Back when you first started trying to conceive, you probably knew that conception wouldn’t happen overnight. But you were pretty confident it would happen — and that it would happen in the privacy of your own bedroom.
Fast forward to now, following test after test — and perhaps even a few rounds of fertility medication — and it may be time to try something new.
Enter artificial insemination (AI) or intrauterine insemination (IUI) — one of the oldest and simplest assisted reproduction techniques, and still one of the most successful ones.
What is artificial insemination (AI)?
Artificial insemination, or AI, is a fertility treatment that places your partner’s (or a donor’s) sperm inside your reproductive tract when you’re ovulating to help promote conception.
AI aims to give sperm a better chance of reaching Destination Egg by bypassing the initial hurdles they would encounter in the vagina and cervix — sort of a running (or swimming) head start.
What is intrauterine insemination (IUI)?
Intrauterine insemination, or IUI, is a type of AI in which sperm are placed directly into the uterus close to the fallopian tubes, where fertilization takes place.
The goal: to get those sperm as close as possible to their target — your waiting egg — so they can be at the right place at the right time.
Skipping the trip through the vagina and the cervix cuts down on the swimming sperm have to do, making it more likely that they’ll reach the egg on time.
What's the difference between IUI and IVF?
In IUI, the sperm are inserted directly into your body (specifically, the uterus) in the hopes of fertilizing an egg. During in vitro fertilization (IVF), an egg is fertilized with sperm in a laboratory, then transferred back into the uterus.
Whereas an IUI procedure takes only a few minutes, an IVF cycle can take a month or more to complete.
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With IVF, you'll likely need to get hormone shots to stimulate your ovaries and will get a human chorionic gonadotropin (hCG) injection or another drug to help your eggs mature.
The eggs will then be retrieved using an ultrasound-guided needle, and fertilized with your partner or donor's sperm. After three to five days, the embryos can be transferred into the uterus.
Women may want to try IVF if they have severe blockages in the fallopian tubes, poor egg quality or endometriosis.
Who's a candidate for artificial insemination or IUI?
Couples experiencing otherwise unexplained fertility issues, where it’s clear nature could use a nudge, are good candidates for IUI.
Couples with mild male factor fertility problems are also good candidates. This assisted reproductive technique can also help when the cervical environment or cervical mucus is hostile to sperm, making it hard for them to swim.
Same-sex couples may also turn to artificial insemination for help starting their family (either themselves or with a surrogate), as can single women who want to become moms on their own with a sperm donor.
IUI isn’t recommended for women who have significant fallopian tube blockages or conditions, a history of pelvic infections or severe endometriosis.
Does your guy have a very low sperm count, or significant problems with sperm motility or morphology (the percentage of sperm that appear to be of normal shape and size)? Fertility specialists will usually not recommend IUI in those situations, since it’s less likely to be successful.
How is IUI done?
IUI is done in the doctor’s office, during a visit timed to correspond to when you’re ovulating.
Ovulation may be induced with Clomid or another ovulation induction medication, though for women who don’t need the extra help, the procedure can be timed to correspond with your natural window, in what’s called a natural-cycle IUI.
Here's what to expect during the procedure:
- First you’ll lie on the exam table with your feet in stirrups — the same position as for a pelvic exam.
- The doctor will take a concentrated sperm sample from your partner or donor and inject it into your uterus through a thin, flexible catheter placed into the vagina and through the cervix. Because the procedure is done when you’re ovulating, your cervix will already be slightly open, making the insertion of the catheter and injection of the healthy sperm easier.
- Once the insemination is complete, you’ll be asked to lie on your back for a brief period, and then you’ll be able to return to regular activity.
The whole IUI procedure takes only a couple of minutes, and there isn’t much discomfort — or, about as much as you’d have during a Pap test. There's also no need to worry if you experience light spotting for a day or two after your IUI — that’s normal for some women.
A few notes about the sperm used in IUI: This sperm isn’t “fresh” — it’s been washed in preparation for the procedure, optimizing the sperm to maximize the odds of fertilization.
Because sperm is inserted directly into the uterus during IUI, it bypasses the cervical mucus. The washing process accomplishes what the cervical mucus would normally do, separating sperm from the semen, separating nonmotile sperm from motile sperm and purifying the sperm by removing potentially toxic substances and fluid.
For at least 48 hours before the procedure, sex and ejaculation will be off the table for your partner or donor. He’ll provide his sperm sample, either in the clinic’s collection room or at home, on the same day as your IUI, making sure that the sperm sample is handed over within an hour or so of the IUI.
