Intrauterine Insemination (IUI): What to Expect

What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) involves “in-vivo” fertilization, meaning the process of fertilization of the egg by the sperm takes place inside of the woman’s body- more specifically the fallopian tube. After fertilization of the egg the resulting embryo slowly migrates into the uterus, where it implants approximately 7 days after ovulation.

When is an IUI recommended?

Insemination treatments may be recommended because of “mild male factor”, when one of more parameters on the semen analysis are abnormal, or in cases of “unexplained infertility”. The IUI procedure involves the transfer of a washed and concentrated sperm sample into the uterus. During regular intercourse the sperm is deposited near the cervix, and has a longer way to travel to reach the tube where the egg may be waiting to be fertilized. So IUI treatments can be viewed as a way to optimize the conditions for pregnancy, by maximizing the concentration of high quality sperm in the right place at the right time.

IUI “natural cycle” meaning.

IUI can be done in a “natural cycle”, without the use of medications. This may be recommended in cases where donor sperm is used (by single women or women in a same-sex relationship, or when the male partner has “azoospermia” = no sperm in the ejaculate). When IUI is done in a natural cycle in a patient with regular menstrual periods, it is usually sufficient to check ovulation predictors kits (OPKs) and call the clinic with a +OPK result. The IUI can then be scheduled the day after.

IUI in a natural cycle may also be done in couples with “mild male factor” or “unexplained infertility” if the couple is worried about the risk of multiple pregnancy mediated by the use of medications to stimulate the ovaries, such as Clomid, Letrozole or injectable gonadotropins. The baseline risk of a twin pregnancy in a natural cycle is about 1-2%.

However, most fertility specialists will recommend the use of Clomid in this setting, in order to increase the chance of pregnancy, mostly by increasing the number of dominant follicles ready to ovulate after the stimulation. The risk of twins increases to around 5-10% with the use of Clomid. For this reason, it is important to do a monitoring ultrasound after the use of the medication, to determine the number of follicles that are ready to ovulate. If a patient has side effects on Clomid, or a very thin lining of the uterus after Clomid use, then your doctor may also use Letrozole (Femara) in this situation. Low-dose injectable gonadotropins (containing the hormones FSH and LH) may also be used in this setting, but FSH+IUI cycles are used less and less nowadays, because the chance of pregnancy is not a whole lot higher than with Clomid or Letrozole, but the risk of multiple pregnancy (including “higher order multiple pregnancies” such as triplets or quadruplets) increases substantially.

What to expect during an IUI cycle?

In practical terms, most clinics have a similar protocol for Clomid+IUI cycles, although the exact instructions may vary a bit from clinic to clinic. You call the clinic with the first day of your menstrual period (“cycle day 1” / CD1) and a baseline ultrasound is scheduled on CD2 or CD3 to look for any cysts in the ovaries and to make sure it is OK to start the medication. You then take the medication for 5 days, usually a dose of 50 mg (one tablet) or 100 mg (two tablets) daily. Around CD 10-12 (depending on clinic protocol, but also on how long your cycles usually are) you come back for a monitoring ultrasound. The purpose of this ultrasound is to assess the lining of the uterus, and to measure all the follicles over 10 mm in size that have developed as a result of taking the medication. If too many follicles have developed (depending on age ≥3 or ≥4 may be too many) then you may be advised to cancel the IUI because of an excessively high risk of multiple pregnancy. If the number of dominant follicles is reasonable and it is OK to proceed, there are two ways to time the IUI procedure: by OPKs or using the ovulation “trigger”. There is no clear evidence that one is better than the other, the chance of success is similar between the two methods. If you are very comfortable with the OPKs and they are reliable for you, it is totally OK to use the OPK method and schedule the IUI the day after a +OPK result. If the OPKs do not work well for you, or if you do not want to take a chance on the OPKs because you may miss ovulation, then the “hCG trigger” can be used. There are different names for the different hCG preparations, but all of them involve an injection (either intramuscular or subcutaneous) 36 hours before the insemination procedure.

Insemination day:

On the day of the insemination, unless donor sperm is thawed and used, the male partner provides a specimen a couple of hours before the IUI procedure. The lab then washes and spins the sample, in order to produce a “clean” sample of sperm with the fastest and highest quality sperm cells. When the sample is ready the sperm is injected directly into the uterus with a small catheter. In order to do this, the provider needs to place a speculum exam in your vagina, similar to a Pap smear. After the procedure you will be instructed to rest for 10 minutes, after that you can go about your day in the usual fashion, no special precautions necessary.

Is intercourse okay after an IUI?

With regards to intercourse before and after the procedure- in heterosexual couples- this is allowed and even encouraged up to 36 hours before the procedure and any time after the procedure. Your doctor may recommend vaginal Progesterone supplementation after the IUI procedure until the pregnancy test, however the evidence for any benefit of this is relatively weak.

Medical Disclaimer:

The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.