Everything About Intrauterine Insemination (IUI)?

Intrauterine Insemination (IUI) is an adjunctive method for pregnancy that involves placing sperm directly into a woman’s uterus during ovulation and is sometimes combined with fertility drugs to increase the chances of fertilization.

During a normal pregnancy, sperm must pass through the vagina, into the cervix, into the uterus, and then into the fallopian tube, where it reaches the egg. In IUI, sperm are washed and concentrated, placed directly in the uterus, and reach the egg quickly and easily. IUI is a cheaper and less risky option compared to similar treatments such as in vitro fertilization.

IUI is performed around the time of ovulation or with fertility drugs to maximize the chance of pregnancy. This process can increase the chances of pregnancy in certain couples who have had difficulty conceiving.

Who does IUI help?

Intrauterine Insemination is used to treat different types of infertility and is often done in several different periods until pregnancy. Intrauterine Insemination is often the first method tried before moving on to more aggressive options, such as in-vitro fertilization (IVF). IUI cycles may be recommended to treat any of the following infertility conditions:

Unexplained infertility
Mild endometriosis
Issues with the cervix or cervical mucus
Low sperm count
Decreased sperm motility
Problems with ejaculation or erection
Same-sex couples wishing to conceive
A single woman wishing to conceive
A couple who wants to prevent the transmission of a genetic defect from a male partner

Intrauterine Insemination is not effective in the following situations:

Women with moderate to severe endometriosis
Women who have had both fallopian tubes removed or have both fallopian tubes blocked
Women with severe fallopian tube disease
Women who have had multiple pelvic infections
Men who produce no sperm

What can I expect during Intrauterine Insemination?

Before IUI, fertility drugs may be used to help the eggs mature and prepare. The doctor performs the insemination procedure during ovulation. Sometimes hormones are given that stimulate ovulation and maximize the chance of fertility.

A partner or donor collects a sample of semen at home or in a doctor’s office. Sperm is prepared for fertilization through sperm washing, which removes a concentrated amount of unhealthy sperm. Sperm washing also helps to get rid of chemicals in the semen that can cause reactions in the uterus and make pregnancy difficult.

During the procedure, the doctor inserts a thin, flexible tube into the uterus through the cervix. They use a small syringe to insert sperm directly into the uterus. Pregnancy occurs if the sperm fertilizes the egg and the fertilized egg is implanted in the lining of the uterus. Intrauterine Insemination procedure is performed in a doctor’s office or fertility clinic and takes only about 5-10 minutes, and does not require anesthesia. IUI is not usually painful, but some people have mild cramps.

After the Procedure

This method is not dangerous and, under most circumstances, will not require sedation. This means that women can go home after doing it and return to normal activities immediately.

Following an Intrauterine Insemination procedure, it is important for the person to behave as if they are pregnant, ensuring that if the implantation is successful, the pregnancy will begin in the best possible way. A woman who has had an IUI should talk to her doctor about any medications she is taking, especially prescription drugs that can affect pregnancy. Tips to follow after Intrauterine Insemination include:

Avoid alcohol, illegal drugs, and cigarettes
Eat a healthy, balanced diet that is rich in protein
Drink plenty of water
Get enough sleep
Remain physically active, but do not try to lose weight or start an overly intense exercise routine
Find ways to manage stress
Take a prenatal vitamin containing folic acid or folate

3 Days After Intrauterine Insemination

Some women experience spotting immediately after IUI surgery. This is due to the stimulation of the delicate tissue of the cervix and vagina and not implantation bleeding. Implantation bleeding occurs later, usually 7 to 11 days after Intrauterine Insemination, when the egg is implanted in the uterine wall.

In about three days, any initial spotting will stop. If bleeding continues, muscle cramping, or pain, be sure to tell the doctor.

6 Days After Intrauterine Insemination

Implantation usually occurs about a week after IUI, when implantation symptoms can be monitored. If the spotting is low, it could be a sign of implant bleeding. Some women also experience muscle cramps during implantation. However, most women do not experience implant bleeding and have no early symptoms. So, the absence of symptoms does not necessarily mean that woman is not pregnant or the procedure has failed. In addition, some women experience implants much later, 11 or 12 days after IUI.

After IUI, a progesterone suppository may be prescribed. The doctor may check progesterone, estrogen, and hCG levels about a week after IUI. The doctor will usually order a pregnancy blood test ten to 14 days after the Intrauterine Insemination operation.

What are the risks?

In IUI, there is a small risk of infection. The doctor uses sterile instruments, so infection is very rare. As fertility drugs increase the chances of releasing more than one egg, they also increase the chances of having multiple pregnancies. The doctor tries to balance the amount and type of medication with blood tests and ultrasound to prevent excessive egg secretion at the same time.

Sometimes the ovaries overreact to fertility drugs, and a condition called ovarian hyperstimulation syndrome may develop. Many eggs may mature at one time and possibly be released. This can lead to enlargement of the ovaries, accumulation of fluid in the abdomen, and cramps. In rare cases, ovarian enlargement syndrome can lead to fluid accumulation in the chest and abdomen, kidney problems, blood clots, and torsion. should see a doctor if have any of the following symptoms while using fertility drugs for IUI:

Dizziness or lightheadedness
Sudden weight gain of more than 5 pounds
Shortness of breath
Nausea and vomiting
Severe abdominal or pelvic pain
The sudden increase in abdominal size

What’s the success rate like?

