Infertility — the inability to conceive after unprotected sex for a year (six months if over 35) — affects millions. So sometimes we need a little science to create a miracle. Luckily, the cultural conversation has shifted from one of taboo and shame to one that normalizes the dialogue around infertility. About one in eight women has received assistance for their infertility in their lifetime, and while in vitro fertilization (IVF) is one of the most widely known types of reproductive technologies, there are other options your fertility specialist might recommend. Did you know the less invasive — and less expensive — intrauterine insemination (IUI), is often the first step before IVF?
Over 67,000 infants are conceived annually using assisted reproductive technology (IVF, IUI, and related procedures). It’s true, fertility care in the U.S. is still inaccessible to many due to cost, but luckily, more and more insurance companies and employers are offering and covering all or partial fertility services. While the costs remain prohibitively high for some, these are important first steps to accessibility. With that in mind, IUI — the process during which a doctor takes sperm and inserts it into the uterus — has become a more affordable option for couples who qualify for the procedure. Fewer steps than IVF and no invasive egg retrieval makes IUI an optimal choice for those seeking fertility assistance.
If you’ve just started researching your reproductive options or a loved one is currently going through fertility treatment, you might be wondering, “What is IUI?” Here’s an introduction to the procedure, its success rates, and costs.
What Is IUI?
During IVF, the egg is fertilized outside the body. With IUI, that takes place within the body. Think of IUI as an assistant to natural conception. The goal is to get as much sperm as possible close to the egg at the perfect time. A doctor places a catheter through the vagina into the uterus and a concentrated sperm sample gets pushed through the catheter toward the opening of the fallopian tubes.
Some IUIs are medicated and monitored with follicle stimulation medications like Clomid or Letrozole and include an ovulation trigger shot. Sometimes the doctor will prescribe injectable gonadotropin, which is a follicle-stimulating hormone. Non-medicated IUIs use ovulation predictor kits to time the IUI.
What Does an IUI Cycle Look Like?
Here’s what you might experience during a medicated IUI cycle. Use the term “month” loosely as the cycle can last anywhere from 28-40 days.
- Day 3 of the menstrual cycle, get baseline transvaginal ultrasound and bloodwork. Your doctor will do a follicle count and go over your plan for this cycle. Medications like Clomid stimulate follicles, so you produce more eggs and improve your chances of successful ovulation.
- Days 3 to 7 or 5 to 9, take Clomid at the same time each day for five days. Your doctor will decide if you start on day three or day five and the dosage.
- On day 10 of your cycle, go back for ultrasound and bloodwork. Here is where you’ll find out if the uterine lining is thickening and the follicles are responding to the medications. Meds might be adjusted as needed. Your doctor might ask you to come back in two or three days to check again. This process will continue every two to three days until the doctor declares you ready for a trigger shot. Just like a perfect Thanksgiving Day turkey, the follicle is ready when it’s ready.
- Around days 13 to 18, your ultrasound and bloodwork will show that you’re ready to induce ovulation. It’s time to partake in the time-honored infertility warrior tradition of the trigger shot — sadly, not nearly as fun as Jello-O shots. You trigger in the evening in the stomach, and 36 hours later, you ovulate. Your IUI will be scheduled for this day.
- It’s time for the IUI around days 15 to 20. On the morning of the IUI, your partner will make a sperm deposit at the clinic. Your clinic then “washes” the sperm with a special fluid to ensure only the strongest swimmers get used. If using donor sperm, it will be thawed and prepped. A short time later, it’s your turn at the clinic. The doctor will use a speculum, insert the catheter, and inject the sperm. Afterward, lie flat on your back for about 15 minutes and let gravity aid the process. This is the official start of the dreaded “two-week wait.”
- Three or four days after your IUI (roughly between days 19 to 24), you’ll get bloodwork to confirm that you ovulated. Once confirmed, many women are instructed to insert progesterone vaginal suppositories before bedtime for the rest of the two-week wait. This medication helps prevent miscarriage.
- Depending on when you had your IUI, your two-week wait will most likely be over around days 29 to 34. Back to the clinic for your blood test to determine if you’re pregnant.
What Are IUI Success Rates?
The IUI can bring luck to many couples struggling to have a child. The highest chance of success is in women under the age of 35 who undergo more than one IUI cycle. Women under 35 have a 10 to 20 percent chance of pregnancy. Women over 40 will have a 2 to 5 percent chance. In addition to age, success rates can vary depending on the reason for infertility, medicated vs. non-medicated cycles, fresh vs. frozen sperm, and so on.
Repetition plays a big role in IUI success rates. A vast majority of successful IUIs happen within three to four cycles. After three or four cycles, success rates flatten out.
Why Choose IUI?
- IUI is a relatively safe and simple procedure.
- IUI is a great option for single women or same-sex couples using donor sperm.
- IUI is less expensive than IVF.
- IUI is often the only fertility option covered by most insurance plans.
How Much Does IUI Cost?
The cost varies on what type of insurance coverage you have. Without insurance, the procedure costs $300 to $1500. Sometimes, insurance covers the IUI, but not the fertility medications.
How Can I Improve IUI Success Rate?
The keys to a successful IUI are timing, egg quality, and sperm quality.
- Enhance egg quality with supplements like CoQ10 and Vitamin D and a diet rich in leafy greens, lean proteins, and healthy fats.
- To help set your body up for egg implantation, limit high-intensity exercise and try yoga, Tai Chi, light stretching, or walking. CBD supplements are also known to reduce inflammation and improve blood flow to the uterus and ovaries.
- Men need to exercise regularly, get plenty of zinc and vitamin C, and — here’s the fun one — ejaculate often. Regular ejaculation boosts sperm quality and helps sperm motility.
- It also helps to avoid stress and anxiety. It’s normal to be concerned about the results but avoid getting worked up. Remind yourself to have realistic expectations because becoming overstressed can disturb the process. Again, so some yoga and remember to keep your body healthy by staying hydrated and eat a well-rounded diet full of veggies, fruits, lean proteins, dairy, and fiber.
When it comes to deciding between IUI vs. IVF, knowing when to move on to more advanced treatments like IVF is essential for your mental and financial well-being. Some fertility specialists might recommend IVF if Clomid and IUI do not work. Though more expensive and invasive, IVF has a much higher success rate than IUI.
Infertility is tough and emotional and surreal and awkward…and even funny sometimes. What’s important to remember as you embark on this journey is that your infertility does not define you.