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The Ultimate Guide to IUI

Everything you need to know about the IUI process, success rates & costs for treatment and medications. We bet this is the most detailed guide to intrauterine insemination you've ever seen.
The Ultimate Guide to the Intrauterine Insemination Process
The Ultimate Guide to the Intrauterine Insemination Process
If you’re going in to see a fertility specialist for the first time to help you get pregnant and they recommend you to do treatment, their first suggestion may be to try an IUI cycle. 

IUI stands for intrauterine insemination and is also known as artificial insemination (AI).

IUI is often the first line of treatment that a reproductive endocrinologist would suggest for couples who have been trying to conceive naturally to no avail. 

When most people think of infertility treatment, they think of IVF. However, intrauterine insemination is often suggested first as it’s much less invasive and less expensive than IVF, so it can make more sense for patients that don’t have an apparent necessity for in vitro fertilization.

This is a very in depth guide to the IUI process, so prepare yourself now!

We'll be covering everything about intrauterine insemination, answering:
  • what is IUI
  • how much does IUI cost
  • what medications are used for IUI
  • the cost of IUI medications
  • IUI success rates by age and diagnosis
  • the step-by-step process of an IUI cycle

After reading through this guide, you'll know what to expect for treatment. 

What is IUI?


Intrauterine insemination (IUI) is a treatment used at fertility clinics to help a woman get pregnant by timing ovulation with an insemination procedure to give the sperm a better chance of reaching the egg while it is viable. 

When an egg is released into the fallopian tube, there’s a short window of time when it can be successfully fertilized by a sperm, so it’s important to time the insemination as closely as possible to ovulation.

To put the IUI process simply:

👉 A woman’s menstrual cycle is tracked for ovulation. She may be prescribed medications to help stimulate the ovaries and time ovulation. 

👉 On the day of ovulation, the male partner will provide a semen sample at the clinic (or donor sperm is thawed for patients using a sperm donor). The doctor or nurse will perform the insemination procedure, which is done using a catheter that releases the sperm into the uterus.

👉 Two weeks later, you'll go back in for a blood pregnancy test to see if the cycle was successful.

We’ll get into the specifics of each day of the process in the IUI timeline later in this article! But first, let's talk money.

How much does IUI cost?


Let’s get right down to the financial aspects of an intrauterine insemination cycle. 

The cost of IUI varies based on the individual clinic, whether you will have monitoring appointments, and how many monitoring visits you will need throughout the two weeks of treatment. 

Each monitoring visit has its own cost for the bloodwork and ultrasound and some women will need more monitoring visits than others. However, there are some estimates you can use to get a general idea. 

On average, an IUI costs $2500 for a cycle.

That’s not including medications but for many women the medication cost for an IUI is actually quite low. 

So what does the cost of IUI entail? 

Here’s the cost breakdown for an IUI cycle:
  • monitoring appointments for bloodwork & ultrasounds ($1500)
  • sperm preparation & insemination procedure ($1000)
  • IUI medications ($170-$2700; see later in this article for our medication cost table)

💊 We made you an IUI medication cost table later in this article that explain the cost of different medications you might be prescribed! 

How much does intrauterine insemination cost with insurance?


The numbers above are good estimates for women who are self-paying and not using insurance. 

To figure out how much an IUI costs with insurance, you need to know some specific details about your health insurance plan, such as the deductible and your co-insurance. 

You can check out our infertility insurance guide on how to calculate the cost of infertility treatment with insurance. 

In that article we use IVF as the example for the calculations but the principles remain the same for calculating IUI cost as well, you can just sub in your IUI expenses instead to calculate what you would pay. 

Where to find a fertility clinic for IUI near me


If you're looking to do artificial insemianton, you'll want to seek out a fertility clinic to work with. The doctor can run any fertility tests needed, counsel you on your options & chances of success, and schedule an IUI cycle.

To find fertility clinics in your area, head to our fertility clinic directory.

There you can search by your city or the name of a doctor/clinic if you have one in mind. You can check their success rates, number of doctors, locations, and contact info.

