I've Had 3 Failed IUIs: What's Next?

Whether it’s one, two, three, or more, intrauterine insemination (IUI) is often one of the first steps for those considering Assisted Reproductive Technology (ART) to help grow their family.

Wherever you begin, Dr. Mary Wood-Molo, Reproductive Endocrinology & Infertility Specialist at Institute for Human Reproduction (IHR), emphasized that choosing a method of ART is an extremely personal decision and must be the best option for that specific person or couple. Ultimately, it depends on how aggressive you want to be starting out. According to Dr. Wood-Molo, IUI can be a good way to “ease into” ART.

What to do after 3 failed IUIs: Your options

Three unsuccessful IUIs can leave you feeling defeated, but this is also a natural point in treatment to pause, reassess, and choose your next step with clearer information. Most people who conceive from IUI tend to do so within the first three or four cycles, and a 2020 review in Fertility and Sterility found that pregnancy rates level out after the third attempt. That’s why many doctors recommend checking in now rather than continuing month after month without a new plan.

After three failed IUIs, Dr. Wood-Molo recommends reconnecting with your doctor to ask two key questions: Is it time for additional testing? Is it time to move toward IVF? One option is a laparoscopy, which the American College of Obstetricians and Gynecologists notes can identify issues that ultrasounds and blood tests often miss, including adhesions, scarring, previous infections, or endometriosis. Dr. Wood-Molo suggests choosing a surgeon with strong diagnostic and operative experience, because finding the right problem can sometimes make IUI more successful after the pelvis is “tidied up.”

Your next steps usually fall into four categories. You can move to IVF, which the CDC’s 2022 ART report shows generally offers higher success rates per cycle than IUI, especially as age increases. You can pursue additional testing to uncover anything that may be affecting egg quality, sperm quality, or implantation. You can continue IUIs with a modified protocol if IVF isn’t right for you at the moment. Or you can take a break and give yourself space to recover emotionally. As Dr. Karissa Hammer, Reproductive Endocrinologist and Infertility Specialist alongside Dr. Wood-Molo at Institute For Human Reproduction (IHR), explains, fertility treatment is stressful, and each IUI takes an entire month. She encourages leaning on a support system that can help you through the process, because you shouldn’t have to shoulder this alone.

No matter which path you choose, you still have options, and you’re allowed to make the decision that feels right for your body and your life.

Why did my IUI fail? Common reasons for unsuccessful IUI

IUI can fail for many different reasons, and most of them aren’t things you could have controlled. The truth is that IUI success rates are modest to begin with. Research published in the Archives of Gynecology and Obstetrics in 2022 showed that most cycles carry about a 5 to 15% chance of pregnancy, depending on age and diagnosis, which is similar to trying naturally. That’s why even a perfectly timed and medicated cycle can still end with a negative test.

About 90% of people who will get pregnant through IUI do so within the first three cycles. But if you don’t, there are many possible reasons why it may not have worked. Sperm counts may have been too low to reach the egg. One or both fallopian tubes may be blocked, which an HSG can evaluate. Egg quality may have been affected by age, which influences how likely an egg is to fertilize and develop into a healthy embryo. According to Dr. Hammer, if your IUI fails, it doesn’t necessarily mean anything went wrong. She explains that the chances of getting pregnant from IUI are similar to conceiving on your own when all fertility factors are normal, which means biology often has the final say.

Timing is another important factor. Even with ultrasound monitoring, ovulation prediction, and good sperm preparation, there’s still a narrow window where the egg and sperm need to meet. If ovulation happened slightly earlier or later than expected, fertilization simply may not have had the chance to occur. Hormones also play a key role. If estrogen or progesterone levels were off, the uterine lining may not have been ready to support implantation. The same goes for the uterine environment. A 2021 review in MDPI notes that uterine factors like polyps, fibroids that distort the cavity, or inflammation can affect how easily an embryo attaches. These issues are often invisible without targeted testing, like a saline sonogram or hysteroscopy.

Sperm and egg still have to do a lot of work after they meet. Fertilization must happen, the embryo needs to keep dividing normally, and implantation must occur. Dr. Wood-Molo compares it to a game of Mouse Trap. It sounds simple in theory, but in reality, there are many tiny, complex steps that all need to line up before you ever see a positive test.

There are also situations where everything looks good on paper, and IUI still doesn’t work. This can happen when embryo development just doesn’t progress or when the embryo fails to implant for reasons that aren’t obvious yet. These early biological hurdles are common and often can’t be detected without more advanced testing or IVF, which allows doctors to observe fertilization and embryo growth outside the body.

