What to Expect When You Have an IUI Procedure
Many couples struggling to conceive consider intrauterine insemination (IUI) as a fertility treatment option. During the minimally invasive procedure, sperm is inserted directly into the woman's uterus, increasing the odds of successful fertilization. Here's everything you need to know before signing up for an IUI procedure.
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Why Do People Use IUI?
One in eight couples struggle with infertility, or the inability to conceive after one year of trying (or six months of trying if the woman is over 35 years old). IUI is likely their first fertility treatment, since it's cheaper and less invasive than in vitro fertilization (IVF). In fact, some insurance companies require multiple rounds of IUI before allowing IVF, says Tanmoy Mukherjee, M.D., a board-certified gynecologist and reproductive endocrinologist who works as a co-director of Reproductive Medicine Associates of New York. "We usually try IUI three or four times, then we move onto IVF if the treatment is unsuccessful," he explains.
Oftentimes couples turn to IUI for issues involving the male partner's sperm count. "A semen analysis dictates how much sperm is present, how the sperm are moving, and how they're shaped," says Dr. Mukherjee. "You want at least 10 million sperm per cubic centimeter (cc) in the ejaculate, and you want 40-50 percent of sperm to be moving properly. The shape of the sperm also correlates with the effectiveness of fertilization; you want 6 percent of the sperm to look normal or else the egg might not be fertilized properly." Dr. Mukherjee explains that if there's an issue with sperm count, motility (movement), or morphology (shape), doctors will consider IUI.
Aside from male factor infertility, other reasons couples choose the IUI process include:
Thick cervical mucus that prevents sperm from reaching the uterus
Infertility of an unknown cause
Endometriosis-induced infertility
Use of donor sperm for whatever reason. For example, people may rely on donor sperm if they're in LGBTQ relationships, a single parent, suffering from poor sperm quality, or want to avoid genetic disease.
Something to keep in mind: Women with blocked tubes aren't candidates for IUI, since the sperm can't bypass a blocked tube. They will need IVF instead, says Dr. Mukherjee.
Preparing for the IUI Process
To prepare for IUI, a woman will sometimes take medications like Clomid or letrozole to stimulate ovulation. "We [use medication to] try to push the ovaries to produce more like two to three eggs. Our first thought there is that if the first egg doesn't fertilize, maybe the second or third one will," Dr. Doyle says. "Part of this is just a numbers game. We're increasing the number of eggs and getting more sperm close to those eggs."
If you have no problems ovulating on your own or you're opting for an IUI for non-medical reasons-perhaps because you're single or in a same-sex relationship-you may prefer an unmedicated IUI. In this case, your physician may suggest an over-the-counter ovulation kit to help time the insemination.
Keep in mind that these medications can risks for multiples. "IUIs do not increase your chances of a multiple gestation pregnancy. It's what medicines you take with IUI that can increase your chance," adds Courtney Marsh, M.D., M.P.H., FACOG, assistant professor in the Center for Advanced Reproductive Medicine at the University of Kansas Health System. Dr. Doyle says that of the approximately 15 percent of women who get pregnant via medicated IUI, 92 percent experience single gestation while about 8 percent become pregnant with multiples.
What to Expect During the IUI Procedure
According to Dr. Mukherjee, the optimal time to conduct IUI is prior to ovulation-specifically 12-24 hours before an egg is released. The inserted sperm can survive for five days in the reproductive tract, so this timeline ensures that it's ready for the egg's introduction.
"The treatment is stacked right on top of the patient's regular cycle," says Joseph Doyle, M.D., a reproductive endocrinologist at Shady Grove Fertility in Rockville, Maryland. "[Women] should be able to have one try each month."
If you're not using donor sperm, doctors need a semen sample from the intended father. It takes about an hour to prepare the semen for the IUI process. "You can not put semen directly into the uterus, so you have to first separate sperm from seminal fluid," says Dr. Mukherjee. "Seminal fluid is rich in prostaglandins that cause extremely painful uterine contractions. That's why we process semen so we only have sperm to inseminate with."
The next step is mixing the sperm with a small amount of liquid and loading it into a syringe on a thin, pen tip-sized catheter. The doctor will place this inside of the vagina until it reaches the uterus, then dispense the sperm inside. "The actual insemination is like having a Pap smear," says Dr. Mukherjee. You'll be done with the procedure in a couple of minutes, and you don't need medication.
Intrauterine insemination works by getting sperm closer to the egg than intercourse does, as it bypasses the cervix and cervical mucus. "When you're having intercourse, most of the sperm die in the vagina. The vagina is cooler and more acidic so 90 percent of sperm die there," says Dr. Mukherjee. "But when you're doing insemination, you put the sperm right into the uterine cavity. The uterus has normal body pH and normal body temperature so more sperm survive to populate the reproductive tract."
After an IUI procedure, a woman should look out for early signs of pregnancy. A home pregnancy test will show results in about two weeks. If you experience a failed IUI, you can decide to try IUI again before resorting to other methods like IVF. "If the test is positive, we repeat blood work and then schedule an OB ultrasound," Dr. Marsh says. "If it is negative, they can try again after we review the cycle and make a new plan."
RELATED: 14 Very Early Signs of Pregnancy
Common Side Effects of IUI
You might experience some spotting and mild cramping after IUI. In very rare cases, a woman can develop an infection-but Dr. Mukherjee estimates the chances of infection are less than 0.5 percent. "If you feel warm, have an unusual vaginal discharge, or feel pain within 24 hours of IUI, visit the doctor. They will likely start you on antibiotics," he says.
IUI Success Rates
IUI success varies based on maternal age (younger mothers have a higher success rate), sperm quality, and presence of fallopian tube damage. Taking fertility medications before an IUI procedure can increase the odds of conception.
Here are Dr. Mukherjee's estimations on IUI success rates:
IUI for male-factor infertility: 8-10 percent success rate per cycle
IUI for tubal infertility: 5 percent success rate per cycle
IUI for unexplained infertility: 18-20 percent success rate per cycle
The chances of getting pregnant increase with each additional IUI cycle.If you aren't pregnant after three or four IUI cycles, your physician may recommend in vitro fertilization (IVF).
What's the Cost of IUI?
Since IUI is minimally invasive, it costs less than other fertility treatment options. Expect to pay about $300-$1,000 per cycle without insurance; however, many healthcare plans cover some or all infertility treatments. Donor sperm is an additional cost-usually about $1000 per vial of sperm. Blood work, ultrasounds, and medications to induce ovulation also raise the IUI cost.
IUI vs IVF: What's the Difference?
Although they're both forms of artificial insemination, IUI isn't the same as in vitro fertilization (IVF). The IVF procedure involves collecting eggs from the ovary, mixing them with sperm in a petri dish, and transplanting the resulting embryo into the uterus with a catheter. IVF can also be completed with donor eggs and/or donor sperm.
IVF success rates vary depending on maternal age and medical history, but they're usually higher than IUI, ranging between 13 and 43 percent. IVF is also more expensive than IUI; the IVF procedure costs about $12,000, plus an additional $3,000 - $5,000 for medication.
