IUI Guide
What to expect from intrauterine insemination.
IUI Quick Facts
- What it is: Washed sperm placed directly into the uterus around ovulation
- Success rate: ~10-20% per cycle (varies by age and diagnosis)
- Cost: $500-$2,000 per cycle (less with meds, more with monitoring)
- Best for: Mild male factor, unexplained infertility, single women, same-sex couples
What Is IUI?
Intrauterine insemination (IUI) is a fertility treatment that places washed, concentrated sperm directly into the uterus around the time of ovulation. This gives sperm a head start by bypassing the cervix and reducing the distance they need to travel.
IUI is less invasive and less expensive than IVF, making it often the first step in fertility treatment.
🔬 How It Helps
IUI increases the number of sperm that reach the fallopian tubes, where fertilization occurs. In natural conception, only a few hundred sperm (out of millions) make it that far. IUI delivers thousands of healthy sperm directly to the uterus.
Who Is IUI Best For?
Good Candidates
- Mild male factor infertility: Slightly low count, motility, or morphology
- Unexplained infertility: When testing hasn't revealed a clear cause
- Cervical factor: Thick cervical mucus or cervical scarring
- Ovulation issues: When combined with ovulation-inducing medication
- Single women: Using donor sperm
- Same-sex female couples: Using donor sperm
- Erectile dysfunction or ejaculation issues: When intercourse is difficult
IUI May Not Be Best For
- Blocked tubes: Sperm can't reach the egg
- Severe male factor: Very low counts benefit more from IVF/ICSI
- Advanced maternal age: IVF may be more time-efficient
- Severe endometriosis: May need IVF for best success
- Multiple failed IUI cycles: Time to consider IVF
The IUI Process Step by Step
1 Monitoring & Ovulation Timing
Timeline: Days 1-14 of your cycle
IUI timing is everything—sperm need to meet the egg within hours of ovulation. Monitoring options:
- Natural cycle: OPKs at home to detect LH surge
- Monitored cycle: Ultrasounds to track follicle growth + blood tests
- Medicated cycle: Letrozole or Clomid to stimulate ovulation + monitoring
- Trigger shot: hCG injection to time ovulation precisely
2 Sperm Collection & Washing
Timeline: Day of IUI (or thawed donor sperm)
The male partner provides a sperm sample (usually at the clinic, 1-2 hours before the procedure). The lab "washes" the sperm:
- Separates sperm from seminal fluid
- Concentrates the healthiest, most motile sperm
- Results in a small, highly concentrated sample
Donor sperm arrives already washed and frozen.
3 The Insemination Procedure
Timeline: ~5-10 minutes
A thin, flexible catheter is inserted through the cervix, and the washed sperm is deposited directly into the uterus.
- Similar to a Pap smear in positioning
- Most women feel mild cramping or nothing at all
- No anesthesia needed
- You can resume normal activities immediately
4 The Two Week Wait
Timeline: ~14 days
After IUI, you wait to see if implantation occurs. Your doctor may prescribe progesterone supplementation. A pregnancy test (blood or urine) is done about 14 days post-IUI.
IUI Success Rates
Success rates vary significantly based on age, diagnosis, and whether medication is used:
| Scenario | Success Rate Per Cycle |
|---|---|
| Natural cycle IUI (under 35) | 8-12% |
| Medicated IUI (under 35) | 15-20% |
| IUI with donor sperm (under 35) | 15-25% |
| IUI age 35-40 | 10-15% |
| IUI over 40 | 5-10% |
Cumulative success: After 3-4 IUI cycles, cumulative pregnancy rates reach 30-40% for those under 35. Most doctors recommend trying 3-4 IUI cycles before moving to IVF.
💡 When to Move On
If 3-4 IUI cycles haven't resulted in pregnancy, success with additional IUIs is unlikely. Most couples move to IVF at that point, which has higher per-cycle success rates.
IUI Costs
Typical Costs (2025-2026)
- IUI procedure only: $300-$800
- Monitoring (ultrasounds, blood work): $200-$800
- Ovulation medications (Letrozole/Clomid): $50-$150
- Trigger shot: $50-$150
- Sperm washing: $200-$400
- Donor sperm (if applicable): $700-$1,200/vial
Total per cycle: $500-$2,000 (with monitoring and meds)
Insurance Coverage
Coverage varies widely. Many insurance plans cover diagnostic testing but not treatment. Some states mandate fertility coverage. Check with your insurance and clinic's financial coordinator.
IUI vs. IVF
| Factor | IUI | IVF |
|---|---|---|
| Cost per cycle | $500-$2,000 | $15,000-$25,000 |
| Success rate | 10-20% | 40-60% |
| Invasiveness | Minimal | Egg retrieval surgery |
| Time commitment | A few appointments | Daily monitoring + procedure |
| Multiple pregnancy risk | 10-20% (with meds) | Lower with single embryo transfer |
💰 Cost-Effectiveness
For some couples (especially with mild issues and younger age), 3 IUI cycles may be more cost-effective than jumping straight to IVF. For others (severe male factor, blocked tubes, older age), IVF is more efficient. Your RE can help determine the best path.
Tips for IUI Success
- Timing is critical: IUI should occur within 6 hours before or after ovulation
- Consider medicated cycles: Medications boost success rates significantly
- Sperm count matters: Post-wash counts over 5-10 million have better outcomes
- Healthy lifestyle: Good for both partners—diet, exercise, no smoking
- Manage expectations: Most couples need multiple cycles
- Know when to move on: Don't do more than 4-6 IUIs without reassessing
The Bottom Line
IUI is a relatively simple, affordable first step in fertility treatment. While success rates are lower than IVF, many couples conceive with IUI—especially with medication and proper timing. It's a reasonable starting point before more intensive treatments.
Talk to your doctor about whether IUI is right for your situation, and give it a fair trial of 3-4 cycles before deciding next steps. 💚