What is IUI?
Who is IUI for?
Before you start treatment, remember:
How long does IUI take?
Understanding IUI success rates
What happens next?
What are the risks of IUI?
Is IUI available on the NHS?
How much does IUI cost?
IUI is an assisted reproductive technique (ART) that gives sperm a better chance of fertilising an egg. It's the most direct form of artificial insemination, and involves placing the sperm directly into the uterus with the help of a catheter. This way, sperm bypasses the vagina and the cervix, and gets a head start on its journey to the egg.
IUI is less invasive than IVF, and fertilisation takes place inside the body - unlike in IVF, where fertilisation takes place in a lab.
There are two types of IUI:
IUI is usually not the preferred treatment for those suffering with infertility. However, IUI is used regularly when:
Time: Varies, but approx. 2 weeks
For females, or those assigned female at birth (AFAB), your clinic will run pre-treatment blood tests and ultrasound scans. These predict your body's response to treatment and help to understand the number and quality of eggs available (this is known as your ovarian reserve) .
For men, tests check the quantity and quality of sperm. This is measured as motility (movement) and morphology (shape). Depending on the results, you may need additional treatments, such as intracytoplasmic sperm injections (ICSI).
Both partners undergo mandatory screening for blood-borne viruses, like HIV and hepatitis .
Next, you'll need a follow-up consultation with a doctor to discuss the results and prepare your cycle.
Time: 2 weeks
Location: Home, with minimal clinic visits
Even if you're following an unstimulated natural cycle, this will still need to be tracked to optimise the timing of insemination. You can do this through blood and urine tests performed at your clinic - so be prepared to visit your clinic multiple times over your predicted week of ovulation (days 10-16 of your menstrual cycle). Alternatively, you can use an ovulation prediction kit at home.
Time: 2-4 weeks
Location: Home, with in-clinic monitoring
Now it's time to begin your treatment - or protocol.
Most protocols start on day 1-2 of your period, directly after your bleed. This is when you will begin stimulation. The process typically takes two weeks, during which you inject medication into your abdomen. This encourages follicles in your ovaries to grow and develop multiple eggs at the same rate, increasing your chances of conception. This is different to a natural cycle, where only a 'lead' follicle develops an egg.
The size of the follicle is how your doctor determines whether the egg is ready (since eggs are too small to assess otherwise). To monitor the development of your follicles, the doctor will use hormonal blood tests and a trans-vaginal ultrasound.
Time: A few hours, just prior to insemination
On the morning of the IUI procedure, the male partner needs to produce a sperm sample. This can be a previously frozen sample.
The sample is then 'washed' in the lab to create a higher quality, concentrated sperm package. This process also removes naturally occurring substances in the semen that can prevent fertilisation, and removes any pathogens, like a sexually transmitted diseases, that could be passed on.
If you're using donor sperm, the sample will arrive at your clinic frozen and already washed.
Time: 5 minutes
The insemination procedure is very quick, and is usually carried out without anaesthesia or sedation.
A catheter is inserted into the uterus via the vagina, and the prepared sperm is sent through this fine tube into the uterus. Your doctor will use an ultrasound to guide the catheter, and to help them visualise it clearly, you will be asked to arrive at your appointment with a full bladder.
Time: 2 weeks
After insemination, fertilisation and implantation will hopefully be successful. The 'two week wait' refers to the period you'll need to wait until a pregnancy test can be taken to provide you with a reliable result.
Typical timeline: 6 weeks
This is based on a single round of IUI, from pre-treatment to taking a pregnancy test.
The length of your IUI treatment is the same, whether you opt for stimulated or unstimulated IUI.
The time it takes to complete pre-treatment tests may vary depending on whether your doctor feels it necessary to run further tests, and you may choose to take a break between this phase and starting treatment. Regardless, you'll need to wait until the start of your next menstrual cycle to begin treatment.
If you need further cycles, you won't necessarily need to run the same tests as the first time, bringing the treatment timeline for any subsequent IUI cycles to around 4 weeks.