Not sure which clinic would be best to go with?

Read out guide on how to choose the best fertility clinic for you.

In that article, we give you 5 criteria to take into account when comparing which clinic and doctor makes sense for your unique needs.

Who does IUI work best for?


A reproductive endocrinologist will take several factors into consideration when choosing the best method of treatment for a patient diagnosed with infertility. 

Treatment path can be affected by female age, female diagnosis, male diagnosis, and duration of infertility, to name a few factors. 

IUI is often recommended as a first line of treatment for:

  • women <38 years old (assumed to have no issues with age-related egg quality)
  • unexplained infertility
  • ovulatory dysfunction (e.g. PCOS)
  • mild male factor infertility
  • same-sex female couples (with donor sperm)
  • single parent by choice females (with donor sperm)

Tests that typically need to be in the normal range for IUI to be recommended:

  • HSG to check that fallopian tubes are present and open
  • Semen Analysis for the male partner to confirm normal counts of motile sperm and good morphology

Why do these fertility tests matter for an IUI?


HSG

A hysterosalpingogram (HSG) tests whether the fallopian tubes are open. The test is done by injecting a special dye into the uterus which will travel into each fallopian tube and spill out by the ovary into the pelvic cavity. 

The dye can be seen on x-ray and if it shows that your tubes are open, then sperm would be able to travel through the uterus into the fallopian tube during ovulation to fertilize an egg. 

🙅‍♀️If the fallopian tubes are blocked or not present, the sperm would not be able to reach the egg.

Women that have tubal issues such as blocked or missing fallopian tubes would likely need to do IVF instead. However, some women with one open fallopian tube do choose to do IUI.

Semen Analysis

Your partner's semen analysis results can also affect whether IUI is the best treatment option. 

📈The number of motile sperm in a semen sample significantly affects IUI success rates.

We'll talk about this more later in the article.

If your partner’s semen analysis shows:
  • low sperm count
  • low motility
  • poor morphology

this could be an indication that IVF is the best route to take. 

How long does the IUI process take?


The timeline for an intrauterine insemination cycle from start to finish takes about 2 weeks.

An example of the intrauterine insemination process when taking oral medications such a Clomid or Letrozole. Your clinic will provide you with a calendar for your instructions.
An example of the intrauterine insemination process when taking oral medications such a Clomid or Letrozole. Your clinic will provide you with a calendar for your instructions.
 


Short & sweet overview of the IUI process
  1. Medications usually start Day 2 or 3 of the menstrual cycle
  2. Your doctor monitors the growth of a follicle in your ovary for ~10 days 
  3. Once the follicle is large enough, you take a trigger shot to induce ovulation
  4. The IUI is scheduled 24-36 hours after the trigger shot
  5. Two weeks later, you have a blood pregnancy test to find out the result of the IUI

💡Tip: Cycle Day 1 (CD1) is marked as the first day of your period with a full flow, not spotting. 

The IUI process step-by-step: 
  • Call the clinic on Cycle Day 1 to report the start of your period
  • Ultrasound & bloodwork on Cycle Day 2 or 3 to clear you to begin medications
  • Begin fertility medications on Cycle Day 2 or 3
  • Continue medications for a number of days (5 days for oral medications but up to 13 days for injectable medications. This varies by medication type & your body’s response)
  • Bloodwork & ultrasounds every 2-3 days to make sure you are responding well to the medications & your follicle(s) is growing
  • Trigger shot is taken to induce ovulation once a follicle is large enough (≥18mm)
  • IUI will take place ~36 hours after taking the trigger shot
  • Day of the IUI, the andrology lab processes a fresh or frozen semen sample from your partner or donor to use for insemination (~1 hour for processing)
  • Insemination is performed by a nurse or doctor who will insert the sperm sample into your uterus using a catheter
  • 2 weeks later, return to the clinic for a blood pregnancy test (beta hCG)

 Why are medications needed for IUI? 🧐

The purpose of taking fertility medications for an IUI is to stimulate the ovaries to develop a follicle containing an egg. Most patients will take oral medications such as clomiphene citrate or letrozole. 

