Intrauterine Insemination for Infertility Treatment
Intrauterine insemination (IUI), also called artificial insemination, involves delivering sperm directly into the uterus while a woman is ovulating. When a woman is ovulating, she releases an egg, or eggs, from her ovaries. The egg then travels through the fallopian tubes into the uterus. If the egg is fertilized by a sperm, pregnancy could result. By delivering sperm directly into the uterus around the time of ovulation via intrauterine insemination, it is possible to increase a woman's chances of becoming pregnant. The chances that a woman will become pregnant via IUI is dependent on many factors, including her age, underlying cause of infertility, and more. IUI is less expensive and less invasive than in vitro fertilization (IVF), and because of this, it is often attempted before IVF. The sperm used to inseminate a woman can be her partner's or it can be from a donor.1-6
Figure 1. IUI procedure
When is IUI used?
Even if a woman is using IUI, it is still necessary for her eggs to make it through her fallopian tubes and into her uterus to meet the inserted sperm and potentially implant into the uterine wall for pregnancy to occur. If a woman has a condition that prevents this process from happening, IUI may not be an option, and other methods, such as IVF, may need to be considered. Common causes of infertility that may be aided by IUI include, but are not limited to:
- Mild to moderate endometriosis
- Issues with cervical mucus that make it difficult for sperm to travel through the cervix on its own
- Scar tissue in the cervix
- Unexplained infertility
- Sexual dysfunction, such as erectile dysfunction or ejaculation dysfunction in a male partner during intercourse
- Male factor subfertility, such as a reduction in the number of sperm a male partner produces or a decrease in the quality of sperm produced that can impact their ability to fertilize an egg
- An allergy or sensitivity to semen1-5
Women looking to become pregnant with donor sperm can also use IUI to become pregnant, with or without a partner. Before insemination, your provider will perform several exams to try to determine the underlying cause of infertility and to determine if IUI may lead to pregnancy in your situation. They may use ultrasound images to look at your reproductive system and the eggs that you are producing. Depending on what the underlying cause of your infertility is, your provider may also have you take fertility medications designed to stimulate ovulation.3-5
What happens during intrauterine insemination?
The critical piece of IUI is timing. It is important to inseminate a woman while she is ovulating for the highest chance of becoming pregnant. In order to monitor for ovulation, your provider may have you use an at-home testing kit to monitor for a surge in luteinizing hormone (LH). During each menstrual cycle, LH increases rapidly approximately one to two days before ovulation. By identifying when this surge happens, your ovulation can be predicted most accurately. Once the LH surge is detected, IUI should be performed within a day or two. Another potential option to facilitate IUI timing is to receive a trigger injection of hCG (human chorionic gonadotropin). This trigger injection will help initiate ovulation.3-5
Once the insemination date and time has been determined, the semen sample needs to be obtained. This can come from a donor sample, or a male partner can provide a sample on the day of the insemination. The semen is washed and concentrated, to create a small sample of only sperm cells (without seminal fluid or other chemicals that could be in the semen). This sample is inserted into your uterus through a thin, flexible catheter that is inserted into your vagina. The actual insemination lasts only a few minutes and generally causes minimal discomfort.3-5
Once the insemination is complete and the catheter has been removed, you will remain lying on your back. After your provider determines that the procedure is complete, you can leave and go back to your regular activities right away. There is no recovery period required. Two weeks after the insemination, you can begin taking at-home pregnancy tests, or visit your provider to receive further testing. If the IUI does not lead to pregnancy, another round of IUI can be completed, if desired.4
What are the side effects and risks of intrauterine insemination?
There are few side effects and risks with IUI. It's possible that you may experience slight abdominal discomfort or light spotting after the procedure. Your risk of infection may also be slightly increased as a result of your IUI. If you are artificially inseminated while on fertility medications, your risk for becoming pregnant with multiples may be increased, depending on what medications you are on and their effects. A multiple gestation pregnancy can increase the risk of premature labor and delivering babies with low birth weights. Please note: This is not an exhaustive list of all the possible side effects. Patients should talk to their doctor about what to expect with treatment.3,4