For a woman to get pregnant, a man’s sperm must travel up the vagina, through the cervix into the uterus, and up into one of the Fallopian tubes. If the sperm arrives in the tubes soon after ovulation, the sperm and egg can meet in the tube, and most commonly, fertilization occurs. Because the cervix naturally limits the number of sperm that enter the uterus, only a few sperm make their way to the Fallopian tubes.

Intrauterine insemination (IUI), also known as artificial insemination, is a procedure that bypasses the cervix and directly places the sperm in a woman’s uterus around the time of ovulation. By placing the sperm directly into the uterus, this procedure gives the sperm a better chance at making their way to the egg. IUI is performed to improve a woman’s chances of getting pregnant. After the semen sample is collected, it is washed in the laboratory to concentrate the sperm and remove the seminal fluid. The seminal fluid is removed because it can cause severe cramping in the woman. This process takes less than two hours to complete.

The IUI procedure is performed around the time of ovulation. It is a relatively simple procedure that only takes a few minutes. During this procedure, the woman lies on an examining table, and the clinician inserts a speculum into her vagina to be able to see her cervix. Then, a catheter, or narrow tube, is inserted through the cervix and into the uterus, where the washed semen sample is slowly injected. Though this procedure is relatively painless, some patients have experienced mild and temporary cramps.

The IUI process begins with the onset of the patient's menstrual cycle.

➝ Day 1: The first day of full menstrual flow is considered Day 1 of the cycle. This marks the start of the IUI process.

An initial appointment with a fertility specialist is scheduled early in the menstrual cycle.

➝ Medical History Review: The specialist reviews the patient's and partner's medical history, including any previous fertility treatments and test results.

➝ Diagnostic Testing: The couple may undergo additional testing, such as hormone levels, ultrasound, and semen analysis, to assess fertility status and identify any underlying issues.

➝ Discussion and Plan: The specialist discusses the IUI procedure, its risks, benefits, and success rates. A treatment plan tailored to the patient's needs is developed.

The treatment phase begins, aiming to optimize the chances of successful fertilization.

➝ Medication Protocol: Depending on the patient's specific situation, the doctor may prescribe fertility medications. Common options include:

➝ Clomiphene Citrate (Clomid): An oral medication that stimulates the ovaries to produce one or more eggs.

➝ Letrozole (Femara): Another oral medication that induces ovulation.

Gonadotropins: Injectable hormones (FSH, LH) that stimulate the ovaries to produce multiple follicles.

Ovulation is monitored and, if necessary, induced to time the insemination accurately.

➝ Ultrasound Monitoring: Transvaginal ultrasounds are performed to monitor follicle growth and endometrial thickness. Blood tests may also be used to check hormone levels.

➝ Trigger Shot: When the leading follicle(s) reach an appropriate size (usually 18-20 mm), an injection of human chorionic gonadotropin (hCG) or another trigger medication is administered to induce ovulation. Ovulation typically occurs 24-36 hours after the trigger shot.

The patient may return for follow-up appointments to monitor progress.

➝ Confirming Ovulation: The specialist may schedule a follow-up ultrasound or blood test to confirm ovulation has occurred.

The timing of the IUI procedure is crucial, and it coincides with the release of the egg(s).

➝ Monitoring for Ovulation: The timing of ovulation is closely monitored to ensure the insemination occurs at the optimal time for fertilization. In some cases, a follow-up ultrasound or blood test is done to confirm that the follicle has ruptured.

Intrauterine insemination is performed to place sperm directly into the uterus.

➝ Sperm Collection: On the day of the IUI, the male partner provides a semen sample manually. If necessary, donor sperm can be used. The sample is then washed and processed to concentrate the healthiest, most motile sperm.

➝ Insemination Procedure: The washed sperm are loaded into a thin catheter. The patient lies on an exam table, and the catheter is gently inserted through the cervix into the uterus, where the sperm are deposited. The procedure is usually painless and takes only a few minutes.

➝ Rest: After the insemination, the patient may rest for a short period before leaving the clinic.

Post-insemination medication may be prescribed to support the luteal phase.

➝ Luteal Phase Support: The doctor may prescribe medications, such as progesterone supplements, to support the uterine lining and improve the chances of implantation.

The final step is to determine if the IUI procedure was successful.

➝ Two-Week Wait: The patient must wait approximately 14 days after the IUI before taking a pregnancy test. This period, often called the "two-week wait," can be emotionally challenging.

➝ Pregnancy Test: A blood test (beta hCG) is conducted to measure the levels of human chorionic gonadotropin, indicating whether implantation has occurred and pregnancy has been established.

➝ Ultrasound Confirmation: If the pregnancy test is positive, an ultrasound is scheduled a few weeks later to confirm the pregnancy, check for the presence of a gestational sac, and assess the embryo's development.

➝ Follow-Up Care: If the pregnancy test is negative, the patient will have a follow-up consultation with the specialist to discuss the outcome and consider the next steps, including potential future IUI cycles or alternative fertility treatments.

The success rate for IUI depends on several factors, such as your age, diagnosis (if any), the timing of the procedure, etc. In general, however, the mean pregnancy rate per IUI cycle in the US is around 9%, according to a study published in March 2023 by the NIH.

Like any procedure, there are some associated risks with the procedure. If you are taking fertility medication to stimulate ovulation, there is a small chance you might develop ovarian hyperstimulation syndrome, or OHSS for short. However, risks like that are generally minimal.