Intrauterine Insemination (IUI) is a gentle and cost-effective form of assisted reproduction. Here you’ll learn how the procedure works, what requirements are involved, the costs you can expect, and which factors influence success rates in the United States.
What Is Intrauterine Insemination (IUI)?
With IUI, washed and highly concentrated sperm are inserted directly into the uterus via a thin catheter. This bypasses the cervical mucus and gives sperm quicker access to the egg. You can use either partner sperm or donor sperm.
Common Indications for IUI
- Mild male factor infertility (low sperm count or motility).
- Irregular or absent ovulation in women.
- Cervical factor infertility (thick mucus or antisperm antibodies).
- Unexplained infertility despite regular intercourse.
- Single women or same-sex female couples using donor sperm.
- Immunological issues (anti-sperm antibodies) with otherwise normal semen analysis.
Requirements for a Successful IUI
- At least one patent fallopian tube (confirmed by HSG or HyCoSy).
- Documented ovulation, either natural or triggered hormonally.
- Adequate sperm count after processing (>5 million motile sperm).
- No active infection in the reproductive tract.
- Genetic screening for donor sperm to exclude inherited conditions.
Step by Step: How IUI Works
- Initial Evaluation & Counseling: cycle monitoring, semen analysis, blood tests, and ultrasounds.
- Gentle Ovarian Stimulation: clomiphene citrate or low-dose gonadotropins to develop 1–3 follicles.
- Ovulation Trigger: hCG injection when the lead follicle reaches 17–20 mm.
- Sperm Preparation: fresh or thawed sample concentrated via swim-up or density gradient.
- Insemination: 24–36 hours after trigger, sperm are placed into the uterus using a catheter (procedure <5 minutes, usually painless).
- Luteal Support: vaginal progesterone to support the uterine lining.
- Pregnancy Test: blood β‑hCG 14 days after insemination.
Advantages of IUI
- Direct placement of sperm reduces cervical mucus barriers.
- Minimally invasive, no anesthesia required.
- More affordable than IVF or ICSI.
- Quick outpatient procedure with minimal appointments.
Fertilization Methods at a Glance
- ICI / IVI – Intracervical Insemination
Sperm is placed near the cervix using a syringe. Suitable for mild fertility issues or donor sperm; lowest cost and maximum privacy. - IUI – Intrauterine Insemination
Washed sperm are inserted directly into the uterus. Ideal for moderate male factors, cervical issues, or unexplained infertility; moderate cost with clinical oversight. - IVF – In Vitro Fertilization
Multiple eggs are retrieved, fertilized in the lab, and transferred as embryos. Standard for tubal blockages or failed IUI; higher success rates, higher cost. - ICSI – Intracytoplasmic Sperm Injection
A single sperm is injected into an egg. Used for severe male factor infertility; most expensive but highest precision.
Success Rates: What Are Your Chances?
The pregnancy rate per cycle in the U.S. by age is approximately:
- Under 30 years: 20–25%.
- 30–35 years: 15–20%.
- 35–40 years: 10%.
- Over 40 years: ~5% or less.
After three to six consecutive cycles, cumulative live birth rates can reach about 30–45%.
Tips to Improve Your Chances
Lifestyle Optimization:
- Maintain a healthy BMI, quit smoking, limit alcohol.
- Manage stress through yoga, meditation, or moderate exercise.
Cycle and Sperm Optimization:
- Avoid ejaculation for 2–3 days before sample collection.
- Use precise cycle monitoring (ultrasound & ovulation kits).
- Consider fertility-friendly lubricants during the stimulation phase.
Risks & Safety
Medication Risks:
- Ovarian hyperstimulation syndrome (OHSS) is rare with low-dose protocols.
- Multiple pregnancy risk (5–10%) if more than one follicle releases an egg.
Procedure Risks:
- Mild cramping or spotting after catheter insertion.
- Infection risk is very low with sterile technique.
Mental Health: Repeated negative cycles can be emotionally challenging—consider counseling support.
Costs & Insurance Coverage
In the United States, the average cost per IUI cycle for the procedure alone ranges from $200 to $1,000, while total costs including medications and monitoring fall between $500 and $2,000 per cycle. Insurance coverage varies by state and plan: fifteen states mandate some private fertility treatment coverage, but many plans impose cycle or dollar limits, and self-insured employers are often exempt. Medicaid generally does not cover IUI.
When to Consider the Next Step
- Under 35: after 3–4 unsuccessful cycles.
- 35–40: after 3 cycles without success.
- Over 40 or severe male factor: consider IVF or ICSI sooner.
Your fertility specialist can guide the optimal timing for switching methods or additional testing.
Scientific Sources & Studies
Conclusion
Intrauterine insemination offers individuals, couples, and same-sex partners a realistic chance at pregnancy with moderate costs and low invasiveness. With careful cycle monitoring, appropriate stimulation, and professional care, IUI can be the key step toward parenthood before moving on to more intensive treatments like IVF or ICSI.