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Intrauterine Insemination (IUI): Everything You Need to Know

IUI is a fertility treatment wherein sperm is guided directly into the uterus, providing a fast track to fertilization and increasing the chances of pregnancy.


Intrauterine Insemination (IUI) eggs


In the quest to become parents, many are quick to see its big flashy headlines and jump immediately to In Vitro Fertilization (IVF). And while IVF is a great option for many, it is not the only option. One fertility treatment that often gets overlooked is intrauterine insemination (IUI).


What is intrauterine insemination?


Intrauterine insemination is a fertility treatment that helps sperm reach and fertilize the egg. It can be considered a middle ground between natural conception and IVF as it increases the number of healthy sperm that reach the egg. In other words, IUI does the leg work for the sperm, allowing them to skip the harrowing journey to the fallopian tubes and be deposited via a small catheter right near the egg for fertilization.



Who could benefit from IUI?


Intrauterine insemination has led to thousands of successful pregnancies and live births around the world.


Those who may benefit most from IUI include:

  • Individuals or couples struggling with male factor infertility

  • Women with irregular or absent menstrual cycles (like with anovulation or disorders like PCOS)

  • Women with regular menstrual cycles, but for whom conception has not occured

  • A single woman or same sex couple using donor sperm

  • A same sex couple using a traditional surrogate


Ultimately, intrauterine insemination helps give sperm the highest chance of naturally fertilizing an egg.


IUI procedure


The IUI procedure is relatively simple. First, a sperm sample is collected and goes through a process called a sperm wash. This process clears away non-essential fluid and debris, and leaves only the most potent and viable quality sperm for insemination.


At the time of ovulation the washed sperm from the intended father or sperm donor is inserted directly into the uterus using a small catheter.


However, there are two subtle variations in this procedure: IUI with fertility medications to support ovulation, and IUI without medication.


IUI medications


IUI medications typically act in the same manner as medications used for ovarian stimulation for IVF. IUI is typically combined with these medications when periods are absent or irregular. These medications help stimulate the necessary hormones to produce one or multiple eggs that are ready to be fertilized by IUI.


The three medications most often used are gonadotropins, clomid, and letrozole.



Side effects associated with IUI


There are almost no side effects of IUI without medication. Women may experience a bit of mild cramping and discomfort during the procedure and bleeding for the next few days. However, the risk of additional side effects are virtually non-existent, other than infection which still is very rare at an estimated rate of 1 in 10,000. [1]


Side effects from IUI with medications may include [1]:

  • Hot flashes

  • Cold flashes

  • Weight gain

  • Fluid retention

  • Bloating

  • Nausea

  • Blurry vision

  • Headaches

  • Mood swings

  • Breast tenderness

  • Ovarian cysts*


*Roughly 15% of people who use clomid with IUI develop ovarian cysts. However the vast majority of these cysts are benign and resolve themselves once treatment is finished. [1]


The side effects of clomid are typically very mild, with the most common symptom of hot flashes experienced by roughly 10% of patients. Additionally, side effects of gonadotropins only affect between ¼-⅓ of patients. [1]



IUI Rates of Success


Many healthy, happy babies have been brought into this world by intrauterine insemination. But let’s take a look at how the stats really stack up.


Research suggests the success rate for intrauterine insemination ranges from 5-15%. Where your odds of success fall in this range depend on numerous factors, namely age and history.


Estimates report that, by age, IUI success rates sit at roughly [1]:

  • 13% for women <35 years

  • 10% for women 35-37 years

  • 7% for women 38-40 years

  • 4% for women >40 years


Several studies have explored the differences in success rates for IUI with the varying medications, and found the rates of live births from IUI for unexplained infertility as such [2]:

  • IUI without medication — 1-6%

  • IUI with gonadotropins — 8-10%

  • IUI with clomid — 4-9%

  • IUI with letrozole — 4-9%

Factors that can influence IUI success
  • Age

  • Number of follicles a woman produces

  • Quality of semen sample (total motility count)

  • Whether ovarian stimulation medications are being used

  • Which fertility medications are being used

  • Source of infertility


Multiple births

It’s important to note that IUI treatments are associated with high rates of multiples (twin or triplet births), ranging from 8-30% likelihood per cycle when ovarian stimulation drugs are used. [2]


IVF versus IUI

It can be hard choosing between all the different pathways you can take to parenthood.


Generally, IVF typically has higher success rates than IUI. But this doesn’t mean IUI couldn’t be a better option for your unique story and goals.


Success rates

IVF success rates sit at about 54% per cycle for women under 35 years of age compared to 13% with IUI. From ages 35-37, IVF success rates are about 40% compared to IUI’s 10%. From 38-40, IVF has a success rate of about 26%, and IUI 7%. For women over 40, IVF and IUI rates are fairly similar at 8% and 4% success respectively. [1]



Multiple rates

Medicated IUI treatments actually tend to have higher rates of multiples than IVF. This is because, unlike with IVF where eggs are carefully selected, fertilized, then implanted, doctors have less control over how many viable eggs are released and fertilized with IUI. [1]

  • Multiples from IVF — 1.6% of pregnancies

  • Multiples from unmedicated IUI — <1% of pregnancies

  • Multiples from IUI with clomid — 5-9% of pregnancies

  • Multiples from IUI with letrozole — 1-13% of pregnancies

  • Multiples from IUI with gonadotropins — 32% of pregnancies


Cost

Cost is another factor to consider. IUI typically costs closer to $1,000-3,000 per cycle. A single cycle of IVF can cost between $12,000-22,000, and often people may require up to six cycles. This is not including costs for pre-genetic testing (PGT) that can select embryos free from genetic disorders and abnormalities.




So, is IUI right for you?


More often than not, IUI is considered the next step for individuals who have had trouble conceiving naturally. While IVF may have higher success rates, the process might be unnecessary for couples or individuals who simply need some support in delivering sperm directly to the egg to increase the chance of pregnancy.


  • For those with anovulation (an absent period) or irregular periods from hypothalamic dysfunction, PCOS, or another source, medicated IUI may be the first step in improving the odds of conception.

  • For those with mid to low sperm counts or impaired sperm motility, IUI could increase the number of sperm who reach the egg and have a chance at fertilizing it.

  • For those who are otherwise healthy and have been trying to conceive for over a year, IUI provides a natural next step on the path to parenthood.

  • For same sex couples who are using a sperm donor or a surrogate, IUI offers a less invasive and expensive means to becoming pregnant.


If you are ready to bring your child into the world, the best thing you can do is talk to a fertility specialist. At IMA ART, we’ve curated the world’s leading experts in every aspect of fertility care to guide you on a stress-free and effortless journey to parenthood.


Contact our luxury fertility concierge team to learn more about whether our services are right for you.

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