While the initials I-U-I might make you think of buying a vowel on Wheel of Fortune, it’s actually a medical procedure you should know about if you're considering having kids one day. Intrauterine insemination (IUI) involves sperm being placed directly inside the uterus with the help of a doctor or a midwife. The goal is pregnancy, which will occur if the sperm fertilizes the egg and that fertilized egg implants in the lining of the uterus.
IUI is sometimes referred to as “donor insemination,” “alternative insemination,” “artificial insemination,” or, in pop culture terminology, "the turkey baster method." IUI is timed around ovulation. Ovulation occurs usually once in every menstrual cycle when hormone changes trigger an ovary to release an egg. The IUI procedure places the sperm cells directly into the uterus, so that the sperm starts its journey closer to the egg. Since the goal is reaching the egg and fertilizing it, cutting down on the time and distance of travel helps improve the sperm’s odds of success, as it's more likely to reach the egg. IUI is most effective when one has at least one unblocked fallopian tube, is able to ovulate (with the help of medication), has a healthy ovarian reserve (the capacity of your ovaries to provide egg cells capable of fertilization), and a normal uterine cavity. Your health care professional should evaluate you before you embark on IUI, as well as confirm or dispel the existence of any hormonal imbalances or other conditions.
There are quite a few reasons why you might consider IUI, and we want to remind you that while the path to parenthood can feel daunting and even isolating, all approaches are valid. Some turn to IUI when deciding to be a single parent by choice. IUI is often used by those in LGBTQ relationships. Others use donor sperm in an attempt to stay clear of genetic diseases. Some insurance companies require IUI as the first step before covering medical procedures such as IVF. Couples often choose IUI when fertility issues are linked to male factor infertility. IUI can also be helpful in situations such as low sperm motility (that's the ability to move and swim), low sperm count (meaning that the semen that gets ejaculated contains fewer than 15 million sperm per liter of semen), or one has a condition like sexual dysfunction — that's when there's difficulty at any point during the sexual response cycle.
For Ann, IUI was an answer to fertility issues that stemmed from both her and her partner. “The doctor explained that given our ages (29 and 31), an average couple's chances were around 20-25% per cycle, and for whatever reason, ours were likely no higher than 5%. If we did IUI alone, it would add about 5% chance. If we did just medication, it would add about 5% chance. Combined, they'd add about 15% chance to bring us up to nearly normal fertility. Our issue was my husband's sperm, which while in the normal range for count and motility (movement), was on the low end of normal and was very low for morphology (shape)..I also suspected hostile cervical mucus could be a problem, which makes it difficult for sperm to get through, so I figured IUI would bypass both those issues.”
Before IUI, a partner or a donor will provide a sperm sample. It’s important to remember that most insurance companies don’t cover the cost of purchasing sperm, which can get expensive. Depending on where you order sperm from, it can cost up to $1,000 a vial. Known donor sperm is also an option which comes with its own costs, including legal fees (working with an anonymous donor is less complicated than working with a known one). Most doctors recommend having at least two vials on hand for each IUI attempt.
Once delivered to your doctor, the sperm is “washed.” Some banks also sell sperm that is “pre-washed.” Sperm washing removes chemicals in semen that can cause reactions and even make it harder to get pregnant, and also concentrates it.
The process for the actual IUI procedure is different for everyone. Most individuals do this at a hospital or clinic, although it is possible to work with a midwife in your home. Some OB/GYNs are trained in performing IUI, and it can also be done by a reproductive endocrinologist (RE). REs are specialists in fertility, so you'll see them in order to diagnose and evaluate fertility challenges, and once you're pregnant, you'll continue to see your RE to make sure things are moving along as they should be (your progesterone levels are normal, embryo is growing, etc). You will likely transition to seeing an OB/GYN when you're between 8 and 10 weeks along.
Depending on your age, your hormone levels, and your general health, your preparation may vary. You may take fertility medicines, such as Clomid, to help your eggs mature and get ready to be fertilized. Gina had planned on freezing her eggs when she learned she had low AMH levels - meaning the quality and quantity of her ovarian reserve was low. She moved right into IUI as a single parent-to-be, taking hormones to help trigger ovulation.
During IUI, a thin, flexible tube is used to move the sperm through your cervix and into your uterus. Gina described it as a “pipette shaped" tool. A small syringe is used to then insert push the sperm through a tube and directly into the uterus.
The insemination procedure only takes about 5-10 minutes. Gina found it exciting the first time, but on her second and third try, she mostly found it unnerving. She was told that if you relaxed, it was pain-free, but most everyone can agree that it’s hard to relax under such a command. Although the procedure is quick and done without anesthesia, it can cause some mild cramping. Gina compared it to a pap smear.
For Alison, the process of IUI didn't feel impersonal, but it also didn’t feel meaningful. “I remember I felt calm, and it was over quickly. No discomfort or pain or anything. I think my husband was more uncomfortable than I was - he describes it as ‘watching another man get my wife pregnant.’”
IUI is a relatively simple and low-tech procedure. It can be less expensive than other types of fertility treatments, but the costs do add up. The cost of IUI varies depending on what type of insurance coverage you have and how much your doctor’s fees are. In general, the fees can cost about $300-$1,000 without insurance. When you’re researching IUI, be sure to check out a variety of clinics and ask in about the prices (a good resource is the Society for Assisted Reproductive Technology, where you can find clinics, get your questions answered, and more).
For Gina, the biggest cost was sperm, which she paid for out of pocket. Each round of IUI was $300. Alison’s insurance covered 80% of the IUI treatment, although they paid for sperm out of pocket. For Natalie, living in Massachusetts made the procedure just a bit more affordable, “Because we live in MA and are viewed by the insurance company as a same-sex couple the cost of the procedure was covered after 6 documented attempts.”
Some states have laws dictating that health insurance companies must cover some or all of the costs of infertility treatment if you meet certain requirements. Some will cover IUI if you’re in your mid-30s or older - or will only cover IVF if you’ve had six failed IUI attempts. It’s important to work with both your doctor and your insurance company when making a plan.
Before you head off to think about IUI, Ann has some advice for you. “IUI is a very valid option - there was a lot of myths in my infertility group that IUIs didn't work, everyone ended up with IVF anyway. Well, I definitely conceived with IUI. So there's definitely hope! If you're going forward with an IUI, know you aren't alone and that lots and lots of babies you see out and about are the results of fertility treatment, even if no one tells you. I felt so alone going through it all, so I've made it a point to be out and proud about conceiving my children from infertility, and it has resulted in dozens of friends and acquaintances contacting me over the years to ask for support as they fight their own battles. Stay strong, make choices that are right for your family, and take care of yourself because you matter a lot, regardless of your fertility status.”
There’s no crystal ball when it comes to knowing your fertility future, but understanding your body and hormones can help you plan. The Modern Fertility test can give you information about your body and your fertility. You can even get a sense of your fertility timeline in order to have frank conversations with doctors and partners.