Intrauterine Insemination: What It Is, How the Procedure Works

For people who are struggling to get pregnant, one widely used fertility treatment option is intrauterine insemination (IUI).

To help you understand this procedure and whether it’s right for you, this guide will outline what it is, how it works, what to expect during the process and its costs and success rate. It will also break down the differences between IUI and in vitro fertilization (IVF).

What is intrauterine insemination (IUI)?

To help sperm have an easier time fertilizing an egg, they are injected directly into the uterus during an IUI fertility treatment. The American Pregnancy Association notes this may be done for several reasons, including:

• Low sperm count
• Cervical scarring that stops sperm from entering the uterus
• Lowered sperm mobility (impaired swimming ability)
• Ejaculation dysfunction
• Cervical conditions that make it difficult for sperm to travel
• Unknown fertility issues

How does IUI work?

An IUI treatment is given during the time women are most fertile. This is known as the fertility window, and it occurs around the time of ovulation (when an egg is released). The American Pregnancy Association notes doctors sometimes prescribe ovulation-stimulating drugs prior to scheduling an IUI procedure in order to promote success.

You’ll be monitored for an increase in LH hormone, which indicates ovulation is imminent, and typically have your IUI procedure 24 to 36 after that occurs.

“For IUI, a semen sample is washed to separate sperm from the seminal fluid and then the entire sperm sample is injected directly into the uterus," Dr. Jenna Rehmer, quality and safety director of the Cleveland Clinic Fertility Center, explained on the clinic's website. “This significantly increases the number of sperm in the uterus over intercourse."

IUI vs. IVF treatment: What’s the difference?

IUI is a one-step process and, according to Penn Medicine, is done on an outpatient basis. It’s less expensive than in vitro fertilization (IVF) and takes just a few minutes.

IVF, on the other hand, requires multiple steps, starting with injectable hormone treatments to increase the number of eggs released during ovulation, according to Rehmer.

“The goal is to produce 10 to 15 follicles, which contain eggs,” she said. “Some people make more and some less, depending on age, medical history and some factors like ovarian reserve."

Penn Medicine says this first step is followed by sperm and egg retrieval, fertilization in a lab and then transfer of the embryo from the lab to the uterus. The whole process takes about three weeks.

While many of the steps of IVF treatment can be done on an outpatient basis, unlike with IUI there is some recovery time. IVF does have a higher success rate than IUI, but it’s more expensive. It may be recommended in certain situations, such as:

• Severe endometriosis in women
• Advancing reproductive age in women
• An LGBTQ+ couple or individual wanting a family
• Low male sperm count
• Low female egg supply
• Missing or blocked fallopian tubes in women

Rehmer noted that because IUI is both less invasive and less expensive than IVF, it’s often recommended first for people who have moderate male-factor infertility or unexplained fertility issues. If you’ve undergone three to four unsuccessful IUI treatments, your doctor may recommend IVF, she said.

What’s the IUI process like?

When you go in for an IUI procedure, it will be at an outpatient treatment facility, such as your doctor’s office or a clinic. Planned Parenthood notes the procedure takes about five to 10 minutes and doesn’t require anesthesia or sedation.

Your doctor will place a flexible, thin tube through your cervix and into your uterus. A syringe that contains the washed sperm is then released into the tube to complete the treatment.

What’s the IUI success rate?

The American Pregnancy Association says that people who have monthly IUI treatments have success rates as high as 20% per cycle.

The Cleveland Clinic says range is 15% to 20% per cycle. With three to four treatments, the cumulative success rate goes up to 40% to 50%.

How much does IUI cost?

Planned Parenthood advises that you can expect to pay $300 to $1,000 per treatment without insurance for IUI, depending on your doctor's fee. In some states, insurance may be required to cover all or part of your fertility treatment costs.

Whether you choose IUI or IFV, Rehmer emphasized that multiple treatments may be required to have success.

“Know that it is a journey that can take many months, even years, to result in a successful pregnancy," she said.