None of this means your body did anything wrong. It means conception is a delicate process that depends on timing, egg and sperm quality, a receptive uterus, and sometimes plain luck. If your IUI didn’t work, it’s worth reconnecting with your doctor to talk through which of these factors might be at play and whether further testing is helpful. You’re not out of options, and you’re not alone in this.

Understanding the Mouse Trap of conception

Think of the “Mouse Trap” of conception as your body trying to pull off a ridiculously complicated Rube-Goldberg machine. One tiny thing has to trigger the next tiny thing, and if even one piece hesitates or wobbles, the whole chain pauses. That’s why Dr. Wood-Molo uses this analogy. In theory, the laundry basket should just fall on the mouse. In reality, there are about 20 steps before you ever get close.

For pregnancy to happen, your ovary has to grow the right follicle, your hormones have to rise in the right rhythm, and ovulation has to happen on time. The egg is only around for about a day, while sperm have to survive a whole obstacle course to reach it. A 1997 review for National Academies found that out of millions of sperm, only a few hundred make it to the fallopian tube, which tells you how intense the journey is.

And even if the egg and sperm do meet, the embryo has to divide normally for several days, the uterus has to be perfectly prepared, and the embryo and lining need to “talk” to each other so implantation can happen. A 2023 review in Frontiers in Endocrinology points out that even tiny interruptions in this conversation can stop implantation altogether.

So the Mouse Trap analogy is really this: conception looks simple from the outside, but inside your body, it’s a whole chain reaction of delicate, timed little miracles. If one step doesn’t click, it doesn’t mean you messed anything up. It just means this machine is more complex than anyone ever admitted in health class.

Third IUI success rate: Should you try again?

The short answer is that a third IUI can still work for some people, but this is also the point where doctors usually pause and reassess. Most of the research we have shows that if IUI is going to succeed, it often happens early. The highest per-cycle pregnancy rates occur in the first three to four IUIs, and cumulative success usually plateaus after that. In other words, your chances don’t drop to zero after three tries, but they also don’t typically increase with more cycles.

If you’ve had three unsuccessful IUIs, try not to panic. Sometimes, after additional testing, trying again can be successful. Ultimately, though, both doctors stressed that the more cycles of IUI you attempt, the more your odds of success decrease.

So, should you try again? It depends on your age, diagnosis, emotional bandwidth, and what your doctor sees on testing. If you’re younger, have unexplained infertility, or are using donor sperm, many clinics feel comfortable offering a fourth IUI, especially if ovulation timing or medication doses can be fine-tuned. There are absolutely situations where cycle four becomes the lucky one.

But if you're older than 35, have already done medicated cycles, or have factors like low motility, tubal issues, or suspected egg quality concerns, moving to IVF may give you clearer answers and higher success rates per cycle. CDC data from the 2022 Assisted Reproductive Technology report shows that IVF success generally outperforms IUI across all age groups because it allows doctors to see fertilization and embryo development directly instead of guessing what’s happening inside the body.

Continuing IUI makes the most sense when the underlying issue is mild or unexplained and when treatment still feels sustainable. Moving on tends to be the better option when time, age, or test results point toward IVF offering a higher chance of pregnancy.

This decision isn’t about being “done” with IUI or rushing toward the next thing. It’s about understanding where your best odds are and choosing the path that feels right for your body and your life. You’re not out of options, and you’re allowed to shift direction whenever you need to.

When more IUIs might work

More IUIs might work when the underlying fertility picture suggests that you still have a reasonable chance with this approach. Age is one of the biggest factors. People under 35 tend to have higher-quality eggs and more predictable ovulation patterns, which can make additional IUIs worthwhile. Research published in the Chinese Medical Journal in 2016 showed that younger patients have higher per-cycle IUI success rates than those in their late 30s and 40s, simply because egg quality plays such a big role in fertilization and early embryo development.

IUI can also be a good option when ovarian reserve looks healthy. If your AMH and antral follicle count suggest that you respond well to medication and ovulate regularly, your chances of a later-cycle IUI working may be higher. The same goes for situations where male factor is the primary issue. IUI is designed to help sperm bypass the cervix and get closer to the egg, and studies have shown improved outcomes for mild to moderate motility issues compared with trying naturally.

