Intrauterine Insemination (IUI): Process, Success and Cost

What is IUI?

Intrauterine insemination (IUI) is a fertility treatment in which sperm that have been washed and concentrated in a lab are placed directly into the uterus around the time of ovulation. It shortens the sperm’s journey and brings more of the healthiest sperm close to the egg. Fertilization still happens inside the body.

Who IUI may help

• Couples with unexplained infertility
• Mild male factor problems
• Cervical factors or ejaculation problems
• People using donor sperm, including same-sex couples and solo parents (see LGBTQ+ and solo-parent fertility)
• Those with ovulation problems, combined with ovulation induction

It requires at least one open fallopian tube.

What a cycle involves

1. Baseline testing if not already done, including semen analysis and tube check.
2. Ovulation medication (optional). Letrozole, clomiphene or low-dose injectables may be used.
3. Monitoring with ultrasound and sometimes blood tests, or ovulation (LH) test kits at home.
4. Trigger shot (optional) to time ovulation. See trigger shots.
5. Sperm preparation on the day of the procedure.
6. Insemination, a few minutes with minimal discomfort, followed by a short rest.
7. Pregnancy test about two weeks later. Coping with the two-week wait offers ideas for that period.

Success and how many cycles to try

Success per cycle is usually lower than with IVF and depends strongly on age, diagnosis and whether medication is used. Many clinics suggest up to three or four cycles of IUI if the diagnosis suits it, then a move to IVF. Older patients are often advised to move on sooner.

Risks

• Multiple pregnancy, mostly when medication stimulates more than one follicle
• Infection (rare)
• Cramping or spotting afterward
• Ovarian hyperstimulation (rare, mainly with injectable medication)

Cost

IUI costs far less than IVF, but fees vary by clinic and by whether medication, monitoring and sperm preparation are included. Ask for an itemized quote and see fertility costs and insurance. Our cost estimator can help you total it up.

Preparing for an IUI cycle

Preparation starts with confirming the basics: at least one open tube, adequate sperm after preparation and a way to time ovulation. Your clinic will usually ask you to call on the first day of your period, start any medication on a set cycle day, and come for monitoring visits. If you are using donor sperm, the sample must be ordered and shipped in advance, so plan for lead time. Take a prenatal vitamin with folic acid. See prenatal vitamins.

The day of the procedure

On the day, a sperm sample is collected, either at the clinic or at home with delivery within a short window, and washed in the lab to concentrate motile sperm and remove other components. You lie on an exam table, a speculum is placed, and a thin catheter passes through the cervix to place the sample in the uterus. It takes a few minutes. You may be asked to rest briefly. You can usually return to normal activities right away.

After the procedure

Some clinics prescribe progesterone after IUI, while others do not. You may notice mild cramping or spotting. Avoid obsessing over symptoms, since they cannot tell you the result. The wait is long. See coping with the two-week wait and use the due date calculator if the test is positive.

Single or double insemination

Some clinics perform two inseminations in a cycle, about a day apart, while most do one well-timed procedure. Studies have not clearly shown that doing two improves outcomes for everyone, and it adds cost. Ask what your clinic does and why.

Using donor sperm

IUI with donor sperm is a common route for single parents and same-sex couples. Donor sperm is screened and quarantined according to regulations and is thawed on the day. Because frozen sperm survive thaw less well than fresh, timing is especially important. Consider legal steps and counseling. See LGBTQ+ and solo-parent fertility and donor egg, sperm and embryo.

When to stop and move on

Most success with IUI occurs in the first few cycles, and chances per cycle do not improve with many repeated attempts. That is why clinics often suggest a limit, then a change in plan. If you are older, or have other factors, the limit may be lower. Agree on a checkpoint before you start, so that the decision to move on is made calmly rather than in disappointment.

Questions to ask

• Is IUI the best option for our diagnosis?
• Will we use medication, and how will ovulation be timed?
• How many cycles do you recommend before IVF?
• What does each cycle cost, including monitoring and sperm preparation?

Frequently asked questions from patients

Do I need to lie down afterward? A short rest is common, but there is no evidence that staying down for long improves success. Can I have intercourse after IUI? Your clinic will advise, and many say it is fine. Will I have the day off? Most people return to work the same day. What if I get my period? Call your clinic to plan the next cycle, and consider reviewing the plan if several cycles have not worked. Is bleeding after IUI normal? Light spotting can happen, but heavy bleeding or severe pain needs a call to the clinic.

IUI vs. IVF

IUI is less invasive and less expensive, while IVF has higher per-cycle success and can overcome tubal or severe male factors. Read IVF vs. IUI to compare them.