Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a fertility procedure in which specially prepared sperm are placed directly inside the uterus (womb) around the time of ovulation (egg release), giving the sperm a shorter path to reach the egg.

In a natural conception, sperm must travel through the vagina and cervix (the narrow opening of the womb) before reaching the uterus and fallopian tubes (the channels that carry eggs from the ovaries). IUI skips part of that journey by depositing the sperm past the cervix. The sperm are first washed and concentrated in a laboratory so that the strongest, most active ones are selected. Timing is carefully matched to ovulation so a sperm and egg have the best chance of meeting.

IUI is used when there is a known or suspected barrier to natural conception that can be overcome by placing sperm closer to the egg. A fertility specialist will review the couple's full history before recommending it. Common situations where IUI is considered include:

• Mild to moderate low sperm count or reduced sperm motility (ability of sperm to swim)
• Unexplained infertility, where no clear cause has been found after standard testing
• Cervical factor infertility, where the cervical mucus (the fluid at the entrance of the womb) is too thick or hostile to sperm
• Ovulation disorders (problems with regular egg release), often treated alongside ovarian stimulation medication
• Use of donor sperm, for example in single women or same-sex female couples
• Mild endometriosis (a condition where tissue similar to the womb lining grows outside the womb)
• Ejaculation difficulties or certain physical barriers that prevent natural intercourse

IUI is generally not recommended in certain situations. Your doctor will discuss alternatives, which may include IVF (in vitro fertilisation), if any of the following apply:

• Both fallopian tubes are blocked or severely damaged, as sperm cannot travel to the egg
• Severe male infertility with very few or no motile (moving) sperm
• Moderate to severe endometriosis causing significant scarring
• Previous multiple IUI cycles that have not resulted in pregnancy
• Advanced maternal age combined with significantly reduced ovarian reserve (the supply of remaining eggs)

IUI is a minimally invasive procedure and its direct risks are generally low, but patients should be aware of the following possibilities:

• Mild cramping or discomfort in the lower abdomen during or shortly after the procedure, which usually eases within a few hours
• Light spotting (small amount of bleeding from the vagina) on the day of the procedure
• Infection in the uterus or fallopian tubes, which is uncommon but can occur if bacteria are introduced during the process
• Ovarian hyperstimulation syndrome or OHSS (a condition where the ovaries overreact to stimulation medication), if fertility drugs are used alongside IUI — this ranges from mild bloating to, in rare cases, more severe swelling and discomfort
• Multiple pregnancy (twins, triplets, or more), which carries higher risks for both mother and babies, particularly when ovarian stimulation medication is used
• Emotional and psychological stress from repeated treatment cycles if pregnancy does not occur

Preparing for IUI usually begins days or weeks before the procedure itself. Unlike many surgical procedures, IUI does not require general anaesthesia (being put fully to sleep), so fasting is not usually necessary. However, your care team will give you specific instructions based on your individual plan.

Your doctor will usually ask about — and in some cases pause or adjust — any medications that could interfere with ovulation or uterine (womb) function. Do not change any medication without guidance from your fertility team. It is generally advised to avoid alcohol and smoking in the weeks leading up to the procedure, as both can affect egg and sperm quality.

Tests and monitoring that are typically arranged before IUI include:

• Blood tests to check hormone levels, particularly to track the LH surge (a hormone rise that signals ovulation is about to happen)
• Transvaginal ultrasound (an internal scan using a small probe placed gently inside the vagina) to monitor follicle growth — follicles are the fluid-filled sacs in the ovaries that contain the developing eggs
• Semen analysis to assess sperm count, shape, and motility before deciding whether IUI is appropriate
• Screening blood tests for both partners to check for infections such as HIV and hepatitis
• A hysterosalpingogram or HSG (an X-ray that uses dye to check whether the fallopian tubes are open) may be done before the first IUI cycle if not already performed

On the day of the procedure, here is what typically happens, step by step:

• The male partner provides a semen sample, or a donor sample is thawed, usually a few hours before the scheduled insemination time
• The sample is processed in the laboratory — a technique called sperm washing — to concentrate the most active sperm and remove the fluid that could cause cramping if placed directly into the uterus
• The patient lies on an examination table, similar to a routine gynaecological (reproductive health) examination
• A speculum (a small instrument that gently opens the vagina) is inserted so the doctor can see the cervix
• A thin, flexible tube called a catheter is passed gently through the cervix into the uterus
• The prepared sperm sample is slowly injected through the catheter into the uterus
• The catheter and speculum are removed; the patient usually rests for a short time before leaving
• The entire procedure typically takes only a few minutes, though the preparation beforehand takes longer

Recovery after IUI is straightforward for most people. Because no incision (surgical cut) is made and no sedation (medication to make you drowsy) is required, most patients can return to normal daily activities on the same day. Your fertility team will advise you on the specific restrictions that apply to your situation.

• Monitoring: You will usually remain in the clinic for a short rest period of around 10 to 30 minutes after the procedure, though the exact time varies by clinic
• Mild cramping or spotting: This is normal for a day or two and usually does not require any special treatment
• Activity: Light activity is generally fine on the day itself; your doctor will advise whether to avoid strenuous exercise in the days that follow
• Intercourse: Guidelines vary — some doctors recommend normal intercourse around the time of IUI to support conception, while others advise a brief rest; follow your clinic's specific advice
• Medication: If ovarian stimulation or other hormonal support medication was prescribed as part of the cycle, the fertility team will instruct you on how long to continue it
• Pregnancy test: A blood test to detect the pregnancy hormone hCG (human chorionic gonadotropin) is usually scheduled about two weeks after the procedure — this is more accurate than a home urine test at this stage
• Follow-up: If the first cycle does not result in pregnancy, the fertility team will review what happened and discuss whether to try another cycle or consider other options
• Emotional support: Waiting for the result can be stressful; many fertility clinics offer counselling support, and speaking with a counsellor or support group is something many patients find helpful