IUI (intrauterine insemination) is a treatment which involves directly inserting sperm into the uterus. That’s the definition, but – like with almost every fertility topic – there’s much more to it than that. Here are the top-searched IUI questions on Google, answered by UK Medical Lead, Dr James Hopkisson, at TFP Fertility UK.
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1. What is IUI?
IUI is a fertility treatment that involves placing prepared sperm inside the uterus to improve the chances of conception. Either partner or donor sperm can be used – donor sperm insemination is often referred to as DI.
The treatment increases the chances of conception by placing sperm within the uterus around the time of ovulation. IUI might not be recommended if partner sperm doesn’t meet certain recommended parameters – for example if number or motility isn’t in an optimal place.
The treatment is more suitable for people with normal tubal function, and we do see decreased success rates with pelvic pathology – often from a previous infection, or endometriosis.
On the topic of success rates, we see between 10-16% / cycle, depending on age, stimulation approach and individual medical circumstances.
2. When would a doctor recommend IUI, and why?
You may be offered IUI if your treatment involves donor sperm insemination (DI), or if you’re keen to avoid IVF, perhaps for social or ethical reasons. IUI treatment offers an alternative here, increasing the chances of natural conception, without going for IVF.
It’s important to note that The National Institute of Clinical Excellence (NICE) give guidelines for this area of treatment, suggesting that universal use of IUI in unexplained subfertility is not cost-effective. A number of medical practitioners dispute this, however, and at TFP Fertility UK our position is that – if you’re working with one of our doctors – they’ll always discuss indications, appropriateness and success rates of any treatment first, ahead of building your care plan.
3. What’s involved in IUI? Can you tell me the process?
IUI involves placing prepared sperm inside the uterus, around the time you’re ovulating. This can be prepared partner sperm or sperm from a donor.
At TFP Fertility UK, before starting treatment your doctor will recommend baseline tests to assess your uterine structure, and whether your fallopian tubes are clear and ‘open’. We’ll then chat through benefits and risks of treatment, and whether ovarian stimulation is required, to improve your chances of conceiving.
If you’re using donor sperm you’ll also be offered genetic counselling, before starting donor matching. Once your donor sperm is ready and shipped to the unit, we can start the IUI treatment process.
A note on your menstrual cycle
IUI treatment also involves monitoring your menstrual cycle – we’ll be looking at how your follicle(s) are developing, using ultrasound and urine-based LH (luteinizing hormone) testing to optimise insemination timings. If you’re undergoing ovarian stimulation as part of your treatment plan, we’ll use ultrasound checks to reduce the risk of ‘over-response’, and a multiple pregnancy.
The insemination procedure is straight-forward and doesn’t require sedation, and involves a soft catheter being passed through your cervix, with sperm being placed inside your uterus. Patients often compare the mild discomfort to a smear test, and it’s rarely painful. Your doctor and team will be available for any questions you have before IUI, and your comfort is our top priority.
4. What happens day-by-day, after IUI?
Hopefully, a lot will be going on inside your body, but as far as treatment goes, not too much! IUI is typically quite light-touch after insemination, and we won’t usually need to follow up with hormonal support.
We’re now monitoring and waiting for spontaneous conception, across your two week wait. If your IUI treatment has been unsuccessful this time, we can look at trying again straight away – with back-to-back cycles – or take a break.
5. How long does the IUI process take?
When planning out your treatment and calendar, it helps to see IUI as a series of treatments.
These run on a monthly cycle, and to start off with we’d suggest committing to three treatment cycles before reassessing the plan. From there, we might start ovarian stimulation to increase the chance of conception, or move to other treatment options, including IVF.
6. Tell me about IUI success rates – how effective is it?
In general, success rates are between 10 to 16% / cycle and will be influenced by female age, medical history and the use of ovarian stimulation.
Ovarian stimulation increases success rates, but also carries an increased risk of cycle cancellation because of over-response, and increases the risk of multiple pregnancy.
7. IUI vs. IVF – how are they different?
IUI comes with a lower level of intervention in terms of medication, monitoring, physical intervention, and laboratory work. IUI is also less expensive, which can be a key concern for anyone self-funding their treatment. However, it has a lower success rate than IVF.
8. Am I more likely to have twins with IUI, or a multiple birth?
When using stimulated IUI (with ovarian stimulation), there is a risk of multiple birth. This ranges between 2 and 10% / cycle and depends on your treatment unit’s policy for cancelling treatment due to ovarian over-response. So do make sure you’re completely clear on your team’s policy, before starting IUI treatment.
At TFP Fertility UK, if more than two dominant follicles develop (over 14 mm diameter) we’d usually recommend cancelling that cycle.
9. How can I prepare for IUI?
In most cases, we’d recommend all the usual good habits and lifestyle tweaks for pre-conception, including:
- taking a folate and Vitamin D supplement
- quitting smoking, if you do
- keeping your BMI (body mass index) within the healthy range
For men, we’d recommend taking a multivitamin, cutting down on alcohol intake and maintaining a healthy lifestyle, to boost sperm ahead of IUI.