During the follicular phase, the hypothalamus region of the brain releases GnRH which signals to the pituitary to release FSH (Follicle Stimulating Hormone) to stimulate the ovaries to grow a follicle. These medications work differently but both send a signal to the brain that more FSH is needed to stimulate the ovaries to grow a follicle. 

In some cases, patients might need more heavy-duty stimulation and instead of using oral medications, they would use injectable gonadotropins. If using injectable medications, the goal is not to signal to your brain to produce FSH. Instead the medications actually contain FSH and are acting on the ovary directly to grow a follicle. 

Sometimes during the IUI stimulation process, fertility medications cause the ovaries to work extra hard and start growing 2 or more follicles containing eggs. 

Physicians try to avoid recruiting too many follicles for an IUI cycle as this increases the risk of multiple gestations, which can lead to health issues with the mother and the babies. 

An IUI is typically cancelled if more than 3 follicles are growing as the risk of twins or triplets is too high.

Why are ultrasound & bloodwork appointments needed for IUI? 🧐

Monitoring helps your doctor time when the IUI should take place.

Your physician needs to monitor your progress prior to ovulation to make sure you are responding well to the medication protocol and that the optimal number of follicles are growing. The amount of monitoring needed varies based on the clinic & the individual. 

They also need to follow the development of your follicles as an indication of when to trigger ovulation. They are looking for the follicle to reach a certain size, usually ≥18mm.

What does the trigger shot do for IUI? 🧐

During a natural menstrual cycle in the follicular phase when a follicle is developing, it produces estradiol. Estradiol at a certain level signals to the brain to keep producing FSH to continue to stimulate the follicle to grow. As a follicle grows larger, higher amounts of estradiol are produced which causes the pituitary to release a burst of LH, known as the LH surge. The LH surge induces final egg maturation and ovulation occurs about 24-48 hours later. 
 
The trigger shot mimics the body’s natural LH surge that occurs during the menstrual cycle to induce ovulation. The trigger shot contains hCG which has homology to LH and can act similarly in the body.

Ovulation occurs about 36 hours after the trigger shot is administered. 

Some women might not take a trigger shot and will be monitored for their body’s natural LH surge to time when ovulation will occur. 

How is the semen sample prepared for artificial insemination?

On the day of the IUI, either the male partner will provide a fresh semen sample to the lab or a frozen vial of donor/partner sperm will be thawed and processed. 

The semen sample is processed in order to remove any immotile sperm and leave only the motile sperm that would be able to travel through the uterus to reach the egg.

This gives the sperm that can move a better chance of moving through the uterus. A sample containing a high percentage of immotile sperm can sometimes create a mesh-like structure making it difficult for the motile sperm to navigate out of. 

The sperm processing takes about 1 hour. 

Once the IUI sample is ready, a nurse or reproductive endocrinologist will use a catheter to insert the sperm sample into the uterus.

The Two-Week Wait

A blood pregnancy test will be done at the clinic about 2 weeks later to assess whether the IUI was successful. A beta hCG level of >5 mIU/mL indicates a positive pregnancy. 

And that’s the whole process!

What medications are used in IUI?


There are two main types of treatment protocols:
  • natural IUI cycles 🌺
  • medicated IUI cycles 💊

Natural Cycle IUI 🌺


Patients don’t always take fertility medications for an intrauterine insemination cycle. 
If you will not be using fertility medications, it is called a natural cycle

In this case your doctor will follow your body’s natural menstrual cycle & hormone fluctuations to monitor follicle growth and will time the IUI for when your body ovulates on its own. 

Medicated IUI Cycle 💊


A medicated IUI cycle is a common route patients take. 

Medications are necessary for women who do not ovulate on their own or who have irregular cycles but are also used for women who have regular cycles as well. 

Fertility medications allow for more control over the timing of ovulation and can encourage one to two follicles to develop to increase chances of pregnancy.  

