Intrauterine insemination (IUI), also known as artificial insemination, is a fertility treatment in which sperm is processed in a laboratory and then placed directly into the uterus. Typically, IUI is performed after ovulation is triggered, and ovarian stimulation may be used beforehand to increase the number of mature eggs and improve pregnancy chances.  

Who Is It Recommended For?  

IUI is primarily used when infertility is related to male factors, such as difficulty ejaculating into the vagina. By bypassing this barrier, IUI gives the woman the same chances of conception as couples having regular intercourse. It is also the first-line treatment for sperm donation when the woman has no fertility issues.  

Additionally, IUI may be recommended for:  

• Unexplained infertility  

• Mild endometriosis  

• Mild male factor infertility (such as low sperm motility)  

• Cervical infertility (issues with sperm passing through the cervix)  

• Single women or same-sex female couples  

What Tests Are Required Before IUI?  

To ensure that IUI is feasible, several tests are performed:  

• For the woman: A fertility workup confirms that at least one fallopian tube is open, as sperm must travel to meet the egg. Ovarian reserve and uterine cavity assessments are also conducted.  

• For the man (or sperm donor): If the couple is heterosexual, a sperm analysis determines if IUI is a viable option. A "motile sperm survival test" assesses the number of motile sperm that can be processed. At least 1 million motile sperm are required for IUI eligibility.  

• IUI can be performed in a natural cycle (with a single follicle developing naturally) or after mild ovarian stimulation, especially for women with PCOS or those using sperm donation.  

How Is the Procedure Performed?  

IUI is a quick, painless procedure. It is performed 36 to 40 hours after ovulation is triggered, either naturally or by an injection. On the day of the procedure:  

1. The sperm sample is collected and prepared in the lab through a series of washes, which isolate the most motile sperm. This process takes about one hour. Frozen sperm may also be used.  

2. The woman is placed in a gynecological position. A speculum is inserted, and the cervix is cleaned.  

3. A thin catheter attached to a syringe containing the prepared sperm is gently inserted into the uterus.  

4. The sperm is carefully released into the uterine cavity, allowing it to travel toward the fallopian tubes for fertilization.  

5. The procedure does not require bed rest, although some doctors may suggest resting briefly afterward.  

What Are the Success Rates and When Can a Pregnancy Test Be Done?  

The success rate of IUI is 10-20% per cycle. A β-hCG blood test should be performed 14 days after insemination. If progesterone supplementation was used, the menstrual cycle may be slightly delayed. Testing too early can lead to false positives due to residual hCG from the ovulation trigger shot.  

If pregnancy occurs, the first day of pregnancy is counted from the day of IUI.  

What Happens If IUI Fails?  

For unexplained infertility, IUI is usually attempted for three cycles before considering other treatments. For women who do not ovulate naturally or those using sperm donation, IUI may be continued for up to six cycles.  

Are There Any Risks?  

The main risk associated with IUI is multiple pregnancies, especially when ovarian stimulation is used. Since millions of sperm are placed directly into the uterus, all mature eggs released can potentially be fertilized, leading to twins, triplets, or more.  

Unlike IVF, where the number of embryos transferred is carefully controlled, IUI does not allow for such control. If three, four, or five eggs mature during stimulation, each one has the potential to result in a pregnancy.  

The risk of infection is extremely low if the sperm preparation is performed under strict sterile conditions.