10. I’d like to try a second round of IUI – anything I should know?
You’ll need to cover off a few factors with your team, including:
- how treatment fits into your everyday life and calendar – it may not be convenient to run cycles back-to-back, for example
- use of oral or injectable drugs to stimulate follicle development, if ovulation was an issue in your previous cycle
11. What are the IUI waiting lists like?
At TFP Fertility UK, we don’t have waiting lists for treatment. Our aim is to be ready to go, when you are, and all the necessary tests can start once you’ve had an initial consultation.
Using donor sperm? In this case, there may be a wait (usually up to three months) until this is available – especially if you’re sourcing this from an external provider or donor.
Find out more about our in-house sperm donation options, for a one-stop process.
12. I’m in a same-sex/LGBTQ+ couple – what’s your approach to IUI?
With many of our patients identifying as LGBTQ+, TFP Fertility UK offer an outstanding level of experience here. We’ll discuss different options for using donor sperm, individualising your care, and set out next steps for your treatment plan. This may be donor insemination (with or without stimulation), or IVF.
13. I’m single – how will IUI work for me?
Again – lots of expertise here! We’ll chat through donor sperm options, individualise your care plan, and cover next steps for treatment using IUI (with or without ovarian stimulation), or IVF.
14. How much does IUI cost? Can you give me a typical cost break-down?
Your doctor and team will take you through different options for treatment, and the costs involved. At TFP Fertility UK, we’ll provide you with an individualised cost plan, with details on refunds if cancellation occurs. If using medication to stimulate your ovaries, we’ll also give you an approximate cost for this too.
15. Are there any payment options I can look at?
We have a number of finance options available, to help you plan for treatment. These vary across our UK-wide clinic network, so do ask your local team for more details.
16. When is the best time to start IUI?
When you’re ready. This is your decision, and at TFP Fertility UK we operate on a patient-first basis. We’re here to give you all the support and information you need – you don’t need to commit to any treatment.
17. What tests are involved with IUI?
Ideally, your GP will be able to organise a few baseline tests, looking at your hormones between days one and five of your cycle (FSH/LH) and a mid-luteal (day 21) progesterone reading, to assess for ovulation. We can help with this, and your team will cover off everything required in your initial consultation.
We also recommend:
- screening for chlamydia
- confirming you’ve been immunised against rubella
- pelvic ultrasound and tubal patency test
18. How soon after my LH surge should I do IUI?
Between 24-38 hours. All TFP Fertility UK units will optimise success by fitting treatment in line with your own LH surge, or with medication.
19. Donor conception and IUI – how does it work?
The process doesn’t really vary, apart from the fact you’re using donor sperm! We’ll discuss different options for treatment and the costs involved. One important aspect of IUI with donor sperm is counselling, and at TFP Fertility UK we offer all patients support with setting this up. Counselling should also cover the legal aspects of using donor sperm, including parentage.
20. I’ve had a couple of failed rounds – why is IUI not working?
As things stand, it’s not possible to give an absolute cause for IUI not working. With IVF we’re better able to monitor fertilisation in the laboratory, the development of embryos and their quality. With IUI there’s less intervention, so we can’t get that super-clear picture.
21. I have PCOS – can IUI still work for me?
Yes, in many cases. For anyone with an ovulatory disorder, we can give medication to boost ovulation. If you’re using donor sperm and have PCOS, we can also go down the route of DI, combined with stimulation. Monitoring is key, and good understanding – through pre-treatment counselling with your team – that if over-response occurs, your cycle will or may need to be cancelled.
22. Does IUI hurt?
IUI involves passing a speculum (much like the ones used in your smear test) and then inserting a very fine catheter through the neck of the womb. This should not be painful, but if you find smear tests cause you pain, do let your doctor know in advance – we can look at ways of making the procedure easier for you.
23. Can you do IUI without fallopian tubes?
You require normal fallopian tubes to undergo IUI. At TFP Fertility UK we recommend moving to IVF, if you have a history of pelvic infection, tubal surgery or endometriosis, to optimise success.
24. Is there anything I should do, or avoid, after IUI?
Following IUI and IVF, we recommend that all patients try to live life as normally as possible. So, continue to supplement your diet with folate and Vitamin D, minimise alcohol and caffeine and eat a nutrient-dense diet.
If you’re concerned about anything at all after treatment, there is always an on-call doctor at your TFP Fertility UK unit.
25. What symptoms should I watch out for, after IUI?
If you’ve undergone ovarian stimulation as part of your treatment, OHSS (ovarian hyperstimulation syndrome) may occur. This is rare, however, and symptoms are usually mild to moderate, due to the low dose stimulation protocol we use.
26. What are the next steps, if IUI fails?
If you’ve gone through a number of IUI or DI cycles, we’ll sit down with you, go through what we’ve learned and discuss further options for treatment, including IVF.
27. What are the average number of IUI attempts before pregnancy?
According to HFEA, approximately 30 to 35% of our patients will conceive after three cycles of IUI or DI.
IUI success and prep – TFP Fertility UK’s top 3 takeaways
Wherever you’re at in your journey, we recommend all patients:
- Ensure your care is individualised, and evidence-based. At TFP Fertility UK, this is always our starting point, and the basis of every care plan.
- Live as healthily as possible, take a prenatal supplement that works for you, and cut down on alcohol and caffeine.
- Lean on your clinic’s patient support team. They’re there to help with any question or requirement, from an appointment to a blood test, to helping with a symptom query.
Ready for IUI next steps? Connect with TFP Fertility UK for world-leading care, local to you.