When a person conceives naturally, sperm travel from the vagina through the cervix, into the uterus, and up into one of the fallopian tubes. If sperm arrive in a tube soon after the release of the egg from the ovary, the sperm meets the egg and fertilization occurs in the tube. The cervix naturally limits the number of sperm that enter the uterus. This means that only a small percentage of the sperm in the ejaculate actually make their way into the fallopian tubes.

IUI is a procedure where sperm is placed past the cervix into the uterus around the time of ovulation. This makes the passage to the fallopian tubes much shorter, and there is a better chance that more sperm will encounter the egg. IUI stands for intrauterine insemination. You can think of an IUI as helping to give sperm a head start in reaching the egg that is waiting to be fertilized within the fallopian tube.

If you have never heard of intrauterine insemination before clicking this article, or are looking into IUI as an option for growing your family, you probably have a lot of questions. Here’s what you need to know:

Who should consider an IUI?

IUI is helpful under the following circumstances:

• In individuals with infertility
• Individuals with cervical scarring that make it difficult for sperm to enter into the uterus
• In individuals who do not have a sperm-producing partner
• In couples where the male partner is unable to maintain an erection or has problems with ejaculation

What is the process of IUI?

An IUI is performed just before a woman ovulates. Doctors will either time the IUI based on the size of the follicle(s) on ultrasound, hormone blood work, or based on an ovulation predictor kit.

The sperm needed for IUI can be sourced via a partner or using a sperm donor. If using a partner, he will ejaculate into a sterile container that is provided by the clinic/lab where it will be processed. In cases where he is unable to produce, the sample can be collected during intercourse using a special condom. If he is unable to ejaculate or has a spinal cord injury, other collection options will be discussed with him. If using donor sperm, there are various sperm banks that one can choose from.

If the sample is collected fresh, the lab will wash the semen, separate the sperm from the seminal fluid, and place the sperm inside a solution that is similar to the fluid within a woman’s fallopian tube. The sperm are then drawn into a thin IUI catheter. If the sperm were frozen, it is thawed, washed, and similarly drawn into an IUI catheter.

In preparation for the procedure, the woman lies on an examination table, a speculum is inserted vaginally to visualize her cervix, and then the IUI catheter is inserted through her cervix into her uterus. Once inside the uterus, the sperm is slowly injected and the catheter removed. The whole procedure is done within 5 minutes.

Does IUI hurt?

For most, having an IUI performed is a pain-free procedure. Most women do not even feel the catheter as it is being inserted. However, some may have cervical scarring or other anatomic changes that can make it more difficult for the catheter to pass through the cervix; in those cases, women may experience cramping during the IUI.

How long after IUI does implantation occur?

If implantation is successful, a woman’s pregnancy test will become positive 2 weeks after her IUI procedure.

Is IUI less expensive than IVF?

Each clinic sets its price for an IUI procedure. Depending on how a clinic bundles its services, the price for one IUI can range between $1,000-2,000. A standard IVF cycle can range between $10,000 – $20,000.

At what point should you try IVF?

The decision to proceed with IUI versus IVF depends on many factors: the individual or couple’s diagnosis, the woman’s age, the quantity of sperm available, how many children the woman or couple desire, and a host of other factors that are important to each individual. Oftentimes, if a person decides to proceed with IUI first, we typically recommend moving on to IVF after 3 unsuccessful IUI cycles.

Dr. Okeigwe is a compassionate reproductive endocrinology and infertility expert who specializes in advanced fertility care. She is a Bay Area native and completed her undergraduate degree and Masters in Public Health at UC Berkeley. She attended medical school at UCSF before advancing to her residency in Obstetrics & Gynecology at Boston University Medical Center. Dr. Okeigwe then completed her fellowship in Reproductive Endocrinology and Infertility at Northwestern University. Dr. Okeigwe joined Spring Fertility from the Palo Alto Foundation Medical Group and is looking forward to continuing to provide exceptional, patient-centered fertility care in the East Bay.