Infertility affects up to 15 percent of couples. Learn how intrauterine insemination (IUI) works and how the procedure might help you start a family.
Newlyweds Sarah and Jay Hudson looked forward to starting a family. But after several unsuccessful months of trying to conceive, Sarah was diagnosed with polycystic ovary syndrome (PCOS), a reproductive disorder that prevents ovulation.
Anxious to make their dreams of having children a reality, the couple consulted with Joseph Doyle, M.D., a reproductive endocrinologist at Shady Grove Fertility in Rockville, Maryland. Dr. Doyle conducted a complete health assessment to come up with an individualized treatment plan for the Hudsons.
"He started me on Clomid and timed intercourse because he wanted to try the least invasive protocol, but one that he still thought could be successful," says Sarah, 31.
Clomid is a commonly prescribed fertility medication that helps stimulate ovulation. The couple tried this method for three months.
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"After that wasn't working, we moved to IUI."
What is IUI?
Intrauterine insemination (IUI) is a relatively low-tech, out-patient procedure, in which prepared sperm is placed in a woman's uterus while she is ovulating using a thin, pen tip-sized catheter.
The catheter creates a direct route for the sperm to fertilize an egg in the fallopian tube, effectively bypassing the cervix and cervical mucus, which can otherwise hamper its journey.
Unexplained infertility, cervical factor, a blocked fallopian tube, mild endometriosis and mild male factor, in which a partner has low sperm count or decreased sperm mobility, are common reasons couples try IUI.
Donor sperm can be used if a partner's sperm count is too low or if the patient is single or in a same-sex relationship.
How does IUI Work?
"The treatment is stacked right on top of the patient's regular cycle," Dr. Doyle says. "They should be able to have one try each month."
The treatment begins within the first few days of your menstrual cycle with a baseline pregnancy test and ultrasound.
To help your physician time the IUI with when you will be ovulating, you'll visit their office two to three times over the course of your cycle. Your doctor will conduct ultrasounds and blood tests to monitor your estrogen levels, uterine lining, and egg (follicle) growth. If your cycle is longer, you may have to go in for an additional visit. Your last visit, usually the fourth one, will be for the IUI.
Medicated Versus Unmedicated IUIs
Depending on your specific health condition, your age, and the reasons why you are doing the insemination, your physician may prescribe a medication to stimulate ovulation. Usually, you'll take the medication for about five days during your cycle to trigger ovulation. Although it's less common, some women take a daily medication for about 14 days until ovulation occurs.
If you have no problems ovulating on your own or you are opting for an IUI for non-medical reasons—perhaps because you are 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.
"IUIs do not increase your chances of a multiple gestation pregnancy. It's what medicines you take with IUI that can increase your chance," says Courtney Marsh, M.D., M.P.H., FACOG, assistant professor in the Center for Advanced Reproductive Medicine at the University of Kansas Health System.
Different medications carry different risks for multiples. But medication is often necessary to bump up the odds of pregnancy, especially when a couple has already been trying to conceive for 12 to 18 months before they arrive at a fertility clinic. If this is the case, doctors might want to use medication to increase the number of available eggs.
"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."
Dr. Doyle, who rarely does unmedicated IUIs, says that of the 15 percent of women who get pregnant via medicated IUI, 92 percent experience single gestation while about 8 percent become pregnant with multiples.
Timing the IUI is Crucial
Once your doctor pinpoints when ovulation will occur, the IUI is scheduled.
Then every step is meticulously planned on the day of the IUI, from when you take your medication to when your partner produces a sperm sample.
"We have an andrology team prepare the sperm on a sperm up gradient so it's survival of the fittest sperm. They have to swim to the top," Dr. Marsh explains. "The sperm at the top is then put into a catheter."
After placing a speculum in the vagina, the catheter is inserted directly into the uterus and the sperm is injected.
"It felt like light cramping. It took maybe five minutes, plus the 10 minutes you lay down afterward. Like any doctor's appointment, it's the waiting in the waiting room that took longer," Sarah says.
After nine to 14 days, you can take an at-home pregnancy test or make an appointment with your physician for blood/serum or urine pregnancy test.
"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."
Sarah says the post-IUI wait is the hardest part. "I definitely tried to keep my mind off of it and continue with business as usual because the more I got my hopes up, the sadder it was when it didn't work."
IUI vs. IVF
The success rate of IUI ranges between five and 20 percent, depending on a woman's age and other health factors. If you aren't pregnant after about three IUI cycles, your physician may recommend in vitro fertilization (IVF).
It took Sarah and Jay Hudson three cycles of IUI to become pregnant. Now that she is expecting her baby's arrival in June, Sarah says she is happy she started with a low-invasive treatment like IUI.
"I felt like Dr. Doyle made sure my treatment plan was right for me," Sarah says. "I'm also happy because before starting treatment I had an intense fear of needles so moving right to IVF would have been really hard on me personally."
In IVF, daily injectable medications are used to stimulate a woman's ovaries. Practitioners combine an egg and sperm in a laboratory dish and the embryo is then transferred to the uterus. Success rates vary depending on age and medical history but are usually higher than IUI, ranging between 13 and 43 percent.
IUI tends to be a more affordable option for couples: Depending on insurance benefits, medicines, and the clinic, IUI can cost up to $2,000, while one cycle of IVF averages around $15,000.
But, Sarah admits that she was fully prepared to try IVF if the IUI hadn't worked.
"IVF is, of course, more costly, but we could have cut some of the extra things out of the budget to afford treatment," she says. "At the end of the day, we wanted to be parents and we were going to do whatever was necessary to make that dream a reality."
To learn if IUI could work for you, consult with your healthcare provider.