Another reason more IUIs might make sense is if your first cycles were unmedicated. Adding medication like letrozole or gonadotropins can increase the number of follicles you produce and slightly boost success rates. This shift alone can give you a better chance than your earlier attempts.

And for many people, financial reality matters. IVF has significantly higher success rates per cycle according to the CDC’s 2022 ART report, but it also comes with much higher costs. Continuing IUI can be a strategic choice when IVF isn’t financially accessible right now, especially if your doctor still sees a path forward.

If any of these factors describe your situation, trying another IUI isn’t unreasonable. The key is weighing your chances, your resources, and your emotional energy, and then choosing the route that feels like the right next step for you.

When it's time to move on

It’s usually time to move on from IUIs when the odds start feeling too low for the energy you’re putting in, but this decision is incredibly personal. No doctor, statistic, or success chart can tell you exactly when you should stop. What they can do is help you understand the factors that make IUI less effective so you can make a choice that feels grounded and compassionate toward yourself.

Age is one of those factors. Once you’re 38 or older, egg quality shifts more noticeably, and 2016 research in the Chinese Medical Journal shows that IUI success rates drop significantly in the late 30s. That doesn’t mean pregnancy can’t happen, but IVF may give you a better chance per cycle, because your clinic can see what’s happening at each step instead of hoping the sperm, egg, and embryo all cooperate behind the scenes.

Diminished ovarian reserve is another sign that IUI may not be the best tool. If your AMH or antral follicle count suggests you’re working with fewer eggs, IVF tends to give your doctor more to work with at once and can make better use of the eggs you do have.

Time sensitivity matters too. Maybe you’ve been trying for a while. Maybe you’ve experienced losses. Maybe you simply don’t want to spend another year cycling through uncertainty. According to the CDC’s 2022 ART report, IVF success rates remain higher than IUI across all age groups, which is why many people choose to switch when they feel like they’ve waited long enough.

And sometimes the reason to move on is simpler: IUI just isn’t built to solve the issue you’re facing. Blocked tubes, more significant male factor infertility, or conditions like endometriosis can make IUI feel like pushing a boulder uphill.

But here’s the heart of it: moving on from IUI doesn’t mean you’re “done,” or that you’re giving up too soon, or that you’re skipping a step. It means you’re choosing the path that feels most hopeful and aligned with your body, your timeline, and your emotional wellbeing. Only you can know when that moment arrives, and whatever you choose, it deserves to be met with support, not pressure.

Moving to IVF after failed IUIs

If you’re considering your options after IUI, be sure to consult with your trusted medical professional as to what the next best option is for you. If that means IVF, your doctor should explain any additional risks, costs, and success rates associated with making that choice. One benefit of IVF is that it is more controlled and has higher success rates since it can bypass many of those “Mouse Trap” unknowns of human reproduction.

Additional testing to consider after IUI failure

After an IUI doesn’t work, it’s completely normal to wonder what you might be missing. Sometimes the answer is simply timing or chance, but other times additional testing can reveal something that wasn’t obvious from the standard fertility workup. Think of this phase as gathering more clues so your next step is guided by information instead of guesswork. Here are some of the tests your doctor might suggest, depending on your history, symptoms, and treatment plan:

• Laparoscopy: This is a minimally invasive surgery that allows your doctor to look inside the pelvis for things ultrasounds can miss, like endometriosis, adhesions, or scarring. The American College of Obstetricians and Gynecologists notes that laparoscopy is one of the most accurate ways to diagnose pelvic issues that may interfere with conception. It can be both diagnostic and corrective.
• Hysterosalpingogram (HSG): An HSG uses dye and X-ray imaging to check whether the fallopian tubes are open. If a tube is blocked or narrowed, sperm may not be able to reach the egg. An HSG also gives a clearer view of the uterine cavity, which can help identify polyps or fibroids.
• HyCoSy (hysterosalpingo-contrast sonography): This is an ultrasound-based alternative to an HSG that uses contrast to assess tubal patency and the uterine cavity. It avoids radiation and is often more comfortable. A 2014 review for the Journal of Human Reproductive Sciences show that HyCoSy is highly accurate for detecting tubal issues and can be a helpful first step in assessing why IUI may not be working.
• Endometrial Receptivity Analysis (ERA): This test evaluates whether your uterine lining is receptive at the time of implantation. While not recommended for everyone, it may be considered if you’ve had several failed cycles with otherwise normal results. According to a 2025 study in Scientific Reports, ERA may be helpful for some patients with suspected implantation timing issues, although research is ongoing.
• Thyroid and hormone panels: Thyroid hormones, prolactin, and other reproductive hormones can affect ovulation, egg quality, and the uterine lining. The American Thyroid Association recommends evaluating TSH in people experiencing difficulty conceiving because thyroid dysfunction can impact fertility and early pregnancy.
• Genetic carrier screening or karyotyping: Depending on your history, your doctor may suggest genetic testing to look for inherited conditions or chromosomal differences that could affect embryo development.
• Semen DNA fragmentation testing: Standard semen analysis looks at count, motility, and shape, but it doesn’t measure DNA integrity. A 2025 analysis in Frontiers in Endocrinology found that high sperm DNA fragmentation is associated with lower pregnancy rates in both natural and assisted conception.
• Hysteroscopy: This is a procedure where a small camera is inserted into the uterus to look for polyps, fibroids, or structural issues that could interfere with implantation. It allows for diagnosis and treatment at the same time.
• Autoimmune or clotting workup (select cases): This isn’t routine for everyone, but in people with recurrent loss or unexplained implantation failure, doctors may check for conditions like antiphospholipid syndrome (APS), which can affect early pregnancy.