There are 3 common options for IUI medications:
  • Clomiphene Citrate (e.g. Clomid)
  • Letrozole (e.g. Femara)
  • Gonadotropins (e.g. Gonal-F, Follistim, etc.)

Your physician will prescribe one of these medication options for your IUI stimulation protocol.

They also may prescribe a trigger shot (hCG) to induce ovulation. Some women will not need a trigger and their body's natural LH surge will induce ovulation. 

How much do IUI medications cost? 


Medication cost will vary based on the type of medication that is prescribed for your protocol. 

Oral medication such as Clomiphene Citrate and Letrozole are fairly inexpensive while injectable medications of gonadotropins are the most expensive medication type for an IUI.

Note that while Clomid or Letrozole are only take for 5 days, length of gonadotropin shots vary based on how your body responds with the average being about 10 days of injections.

We did some research on the self-pay rates for each medication for a typical protocol, factoring in the average number of days medications are taken & dosage.  

We put it all in this table for you 😘
 
Medication Protocol Clomid Letrozole Gonadotropins
Medications begin Cycle Day 2–3 2–3 2–5
Number of days medications are taken 5 days 5 days ~10 days (ranging 7-13)
Medication cost for an average protocol (range) $21–$36 $47–$81 $1,767–$3,366
Cost of hCG trigger shot $103-$175 $103-$175 $103-$175
Average total cost of IUI medications ~$168 ~$203 ~$2706
We calculated protocol prices using average medication prices from the GoodRx database in conjunction with the current literature for typical medication strength & duration for an IUI cycle.

IUI Success Rates


The success rates of an IUI depend on several different factors on the male and female side so make sure to discuss your estimated chances of success with your physician after your infertility testing is completed. 👩‍⚕️💬

We took a look at the success rates from the research. 

IUI can have fairly low per cycle success rates but they’re higher than TTC (trying to conceive) at home for couples that have a history of infertility. 

Physicians typically suggest a minimum of 3 IUI cycles before considering any more invasive treatments as an alternative. 

However, the recommended number of IUIs can change depending on your diagnosis. 

Diagnosis can impact IUI success


A 2020 review of factors that affect IUI success rates found that diagnosis does affect which couples are likely to have success in just a few cycles. 

One study including patients of all diagnoses showed the success rate after just the first IUI cycle was 16.4%. 

Clinical pregnancy rates do increase over a few cycles depending on different factors.

Patients with ovulatory disorders such as PCOS have shown the highest success rates with IUI compared to other diagnoses.

IUI Success rates after a maximum of 4 cycles using clomiphene citrate were:
  • 46% for ovulatory dysfunction (such as PCOS)
  • 38% for cervical factor / male factor / unexplained infertility
  • 34% for endometriosis
  • 26% for tubal factor 

IUI Success rates by Age


Female age is also known to significantly affect IUI success rates. 

One large study on intrauterine insemination success rates found that pregnancy rates ranged from:
  • 11.1% to 18.9% per IUI cycle for women <40 years old
  • 4.7% per IUI cycle for women 40-45 years old

Women that are 40 years or older are typically advised to move to IVF due to the low success rates of IUI for their age group.

Does sperm count affect IUI success rates?


The severity of male factor infertility can also significantly affect the IUI outcome.

Specifically, the number of motile sperm in a semen sample has been shown to affect IUI success rates. 

A review of the scientific literature found that IUI is ideal when there's at least 5 million total motile sperm or more in the semen sample.

However, some studies recommend a need for at least 10 million sperm count in the sample, so different reproductive endocrinologists may have their own threshold when it comes to recommending IUI for men with low sperm counts.

A large clinical trial sub-analysis of 2,462 cycles found that while a specific lower threshold could not be identified for how many motile sperm will not result in pregnancy, there was an association with increased clinical pregnancy rates and higher total motile sperm counts inseminated. 

The study found that a live birth of a baby from IUI was associated with total motile sperm count:
  • 15-20 million total motile sperm resulted in a 14.8% live birth rate
  • <5 million total motile sperm resulted in a 5.5% live birth rate

Typically if a male partner has a low morphology, reproductive endocrinologists are inclined to recommend IVF. 