If you’re using donor sperm or your partner’s previously frozen sperm, it will be thawed immediately before the IUI procedure. The insemination then takes place as soon as the sperm washing is complete.
Right now, IUI is the gold standard of artificial insemination — and the go-to AI procedure.
Can you do artificial insemination at home?
At-home insemination is attractive to some trying-to-conceive couples who’d like to skip the fertility doctor (and the resulting bills) if possible. For heterosexual couples, at-home AI offers no fertility edge over regular sex. But single women or same-sex women couples may want to try at-home AI before turning the insemination process over to a doctor.
There are a few at-home options: There’s the “turkey baster method” — in which you inject freshly ejaculated semen into the vagina (close to the cervix) using a needleless syringe. Or you can fill a cervical cap, diaphragm, or a period collection cup with semen and insert it over your cervix, leaving it in place for two to three hours.
There are also at-home AI kits. As with IUI, timing is everything with at-home AI: You’ll need to inject the sperm as close to ovulation time as possible. And just as with any artificial insemination technique, an at-home AI won’t be effective if you have ovulation problems or if your partner has a very low sperm count or poor-quality sperm.
There are some potential risks with at-home AI: tissue damage, uterine perforation and even infection if the insertion is too deep or done improperly.
Be aware, too, of potential legal risk if you’re using donor sperm for an at-home AI, since the legal protections afforded by medically supervised donor sperm used for IUI in a fertility clinic — things like the automatic termination of the donor’s parental rights — don’t always cover women who artificially inseminate at home. The laws vary from state to state, so do check your state’s statutes before you do it yourself.
How much does IUI cost?
The average cost of an IUI is just under $1,000. But the price of IUI can range from a few hundred dollars to a few thousand dollars, depending on your doctor, your insurance coverage and where you live.
Your final cost will also depend on what’s going into your IUI procedure. While the actual insemination is a few hundred dollars, if you will also be using fertility drugs to induce ovulation, Clomid could run you an extra $100 a cycle — and injectable drugs (gonadotropins) could add a couple thousand dollars to the price.
Factor in bloodwork and monitoring, and your potential costs could add up to several thousand dollars — not cheap, though still a whole lot less than what more invasive fertility treatments typically cost.
Does insurance cover IUI?
A good number of insurance companies cover IUI, though there are many variables depending on your company and coverage type. Some states also have laws mandating insurance companies to cover fertility treaments, including IUI and IVF.
Some insurance policies may include limits on how many IUI cycles are covered, or may cover IUI only if certain fertility drugs are used.
In some cases, IUI may be a requirement before turning to IVF. Your best bet is to give your insurance company a call to find out what is or isn’t covered.
What are the success rates?
Though IUI’s success rate depends on a host of variables, such as your age, your fertility profile, sperm quality, whether fertility medication is used and so on, you can expect a success rate of anywhere from 5 to 20 percent per IUI.
The success rate of IUI is twice as high when combined with Clomid or other ovulation inducers like letrozole compared with IUI alone.
Because most couples who turn to IUI don’t do so because of female fertility problems, pregnancy rates are high — about 40 percent for younger women after up to six tries.
If the male partner has a very low sperm count, or significant problems with sperm motility or morphology (the percentage of sperm that appear to be of normal shape and size), IUI is not likely to be successful.
If you still haven’t achieved conception success after three to four rounds of IUI, you’ll likely be advised to move to the next step: IVF.
What are the possible side effects?
Some women notice slight spotting after their IUI procedure, most likely the result of the catheter being placed in the uterus. Such spotting is nothing to worry about, and it doesn’t have any effect on your chances of getting pregnant.
Some women report feeling “wetter” after IUI. It’s not sperm dripping out (the cervix does a pretty good job of keeping most of the sperm in), but it could be the result of the catheter loosening cervical mucus, of which there is typically plenty during your peak ovulation period.
Is there any risk to mother or baby?
Happily, IUI is a relatively simple and safe procedure, with few risks of serious complications. In rare cases, a woman undergoing IUI can end up with an infection as a result of the procedure.
And while IUI itself doesn’t increase the chances of a multiple pregnancy, if Clomid or other ovulation induction drugs are used, there’s a higher chance of twins or multiples — which in turn can increase certain risks for mom and babies.While IUI won’t work for all couples who are trying to conceive, if you fit the right criteria for success, the procedure can be exactly what you need to get pregnant.