Additional testing doesn’t guarantee answers, but it can help you feel more confident about whatever comes next, whether that’s another IUI, IVF, or taking a break. You deserve clarity and a plan that actually reflects what your body needs.

Who is a candidate for IUI? (Understanding the basics)

If you’re unsure whether IUI is right for you, Dr. Hammer recommends that a full fertility evaluation, including testing of both partners, be completed prior to starting an IUI cycle. Additionally, if it has been over a year since your initial workup or something else changed in your medical history, you should discuss this with your physician and update your fertility testing.

According to Dr. Hammer, IUI is “a great option for patients with infertility to increase the chances of conception as long as the fallopian tubes are known to be open.” It’s also an excellent treatment for patients who have not had exposure to sperm, meaning that either their male partner is azoospermic (no sperm), requiring IUI with donor sperm, or same-sex female couples. Believe it or not, the chances of conception with IUI may also be higher for some patients with very low ovarian reserve than with IVF.

As always, it’s important to sit down with your healthcare provider to address any and all test results, questions, or concerns you might have before pursuing IUI as the next step in your family-building journey.

How does IUI work?

The goal of an IUI is to get more sperm closer to the ultimate endpoint of the fallopian tube, increasing the chances of pregnancy. IUI requires a semen sample, which is washed and processed, and the motile (moving) and immotile (unmoving) sperm are separated. The higher-motility sperm is then inserted into the uterus via a catheter during ovulation.

IUI can occur after a natural or medicated cycle. A “natural” cycle is when the person with ovaries doesn’t have any pharmaceutical interventions or ovarian stimulation. There is monitoring involved via blood work and ultrasound, and the IUI is scheduled during the body’s natural ovulation window. On the other hand, a medicated cycle can have many variables: oral medications, injectables, ovulation suppression, “trigger” shots, and more. Dr. Wood-Molo referred to this option as “Sex and drugs,” which, to me, sounds a lot more fun than “wildly swinging moods, bloating, and timed intercourse.”

Overall, IUI is a minimally invasive treatment. You may feel a cramp with the placement of the catheter, but the procedure is generally very well tolerated. In addition, the risks of IUI are low but do exist. Any procedure where a catheter is placed into the uterus can pose a small risk of infection or bleeding, but a sterile catheter is used to decrease these chances. The procedure itself typically only takes a few minutes, and you should be in the clear to go on with your day right afterward.

IUI success factors

According to Dr. Hammer, oral ovulation induction medications like clomiphene citrate (Clomid) and letrozole add a slightly increased chance of IUI success since they are used to try to recruit more than one follicle (a fluid-filled sac that contains an egg) to increase the odds of successful conception. However, the downside to these medications is that they come with an increased risk of conceiving twins or, in rare cases, higher-order multiples.

Age is also an important factor in the success of IUI. Dr. Wood-Molo used the example that while a 25-year-old might see an IUI success rate of 18-20% using oral medications (higher for injectables), a 40-year-old might only see a 7-8% chance of success. On average across all patient types, Dr. Wood-Molo estimates that IUI cycles have live birth rates per cycle of between 5 and 15%.

The emotional reality of failed IUI cycles

The emotional reality of failed IUI cycles is often far heavier than anyone prepares you for. On paper, an IUI looks simple. In real life, it’s weeks of planning, medications, ultrasounds, and hope that builds quietly and then crashes just as hard. Even though the success rates are modest, each cycle still asks you to believe that this might be the month it works. When it doesn’t, the grief can feel both sharp and strangely invisible to the outside world.

