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.
Who Is a Candidate For IUI?
If you’re unsure whether IUI is right for you, Dr. Karissa Hammer, Reproductive Endocrinologist and Infertility Specialist alongside Dr. Wood-Molo at Institute For Human Reproduction (IHR), 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 that have not had exposure to sperm, meaning that either their male partner is azoospermic (no sperm) requiring IUI with a 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%.
Reasons IUIs Fail
90% of people who will get pregnant through IUI do so in the first three cycles. But if you don’t, there are many possible reasons why. Sperm counts may be too low. Both, or one, fallopian tube may be blocked (a Hysterosalpingogram, or HSG, can check for that). Or, it could be an egg quality issue related to age.
According to Dr. Hammer, [if your IUI fails,] “rest assured that nothing necessarily went wrong. Unfortunately, the chances of success with IUI are the same as conceiving on your own if you were fertile.” Remember: a sperm must reach an egg, develop into an embryo, and implant to have a positive pregnancy test.
Despite what most of us were told in sex education — that you can get pregnant at any time if you have sex at all — a lot has to take place for fertilization and conception to occur. Dr. Wood-Molo likens it to a game of Mouse Trap: sure, the laundry basket should just trap the mouse, but in reality, lots of other steps have to be in place in order for that to happen.
How many IUIs should you try before moving on?
After three unsuccessful IUI cycles, Dr. Wood-Molo recommends connecting with your doctor to re-evaluate: Is it time for additional testing? Is it time to move toward IVF?
One possibility is to have a laparoscopy, an exploratory surgery where your doctor will check to see if anything is affecting your ability to conceive that can’t be detected from the outside. This is where doctors can discover adhesions, scarring, previous infections, or endometriosis. Dr. Wood-Molo’s advice is to have an excellent diagnostic and operative doctor for the laparoscopy. You want someone who knows what to do when they’re in there. Sometimes, Dr. Wood-Molo said, IUI can be successful after the pelvis is “tidied up.”
While it is reasonable to continue IUI treatments if you are not interested in pursuing IVF or alternative routes for conception, Dr. Hammer empathizes that fertility treatments are stressful. “Unfortunately, each [IUI] takes a full cycle which is one month, and it can be frustrating when you get a negative pregnancy test. I recommend seeking out a support system to help you through the process.”
After 3 Failed IUIs, What’s Next?
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. Plus, 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 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.
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.”
Remember, there are many ways to make, and be, a family. Good luck making yours.
Kristin Diversi is a writer and versatile creative. She is passionate about reproductive health and justice and lives in Longmont, Colorado, with her husband and their son.
