Intrauterine insemination (IUI), or simply insemination, is the placement of a concentrated sample of sperm via a syringe into a uterus for the purpose of producing a pregnancy.
When to consider IUI
You may want to consider IUI in any of the following situations:
- Unexplained infertility.
- Low sperm count. We would recommend IUI if total number of swimming sperm in a semen sample is between 5 and 20 million/mL.
- Problems with sperm motility (its ability to swim) or shape.
- Normal sperm parameters but there is a condition where he is unable to ejaculate into a vagina. Examples include if there is have pain during sex, if there is a disability, or if there is erectile dysfunction or premature ejaculation.
- Using donor sperm to conceive.
- If there has been surgery on the cervix that makes it hard for sperm to pass through the cervix into the uterus and Fallopian tubes. Examples include if the cervix has been removed or if there has been extensive biopsy of the cervix called a cone biopsy.
What are the steps involved?
The IUI process includes the following steps:
Preliminary Testing: 4 - 8 Weeks
All patients will have baseline testing prior to starting a treatment to determine the best fertility care plan.
Cycle Monitoring: Approximately 2 Weeks With 2 – 3 Appointments
In the first half of your cycle, we will do blood tests and internal (transvaginal) ultrasounds to track the development of a follicle (or follicles) in your ovaries. The follicle is where the mature egg will eventually be released from. We will monitor you for ovulation. You will need to see us about two to three times during the first two weeks of your cycle, and these appointments are scheduled in the early morning. We may also ask you to do some monitoring at home with urine sticks.
Ovulation: 1 – 2 Days
You will be given one or two days’ notice for your insemination. It may be recommended to use an injection to trigger the ovulation once the follicles are mature.
Insemination: 1 Day
The procedure is timed around ovulation as sperm will remain in your reproductive tract for a few days.
On the day of the insemination, we will need a sperm sample, which can be provided as fresh ejaculate or a frozen sperm sample.
If a fresh sperm sample is being provided, an appointment for the sperm provider will be scheduled for between 7 – 8 am the morning of the insemination procedure. the sample can produce in one of our private collection rooms at the clinic or if the sperm provider lives close enough, a sample can be produced at home and and then be given to our lab personnel.
If a frozen sample is to be used, it will be thawed the morning of the insemination.
The lab will prepare the sperm in a procedure called a sperm wash.
Once the sperm is ready, the IUI procedure will be performed. This is usually scheduled between 11 am to 12 pm. You do not have to do any preparation for the IUI. First we will insert a speculum so we can see your cervix. Then we will place a soft, thin catheter through your cervix into the uterus. Using a syringe, we will introduce the washed sperm into your uterus through this catheter. The IUI procedure only takes about five minutes. It is not painful and does not require pain medication.
The entire appointment takes about 30 minutes.
Pregnancy Test: Approximately 2 Weeks After Insemination Procedure
You will be asked to do a beta-hCG blood test to determine if you are pregnant. The nurse will make an appointment for you or provide you with a requisition if you want to do the blood work at an outside lab.
What happens if the pregnancy test is positive?
If your pregnancy blood test is positive, you will be asked to repeat the test 2-3 days later to measure for appropriate rise of the pregnancy hormone. If the second pregnancy blood test has risen appropriately, you will be scheduled for an early obstetrical ultrasound around 7 weeks of pregnancy, then referred for obstetrical care.
What happens is the pregnancy test is negative?
If your pregnancy test is negative, you may be able to proceed into another cycle or it may be recommended that you follow up with your fertility care team to determine the best next steps in your fertility journey.
Risks associated with IUI
IUI is a safe procedure, however, there are a few risks involved with IUI. These include cycle cancellation, multiple pregnancy, and other pregnancy risks.
In some situations, your IUI cycle might need to be cancelled. If this happens, we will book an appointment with your primary doctor and a portion of your fees will be refunded depending on the treatments that have already occurred.
The goal of IUI is to have one healthy baby. However, if you have a high number of follicles developing, you will have an increased risk of multiple pregnancy. Because of the risks associated with multiple pregnancy, your doctor may cancel the cycle. Please see our Multiple Pregnancy Fact Sheet for more information.