicle, the kit shows a telltale surge in luteinizing hormone, and insemination usually happens the next day. Your doctor can also figure out when ovulation occurs by doing an ultrasound.
  • Washing the sperm. Once you ovulate, it's time for your partner to produce a sperm sample, which is then "washed." This process concentrates the hardiest sperm into a small amount of fluid.
  • Insemination. Your doctor uses a thin, long tube (a catheter) to put the concentrated sperm directly into the uterus through the cervix. The procedure is usually painless, but some women feel mild cramping.
  • Testing for pregnancy. A pregnancy test is done about two weeks after insemination.

How long does IUI take?

Insemination takes only a few minutes, but you may be on fertility drugs for about a week before you ovulate. Depending on the cause of your fertility problem, you may have three or four IUI cycles before getting pregnant or trying another treatment, such as in vitro fertilization (IVF).

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Some doctors are now advising women in their late 30s and older to try IVF even sooner – either as a first-line treatment or after just one or two unsuccessful IUI cycles.

What's the success rate for IUI?

Success rates depend on a couple's fertility problem and age. Studies have found that for couples with unexplained infertility, the pregnancy rate for each natural IUI cycle is about 4 to 5 percent, and when fertility drugs are used, the pregnancy rate is about 7 to 16 percent. There are no national statistics on live birth rates.

What are the pros of IUI?

  • For many couples, IUI is the first step in treatment because it's less invasive and less expensive than other assisted reproductive technology (ART) treatments, such as IVF.
  • Couples with male fertility problems have an easier time conceiving through IUI than just by timing intercourse.
  • Couples with unexplained fertility problems generally have better results with IUI than with fertility drugs alone.
  • This procedure allows fertilization to occur naturally inside your body.

What are the cons of IUI?

  • You and your partner have to go to the doctor's office as soon as you produce an egg. You usually have only 24 to 36 hours notice before you ovulate.
  • Because the timing of insemination is so crucial, your partner must be able to produce a sperm sample by masturbating into a cup at the doctor's office or clinic on short notice.
  • Taking fertility drugs is linked to a greater chance of conceiving two or more babies, and carrying multiples is considered a high-risk pregnancy. If you use a fertility drug (such as clomiphene citrate) to induce ovulation before IUI, your chance of having twins is about 10 percent. If you use gonadotropins to produce multiple eggs, your chance of conceiving multiples is about 30 percent.
  • With gonadotropins, there's a 10 to 20 percent chance of developing a mild form of ovarian hyperstimulation syndrome (OHSS), a condition in which the ovaries become temporarily enlarged and fluid leaks into the abdomen. This may feel uncomfortable but usually goes away quickly without treatment. Gonadotropins cause a severe form of OHSS in 1 percent of cycles. These cases usually require hospitalization.

How much does IUI cost?

In the United States, the average cost of an IUI cycle using your partner's sperm is about $865.

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Keep in mind that treatment costs vary depending on how much medicine you need, where you live, and whether your state mandates insurance coverage for infertility.

If you use a donor's sperm, be prepared for it to cost a little more. If your insurance policy doesn't cover the treatment, you'll have to pay the entire cost up front.

Learn more about handling the cost of fertility treatment.

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ASRM. Undated. Intrauterine insemination. American Society for Reproductive Medicine. a new window [Accessed November 2016]

CDC. 2016. Infertility FAQs. U.S. Centers for Disease Control and Prevention. a new window [Accessed November 2016]

Mayo Clinic. 2016. Intrauterine insemination (IUI). a new window [Accessed November 2016]

MedlinePlus (ADAM). 2015. Ovarian hyperstimulation syndrome. a new window [Accessed November 2016]

National Infertility Association. 2006. The costs of infertility treatment. a new window [Accessed November 2016]

OWH. 2012. Infertility fact sheet. U.S. Office on Women's Health. a new window [Accessed November 2016]

UpToDate. 2015a. Patient education: Infertility treatment with gonadotropins (beyond the basics). a new window [Accessed November 2016]

UpToDate. 2015b. Patient education: Ovulation induction with clomiphene (beyond the basics). a new window [Accessed November 2016]

Karisa Ding

Karisa Ding is a freelance health writer and editor with expertise in preconception, pregnancy, and parenting content. A mother of two, Ding finds great joy in supporting new and expectant parents by providing information they need for the life-changing journey ahead. Ding lives in San Francisco with her family.