Intrauterine Insemination (IUI)

IUI is used when there is a specific, identifiable barrier to natural conception, or when simpler approaches have not resulted in pregnancy after a reasonable trial period.

• Mild to moderate male factor infertility, including low sperm count or reduced sperm motility (the ability of sperm to swim forward).
• Cervical factor infertility, where the cervical mucus is too thick or hostile for sperm to pass through naturally.
• Unexplained infertility, where no clear cause has been found after standard testing.
• Ovulatory dysfunction, such as irregular or absent ovulation, when controlled with medication.
• Use of donor sperm, for single women or same-sex couples.

IUI is a low-risk procedure, and serious complications are uncommon, but patients should be aware of the following possibilities.

• Mild cramping or pelvic discomfort during or shortly after the insemination, which usually passes within a few hours.
• Light spotting (small amounts of vaginal bleeding) immediately after the catheter is inserted.
• Infection of the uterus or fallopian tubes, a rare but possible complication if bacteria are introduced during the procedure.
• Ovarian hyperstimulation syndrome (OHSS), a condition where the ovaries swell and become painful in response to fertility medication. Mild OHSS is more common; severe OHSS is rare but requires medical attention.
• Multiple pregnancy (twins or more) if ovarian stimulation causes more than one egg to be released. Multiple pregnancies carry higher risks for both mother and babies.

Preparing for IUI involves a series of tests, medication phases, and monitoring appointments spread across a full menstrual cycle, so the timeline is longer than the procedure itself.

Before any treatment starts, both partners typically undergo baseline tests. These usually include a semen analysis (examination of the sperm sample), blood hormone tests for the woman, an ultrasound scan to assess the ovaries and uterine lining, and often a hysterosalpingogram (HSG, an X-ray or ultrasound test that checks whether the fallopian tubes are open). Results from these tests guide whether IUI is appropriate and how the cycle should be managed.

If ovarian stimulation medication is prescribed, it is usually started on a specific day of the woman's period and taken for several days. Regular ultrasound monitoring follows to track follicle (fluid-filled sac containing an egg) growth. When one or two follicles reach the right size, a trigger injection (a hormone shot that causes the final maturation and release of the egg) is given. The insemination is then scheduled around 24 to 36 hours later.

On the day of the procedure, the male partner provides a semen sample by ejaculation into a sterile container at the clinic. Donor sperm is thawed if that is the plan. The sample goes through a laboratory process called sperm washing, which separates active, healthy sperm from the rest of the semen fluid. Fasting is not required for IUI itself. Patients are usually asked to avoid intercourse for two to five days before the sample collection to optimise sperm count.

The insemination steps are as follows.

• The woman lies on an examination table, similar to a routine pelvic examination.

Recovery from IUI is quick, and most women resume normal activities the same day, though the two-week wait before a pregnancy test is emotionally demanding for many patients.

• Most women can return to work and light daily activities within a few hours of the procedure.
• Mild pelvic cramping or light spotting on the day of the procedure is common and usually resolves on its own.
• Strenuous exercise and heavy lifting are generally avoided for a day or two, though the restriction is more precautionary than medically strict.
• If progesterone (a hormone that supports early pregnancy) is prescribed as part of the protocol, it is usually taken as directed by the clinic for the two weeks following insemination.
• A pregnancy test, usually a blood test called a beta-hCG, is done approximately two weeks after the procedure. Testing earlier can give an inaccurate result.

The total cost of an IUI cycle varies widely depending on how many steps are involved, what medications are needed, and where the treatment is carried out, meaning two patients with similar diagnoses can face very different bills.

• Cycle complexity: a natural-cycle IUI with no stimulation medication costs less than a stimulated cycle that requires monitoring scans and a trigger injection.
• Ovarian stimulation medication: the type and dose of fertility drugs needed vary by patient and can form a significant part of the total cost.
• Diagnostic and monitoring tests: blood hormone tests, ultrasound scans throughout the cycle, and any pre-treatment investigations such as an HSG are usually priced separately.
• Sperm preparation: the laboratory fee for sperm washing is standard but can vary between facilities.
• Donor sperm: if a sperm bank is used, the cost of purchasing, shipping, and storing the sample adds to the total.