Some studies show only 8% success (using fertility drugs and IUI), while other studies show a success rate of more than 20%. Success depends on many factors. Intrauterine Insemination repetition also contributes to overall success. The more frequent IUI courses, the more likely they become pregnant. However, several studies show that most successful IUI cases occur within 3 to 4 attempts.

Pregnancy rates following IUI vary depending on the reasons for the need for fertility treatment. Success rates for IUI are reduced in women over 40 and in women who do not become pregnant after three periods of IUI. A number of factors that affect the outcome include:

Age
Underlying infertility diagnosis
Whether fertility drugs are used
Other underlying fertility concerns

Results

Wait two weeks before having a pregnancy test at home. Testing too soon can lead to erroneous results for the following reasons:

Wrong negative

If the pregnancy hormones are not yet at a measurable level, you are pregnant, the test result may be negative.

False-positive

If ovulation-inducing drugs such as HCG are used, the drug that is still flowing in the body can indicate pregnancy when the pregnancy did not actually occur.

Early Signs of a Pregnancy Following an IUI

Some women experience physical symptoms of pregnancy two weeks after Intrauterine Insemination due to high hormone levels.

Nausea

Many women experience nausea due to elevated estrogen levels. Nausea for several weeks after IUI may indicate pregnancy.

Spotty Bleeding

Implantation blockage and bleeding may occur about two weeks after the procedure. This is similar to what some women experience spot bleeding before menstruation.

Breast Tenderness

Progesterone and estrogen cause breast tenderness during pregnancy and ovulation. It also contributes to breast soreness as the breasts prepare to begin breastfeeding, increasing blood flow and fat accumulation.

Feeling Tired

Progesterone makes pregnant women feel more sleepy and tired than usual when it is higher than normal.

What if Intrauterine Insemination Doesn’t Work?

Sometimes the initial test is positive, and after a few days, it is negative. This usually means that a miscarriage has occurred. Although miscarriage can be annoying, it is usually due to a chromosomal abnormality—most women who have a miscarriage experience a healthy pregnancy the next time. A failed IUI course does not usually mean an inability to conceive. It is usually recommended to repeat the course if the conditions are right.

Causes of Intrauterine Insemination Failures

Several reasons lead to Intrauterine Insemination failure, including:

Poor quality eggs: Poor quality eggs tend to have chromosomal abnormalities and remain undivided after fertilization or lead to fetal weakness.
Age: The probability of success with IUI is 15-20% per attempt for women under 35 and then declining. There is no role for IUI in women over 40 years of age.
Poor-quality sperm: Poor-quality sperm cells may not be strong and motile enough to reach the fallopian tubes.
Timing: If there is no sperm within 12-24 hours of ovulation, the egg in the fallopian tube is destroyed.
Endometrial lining: If the inner lining of the endometrium is not suitable, the fertilized egg cannot be placed in the cavity.
Ovulation-related issues: In case of ovulation problems or lack of ovulation, no egg cells will be produced for fertilization.
Progesterone: Progesterone deficiency can lead to IUI failure because it is essential for supporting pregnancy.

Steps can take to improve IUI rates

Steps that can be taken to increase the chances of successful Intrauterine Insemination include:

Taking fertility pills: Increases the number of eggs
Full monitoring of the menstrual cycle: Determining the right time to ovulate increases the success of the cycle
Taking supplements: Supplementation can improve sperm and egg quality

The bottom line

Infertile couples with no fertility treatments have a one to five percent chance of getting pregnant during each menstrual period. But those who have had IUI treatment are about 10 to 20 percent more likely to become pregnant during each menstrual cycle. Intrauterine insemination is an effective fertility method that doubles the chances of an infertile woman becoming pregnant.

Intrauterine insemination is an adjunct to pregnancy that involves placing sperm directly into a woman’s uterus during ovulation and is sometimes combined with fertility drugs to increase the chances of fertilization. This relatively low-risk procedure can be a good option for many women or couples planning to become pregnant. Deciding whether or not to follow an Intrauterine Insemination is a personal choice. Although the success rate of IVF per cycle is much higher, the cost of IUI is significantly lower. This method is also easier and less invasive.

If you have problems getting pregnant or have questions about your pregnancy options, Dr. Arjang Naim MD, and his team can provide the best services in this area.

Additional questions

Is intrauterine insemination the same as IVF?

The main difference between IUI and IVF is that fertilization is done internally in IUI. That is, the sperm is injected directly into the woman’s uterus. With IVF, fertilization takes place externally, or outside of the uterus, in a lab.

How much sperm is used for IUI?

In general, the motile sperm count after processing the sperm sample should be approximately 5 million or more for IUI to be successful.

What causes a low sperm count?

Smoking
Drinking alcohol
Taking certain medications
Long-term sickness (such as kidney failure)
Childhood infections (such as mumps)
Chromosome or hormone problems (such as low testosterone)

What is normal sperm motility?

A total sperm count of more than 20 million is considered normal. However, even if you have more than 20 million motile sperm, it may not increase your chances of pregnancy. If you have less than 20 million motile sperm, your chances of having a successful pregnancy decrease.