Fertility 101: IUI – how it works

What is IUI?

During IUI, the best and strongest-looking sperm are selected, by doctors, from a sample of your partner’s sperm (or your donor’s sperm if you’re using a donor).  They’re then injected directly into your uterus to encourage fertilisation of your egg.

IUI is quite a different treatment from IVF, which is where your eggs are removed from your body and put together with your partner’s sperm in a laboratory (see our Fertility 101 – IVF guide).

The benefits of IUI are:

  • It’s a relatively straightforward procedure and less invasive than IVF so is often a first port of call for anyone struggling to conceive
  • It requires fewer drugs than IVF
  • It’s not as expensive as IVF and can also seem more ‘natural’ – partly because are fewer drugs to take but also because once the best sperm have been placed back inside your uterus they’re left to do their own thing and will hopefully fertilise that egg naturally

 However, the success rates are lower than in IVF (see below) and you might need to undergo numerous treatment cycles so if you’ve been trying for a long time or are over 35 you may want to go straight to IVF.

Is IUI for me? 

IUI should not be considered as a straight alternative to IVF.   There are some people that it’s not a viable option for – if you’ve got blocked fallopian tubes or low-quality eggs, for example.  This treatment is all about helping the best available sperm swim to and fertilise an egg so if the sperm makes it but your egg is poor quality (due to age or other factors) then IUI just won’t work. 

IUI typically benefits couples suffering from a known male factor issue such as low sperm count or reduced sperm motility. And it’s generally the preferred route for anyone using donated sperm; single women and female couples.

It can also be a good option to consider if you’ve been diagnosed with any of the following:

  • Issues with ovulation
  • Problems with ejaculation
  • Abnormalities or an irregular shaped cervix
  • Cervical scar tissue that could prevent sperm entering your uterus easily
  • A condition affecting cervical mucus which can create an unfavourable environment for sperm
  • Unexplained infertility

What’s the process?

The average length of an IUI cycle is around 3 to 4 weeks, so it’s typically shorter than the average IVF cycle (at around 4-6 weeks).  Treatments can vary slightly depending on your history but here’s a rough step-by-step guide:

  1. Fertility drugs. While for some people, IUI treatment can be incorporated in their natural menstrual cycle, for others it’s necessary to take some fertility drugs too to help boost egg production. 
  2. Monitoring. If you are taking fertility drugs, you’ll be booked in for regular scans and blood tests during the stimulation phase – normally every few days.  The ultrasound scans are to check how many eggs your follicles are producing in response to the medication, how quickly they are growing and how big they are.  Your doctor will use this information to estimate when the eggs are likely to be ‘ripe’ and therefore when ovulation might occur.  
  3. Trigger shot. If you’re doing medicated IUI, you’ll be given a hormone injection two days before your eggs are due to be collected to trigger the final ripening of your eggs. If you’re doing IUI as part of your natural cycle, you’ll be tested regularly to pinpoint when you’re about to ovulate so insemination (see below) can be timed to perfection. 
  4. Sperm selection. The sperm from your partner or donor are washed and prepared in the lab.  The very best quality sperm are chosen for insemination.
  5.  Insemination. The chosen sperm are injected into your uterus via a special catheter (a very narrow tube).  This part of the procedure is a bit like a smear test – it might feel a little uncomfortable momentarily but it shouldn’t be very painful and takes just minutes.  
  6. Pregnancy test. For many, the days counting down from insemination to official testing date are the hardest as there’s nothing to do but sit and hope. If your treatment has been successful, you’ll have your first pregnancy scan two weeks later.  If it hasn’t worked, you can discuss with your consultant whether to try another round of IUI or if it might be best to try another treatment such as IVF.

How much does it cost?

IUI treatment costs vary, depending on whether fertility drugs are required.  Per cycle you should expect to pay anywhere from £350-£1000.

Do bear in mind that since success rates per cycle tend to be lower than in IVF, you may need multiple rounds of IUI – six is not unusual – so costs can quickly escalate.

Depending on your age and circumstances you might want to consider the full range of treatment options, including IVF, in case there’s a more suitable option for you.

Will it work?

According to the most recent data from the HFEA (Human Fertilisation & Embryology Authority), the percentage of cycles resulting in a healthy baby being born are:

  • 18% in women aged under 35
  • 14% in women aged 35-37
  • 12% in women aged 38-39
  • 5% in women aged 40-42
  • 1% in women aged over 42

As with all fertility treatments, success rates are higher among younger women.  Incorporating fertility drugs in your IUI cycle to boost egg production also has a positive impact on your chance of success.  For example, a recent study showed IUI with Clomid, a type of fertility drug, increased average success rates from 8% to 15% per cycle in women under 35.

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