For me, repeated IUIs took a dramatic toll on my mental, emotional, and physical health. Every month felt like a loss. Every IUI cycle was a roller coaster of hormones, protocols, doctor’s appointments, hope, disappointment, and grief, only to start again. It was one of the darkest times of my life. I chose, like many, to eventually move on to in vitro fertilization (IVF).

If you’re feeling worn down or even broken by the process, you’re far from alone. Studies have shown that infertility can cause distress comparable to chronic medical conditions like cancer or heart disease. A recent review for the Mayo Clinic by Fadi Yahya, MD, highlighted that infertility can significantly increase symptoms of anxiety and depression, especially when people face repeated losses or long stretches without answers. Your feelings aren’t dramatic. They’re human.

And then there’s the isolation. How do you explain to someone that a negative test isn’t just “bad news,” but the loss of another future you were already starting to imagine? That your body doesn’t just feel tired, but somehow betrayed? That you’re grieving something no one else could see?

Support can help soften the edges. Talking with a therapist who specializes in fertility can provide real coping tools and a space where you don’t have to pretend you’re fine. Resolve: The National Infertility Association offers support groups and free resources. Many clinics also have mental health providers on staff because they know the emotional load is heavy. And if you prefer online spaces, the Rescripted community has thousands of people walking this same road, ready to offer honesty, validation, and solidarity.

Most importantly, there is no “right” way to feel after a failed IUI. You’re allowed to be angry. You’re allowed to be numb. You’re allowed to take time off. You’re allowed to reevaluate everything. Whether you continue IUIs, shift to IVF, or pause entirely, your emotional wellbeing matters just as much as the medical plan.

This journey asks so much of you. Feeling the weight of it doesn’t mean you’re weak. It means you’re human, hopeful, and trying to build something deeply wanted in a process that isn’t gentle. You deserve compassion, support, and care at every step.

Questions to ask your doctor after 3 failed IUIs

After three failed IUIs, it’s completely fair to walk into your next appointment wanting clearer answers and a more informed plan. This isn’t you being “difficult.” It’s you advocating for your body, your time, and your emotional wellbeing. A good doctor should welcome your questions and help you understand what’s going on beneath the surface so you can make decisions that feel right for you.

Here are helpful questions to ask:

• What do you think was the most likely reason these IUIs didn’t work, based on my results so far?
• Should we repeat any tests or add new ones, like an HSG, HyCoSy, laparoscopy, thyroid panel, or sperm DNA fragmentation test?
• How do my age, ovarian reserve, and response to medication affect my chances if I try another IUI?
• Would changing the protocol help, such as adding medication, adjusting timing, or triggering ovulation differently?
• Are there any uterine or lining issues we may have missed that could affect implantation?
• Given my history, would IVF offer a significantly higher chance of success than continuing IUIs?
• How many more IUIs do you think are reasonable for someone with my specific diagnosis?
• What are the risks or downsides of continuing IUIs versus moving on to IVF?
• Is there anything in my partner’s results that we should look at more closely, like motility, morphology, or DNA fragmentation?
• If we continue IUIs, what would you change next cycle and why?
• How should I prepare emotionally and physically for the next step, whether that’s another IUI or something different?

Moving forward: You are not broken

Infertility has a way of making you question everything about your body, your choices, and your future. It’s exhausting, confusing, and deeply emotional, and it’s so easy to slip into the belief that you’re somehow failing at something that should be “natural.” But that belief isn’t grounded in science or truth. It’s grounded in the pressure so many of us grow up with.

In speaking with Dr. Wood-Molo, she offered her advice to anyone struggling with infertility: “Remember, you are not broken. If your parent needed heart surgery for a blocked artery, would you consider them ‘broken?’ Of course not. They are someone in need of medical intervention. So are you. So are we. At IHR, we’re here to help.”

Even under ideal conditions, many healthy embryos never implant, and age, egg quality, sperm quality, hormones, and timing all influence outcomes. None of these factors reflects personal failure. They reflect biology.

And while the science matters, your emotional experience matters just as much. Whether you continue IUIs, move to IVF, consider donor options, or shift paths entirely, you’re making thoughtful, loving decisions in pursuit of a family. That’s something to honour, not judge.

Remember, there are many ways to make and be a family. Good luck making yours.