Intrauterine Insemination (IUI)

Medically reviewed by Dr Manjushree Boob, MD, DNB, FICMCH, FICOG - Infertility & IVF Consultant

What it is

Intrauterine insemination (IUI) is a fertility treatment in which a semen sample is washed and concentrated in the laboratory, and the healthiest, fastest sperm are then placed directly into the uterus through a thin, soft catheter around the time of ovulation. The aim is simple: to shorten the journey the sperm have to make and put a good number of them close to the egg at the right moment.

Fertilisation still happens inside your body, in the fallopian tube, exactly as in a natural conception. That is what separates IUI from IVF, where the egg and sperm meet in the laboratory. IUI is often the first treatment we try because it is gentle, quick, done as a day-care visit, and far less costly than IVF.

Who needs it

IUI works best when the basic machinery is sound and a small push is all that is needed. Common reasons we recommend it:

• Unexplained infertility, where all the tests are normal but pregnancy has not happened after a year or more of trying.
• Mild male factor - a slightly low count or reduced motility, where washing and concentrating the sperm helps.
• Ovulation problems, including PCOS, where tablets or injections bring on ovulation and insemination is timed to it.
• Mild endometriosis with open tubes.
• Cervical factor - when the mucus is hostile or scanty and sperm struggle to pass through the cervix.
• Sexual difficulties that make intercourse timed to ovulation hard.
• Donor sperm or a single woman choosing to conceive.

It is not suitable if both fallopian tubes are blocked, if the sperm count is severely low, or if the woman’s ovarian reserve is very poor. In those situations we would rather tell you straight away than spend your time and money on cycles unlikely to work. Our IUI versus IVF guide goes through how we decide.

“Is IUI a lesser treatment than IVF? We want to give ourselves the best chance.” It is a different treatment, not a lesser one. For the right couple it works well, with far less medication, cost and strain. For the wrong couple it only delays things. The point of our assessment is to tell the two apart honestly, so you do not repeat IUI when IVF is the better door, and do not jump to IVF when a simpler step would do.

How it is done

An IUI cycle is mostly monitoring and timing; the insemination itself is the shortest part.

Before the cycle. We confirm that at least one tube is open, check your ovarian reserve and ovulation pattern, and do a semen analysis for your partner. Infections and thyroid problems are treated first.

Stimulating the ovaries (usually). From day two or three of the period, you take tablets (such as letrozole) or low-dose injections for a few days to encourage one or two good follicles to grow. Some women with regular ovulation need nothing at all - that is a natural cycle.

Monitoring. Two or three vaginal ultrasounds follow the growth of the follicles and the thickness of the uterine lining. If too many follicles are growing, we may reduce the dose or cancel the cycle to avoid a multiple pregnancy.

The trigger. When the lead follicle reaches about 18 to 20 mm, an injection is given to release the egg. Insemination is booked for roughly 36 hours later.

Sperm preparation. On the day, your partner gives a fresh sample. The laboratory separates the active sperm from the fluid and debris, a process that takes about an hour.

The insemination. You lie as for a Pap smear. A speculum is placed, and the prepared sperm are passed through a fine catheter into the uterine cavity. It takes a few minutes. You rest briefly, and then you go home.

Luteal support. Progesterone is usually prescribed for the next two weeks to support the lining.

Duration and what to expect on the day

No anaesthesia and no hospital admission are needed. The insemination takes five to ten minutes, and the whole visit, including sperm preparation, is two to three hours, most of it waiting. You can eat normally, travel home and return to work the same day.

Over a full cycle, plan on four to six visits in total - the baseline scan, a couple of monitoring scans, the trigger and the insemination.

Recovery

The same day. Mild cramping or a few drops of spotting are common. Neither tells you anything about the outcome.

The two-week wait. Carry on normally - work, walk, cook. Continue the progesterone as prescribed. There is no need for bed rest, special diets or avoiding stairs. Symptoms in this fortnight are unreliable, because progesterone itself causes breast tenderness, bloating and tiredness.

The test. Fourteen days after insemination, a pregnancy test. If positive, we arrange a scan at about six weeks to confirm the pregnancy is in the uterus and has a heartbeat. If negative, we stop the progesterone, wait for the period, and sit down together to decide whether to repeat the cycle, change the plan, or move to IVF.

Call us sooner for severe lower abdominal pain, heavy bleeding, fever, or a rapidly bloating abdomen.

Risks and complications

IUI is a low-risk procedure, but nothing in medicine is risk-free, and you should hear the whole list.

• Multiple pregnancy. The biggest real risk, raised when more than one egg is released. This is why monitoring matters.
• Ovarian hyperstimulation syndrome (OHSS). Uncommon with tablets and low-dose injections, but possible; it causes bloating and abdominal discomfort and, rarely, needs admission.
• Infection. Rare, and reduced by sterile technique and washed sperm.
• Cramping or spotting. Usually mild and short-lived.
• Ectopic pregnancy. Slightly more likely after any fertility treatment, which is why the early scan is important.
• Medicine side effects - hot flushes, headaches, mood changes or breast tenderness from the ovulation tablets or progesterone.
• It may simply not work. Success per cycle is modest, even in good candidates, and many couples need more than one attempt. Your age, your ovarian reserve and the cause of the delay all matter, and we will give you a realistic view for your own case rather than a headline figure.

Alternatives

Timed intercourse with ovulation tracking, with or without ovulation tablets, for couples with no major problem who have been trying for less than a year.

IVF or ICSI, the next step when IUI has not worked after a few cycles, or when the tubes, sperm count or ovarian reserve make IUI unsuitable. Our IVF and fertility treatments page covers the full pathway, and the ICSI page explains how the sperm and egg are brought together in the laboratory.

Treating the cause first - surgery for fibroids, polyps or endometriosis, or treatment of a varicocele, where fixing the problem may be enough on its own.

Donor sperm or donor eggs, where the underlying problem cannot be treated.

Waiting and lifestyle change, which has genuine value for some couples. You can see all the procedures we perform.

What it costs

IUI is priced per cycle. These are the approved ranges:

One stimulated cycle (monitoring, trigger, sperm preparation and the procedure): ₹8,000 – ₹15,000

Natural or minimal-stimulation cycle: ₹5,000 – ₹15,000

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your treatment

• Complete the baseline tests - semen analysis, tube assessment, hormone profile - before the first cycle starts.
• Keep a note of your period dates. Call us on day one or two of your period so that we can plan the first scan.
• Take medicines exactly as advised, at the same time each day.
• Abstain from ejaculation for two to three days before the sperm sample, no longer, so that the sample is at its best.
• Stop smoking and cut down alcohol, both partners. These are among the few things in your control that measurably help.
• Take folic acid daily, as advised, from before conception.
• Manage thyroid, sugar and blood pressure if you have any of them.
• Wear something comfortable on the day and bring your partner if you can. Waiting is easier together.
• Plan for the two-week wait. Have something to look forward to and a person to talk to.

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If you have been trying for a while and wonder whether IUI is right for you, the fertility team at Shubham Hi-Tech Hospital and Test Tube Baby Centre, Amravati, will go through your tests with you and give you an honest view, without pressure. Call +91-8668954915 or get in touch here.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.