Intrauterine insemination (IUI) is a technique that involves the insertion of sperm into the uterus using a catheter in order to create a pregnancy. It is a less invasive procedure than IVF and involves inserting sperm directly into the uterus, bypassing the cervix. This reduces spillage and aids sperm passage through the cervical mucus. It can be useful if the male has a low sperm count or if the sperm cannot pass through the woman’s cervical mucus. It may also be used in cases involving same-sex female couples or single women wishing to conceive, as well as couples who are unable to have intercourse or who are experiencing difficulties such as premature ejaculation.

IUI is a relatively painless and noninvasive procedure. The treatment can be done in what is known as the “natural cycle,” which means no medications are given. The woman ovulates naturally and has the sperm implanted at a doctor’s office around the time of ovulation. Alternatively, IUI can be combined with ovarian stimulation medication such as FSH (follicle stimulating hormone) or hCG (human Chorionic Gonadotropin), which causes the ovaries to mature and release an egg or multiple eggs, increasing the chance of pregnancy in certain couples who have had difficulty conceiving.

When compared to more invasive and costly treatments such as in vitro fertilization (IVF) or other methods of assisted reproduction, IUI is a relatively safe and a typically less expensive fertility treatment. In some cases, couples who are struggling to conceive and want to increase their chances of pregnancy may consider IUI before proceeding to IVF, if necessary, with IUI being the only treatment required to achieve pregnancy.

IUI may be recommended for patients or couples in the following scenarios including, but not limited to:

• Those who are just starting their fertility journey and are less than 35 years of age

• Those who are using a sperm donor

• Those with sperm issues, including low count, motility or morphology

• Those with erectile and/or ejaculation issues

• Those who have PCOS or other ovulation challenges

• Those whose cervical mucus may reject semen

• Same sex-couples or single women wishing to conceive

• Those avoiding potential genetic defects from the male partner

• Those with mild endometriosis

• Unexplained infertility

Prior to beginning IUI treatment, patients will need to undergo initial fertility assessment and diagnostic testing.

Cycle Monitoring

Several office visits for transvaginal ultrasounds and blood work may be required during your cycle. The ultrasounds aid in monitoring follicle development and uterine lining thickening. The bloodwork tracks follicle growth. As a follicle grows and its egg matures, the estrogen level in the blood rises.

“Trigger” Medication

A spike in LH (luteinizing hormone) levels occurs just before ovulation, helping in determining the best time for your IUI procedure. When this occurs, your your physician or your fertility nurse will advise you on when to take your “trigger medication” or a “trigger shot” to time ovulation.

Sperm Sample

You will return to the clinic approximately 12 hours after you ovulate and provide a sperm sample on the day of the procedure, or the donor sperm will be thawed and prepared for insemination.

Sperm Washing

The sperm sample provided will be taken to the lab to be “washed.” This procedure removes impurities and isolates the most potent, high-quality sperm to be delivered directly to your uterus. The process of sperm washing increases the likelihood of fertilization.

IUI Procedure

The IUI procedure is typically a few minutes and painless. A speculum is inserted into the vagina, and a very thin catheter containing washed sperm is guided through the cervix to place the sperm in the uterus. Most patients experience little to no discomfort, and sedation is not necessary.

Pregnancy Test

A beta hCG test will be administered 14 days after your IUI procedure to determine if you are pregnant. This test detects pregnancy at an early stage by measuring the level of hCG hormone in your blood.

A typical IUI treatment begins at the start of your period and ends about two weeks later with a blood pregnancy test. In some cases, a patient may be able to undergo up to three IUI cycles. It is recommended that you consult with your preferred doctor or fertility specialist about what is best for you.

The cost of IUI treatment varies depending on factors such as the physician’s clinical experience/technique, geographic location, and additional medical factors such as the number of cycles, medications, and tests. In Canada, the average cost for one insemination, with the potential need for cycle monitoring is between $650 to $2,000.

As with any medical procedure, IUI carries risks and side effects. It is critical that you discuss the procedure with your physician. The risks associated with IUI include, but are not limited to:

• Higher risk pregnancy

• Infection

• Spotting

• Ovarian hyperstimulation syndrome leading to:

• Enlarged ovary

• Fluid build-up in abdomen

• Cramping

If you are taking fertility medications for IUI, risks and side effects can include:

• Dizziness or lightheadedness

• Sudden weight gain of more than 5 pounds

• Shortness of breath

• Nausea and vomiting

• Severe abdominal or pelvic pain

• Sudden increase in abdominal size