However, recent studies (1, 2) have found that sperm morphology is not a significant factor for IUI success rates and a recent study concluded that a low sperm morphology should not preclude couples from trying IUI first if they wish.  

IUI success rates for unexplained/mild male factor infertility


Although a natural cycle without medications can be an option for patients with a regular menstrual cycle, a recent study of 8,583 couples with unexplained infertility or mild male factor infertility has shown that using fertility medications for IUI significantly increases chances of pregnancy. 

For patients in their first IUI cycle, the live birth rate of a natural cycle was 6.4% while medicated cycles on average showed a live birth rate of 9.4%. 

The best performing medication protocol was Letrozole. 

Patients that took Letrozole for their IUI cycle showed comparable live birth rates to the other medication options (10.5%) and had the lowest incidence of multiple gestations (0.8%). 

The goal of an IUI is to provide the highest success rates while keeping the incidence of multiple gestations (twins, triplets, etc) as low as possible to ensure the best health & safety for the mother and baby. 

Outcomes for the first intrauterine insemination cycle in couples with unexplained or mild male factor infertility using different medications. Huang et al., 2018.
Outcomes for the first intrauterine insemination cycle in couples with unexplained or mild male factor infertility using different medications. Huang et al., 2018.

Some women will need to do more than one IUI in order to get pregnant, so let's take a look at the success rates beyond the first IUI cycle.

What are success rates for a 3rd IUI?


Most reproductive endocrinologists will suggest that a patient tries at least 3 IUI cycles before considering any more invasive or expensive treatment. 

The study of couples with unexplained or mild male factor infertility reported that cumulative success rates after 3 IUIs for medicated cycles resulted in a live birth rate of roughly 25%. 

Natural Cycle Clomiphene Citrate Letrozole Gonadotropins
Cumulative live birth rates from a study of 8,583 couples undergoing intrauterine insemination for unexplained or mile male factor infertility.

After 3 cycles, your physician may recommend you consider IVF.

IUI success rates for women with PCOS


Women diagnosed with ovulatory dysfunction such as PCOS have been associated with the highest cumulative pregnancy rates after IUI when compared to women with other diagnoses.

A large study of patients with ovulatory disorders using clomid with IUI resulted in a cumulative clinical pregnancy rate of 46% after 4 IUIs. 

Studies have found that when it comes to patients with polycystic ovarian syndrome (PCOS) and IUI or ovulation induction, there’s a difference in which medication performs the best. 

A cochrane review of 42 randomized controlled trials with a total of 7935 patients found that Letrozole has better outcomes compared to Clomiphene Citrate for women with PCOS undergoing either timed intercourse or IUI. 

A 2019 review also found that ovulation induction using Letrozole improved ovulation, pregnancy rates, and live birth rates for women with PCOS compared to Clomiphene Citrate and had lower risk of multiple gestation. 

Gonadotropins showed higher pregnancy and live birth rates for patients with PCOS compared to clomid as well with one study finding a pregnancy rate of 47.7% per couple.

However, the number of cycles for the couples in this study ranged from 1-9 and a per cycle breakdown for this patient group was not provided.

While injectable medications provide a higher success rate than clomid, there is an unacceptably high rate of multiple gestation and a risk of ovarian hyperstimulation syndrome (OHSS) using injectable medications, so it is not typically recommended for IUI.

The cost of injectable medications is also much higher than clomid or letrozole. 

Are you doing IUI?


Phew, that was a lot of percentages to read through! 

But it’s certainly worthwhile to do your own research so that you go into the clinic with your expectations clearly set. 

If you’re planning on IUI, what is the success rate your doctor gave for your age/diagnosis?

Head to our instagram account for weekly tips, tricks, and support and to find others who are going through the process.

Always remember, #iuigotthis. 

🕵️‍♀️ Ready to start looking for a fertility clinic? Head to our fertility clinic directory to find fertility doctors in your area, learn about each provider & view their success rates.