Like other fertility treatments, success rates are not the same for everyone. Age, the IUI method you use, any underlying conditions, and the quality of care at your clinic all play a big factor.
However, IUI success rates typically range between 5-15% per cycle for women up to 40 years old, making it about a third as successful as IVF. This is why IUI is often carried out as an alternative to sex in those with no evidence of infertility, rather than as a treatment for infertility. This is because if someone is suffering from infertility this would only further reduce the chance of success with IUI.
There's a higher cumulative success rate with IUI compared to a per cycle success rate. That means your chances of conceiving via IUI increase for every additional cycle after your last - with the highest success rates typically seen in the 3rd and 4th cycles.
Up to 37 years of age, stimulated IUI cycles are generally considered more effective. The success rate of stimulated cycles is 13%, compared to 6.5% for unstimulated cycles.
However, for anyone over 37, unstimulated cycles tend to lead to a greater chance of pregnancy than a stimulated cycle (12% versus 8.5%) .
Women are born with all the eggs they will ever have. Unlike other cells in the body, like skin cells, eggs don't regenerate. This means our eggs age like the rest of us, reducing the number and quality of eggs available over time.
But it's not just women who experience an age-related decline in fertility.
Emerging research shows age affects sperm. Men over 30 are more likely to have decreased sperm motility compared to younger men, and men over 40 are more likely to have lower sperm counts.
There's also mounting evidence that sperm quality has been declining generally over recent generations. The exact cause is unknown, but thought to be caused by greater levels of pollutants, changing diets and increased stress levels.
Life after IUI looks different for everyone.
If your cycle was unsuccessful, it can be heartbreaking. Many people may feel the need to take a break before trying another cycle, while others go straight back into planning. Your clinic should provide follow up appointments and counselling sessions to help support you.
While the chance of success increases with every IUI cycle, it's important to contact your GP if you aren't getting anywhere. When accessing care on the NHS, failed IUI cycles can be used to demonstrate infertility, and may help you become eligible for IVF treatment.
Like IVF, IUI can be a lonely process - and multiple cycles can make it even more isolating. While your clinic can offer excellent support along the way, connecting with the fertility community online or offline can offer invaluable friendship, connection and support.
Overall, IUI is pretty safe because its minimally invasive, and if you're using donor sperm, all sperm is screened to exclude certain diseases - like HIV, hepatitis, and syphilis. However, there are some risks to be aware of:
Multiple pregnancy - if following stimulated IUI. Hormone medication used in stimulated IUI increases the number of mature eggs released in a cycle, which each have the possibility of being fertilised. A 2020 study found that if the number of mature follicles was increased from 1 to 5 at the time of IUI, the chance of multiple pregnancy per cycle increased from 0.6% to 6.5% . Multiple pregnancies are associated with a heightened risk of health problems for both mother and babies - such as late miscarriage, premature delivery, gestational diabetes, stillbirth and death. Unstimulated cycles do not increase the chance of having a multiple pregnancy.
The NHS may fund IUI as an alternative to natural conception, for certain groups who cannot safely have sex. These groups include:
Funding for IUI is depends on your postcode and determined by your local Integrated Care Board - the number of rounds of IUI that your ICB will fund can vary from 0-12. To find out your eligibility, use our NHS Fertility Funding Calculator.
IVF may later be accessed if these cycles are not successful. The number of unsuccessful cycles that are required before accessing IVF varies depending on where you live.
IUI may also be offered as an alternative to IVF, where individuals have cultural or religious objections to IVF.
On average, an advertised package price of IUI is £1,265 - but can range from £550 to £2,310, and vary significantly between clinics.
If donor sperm is used, whether from a bank or a known donor, the sperm must be screened and prepared for the process. This will add to the total cost of your IUI treatment. The average price of donor sperm at a fertility clinic is advertised as £1,230 per sample, and you may also have to pay an additional £37.50 per cycle to cover the HFEA fee associated with donor insemination.
Given the chance of conceiving with IUI is around 5-15% per cycle, some clinics offer multi-cycle packages, but remember: whether you purchase a single or multi-cycle package, these are unlikely to include the cost of initial tests, consultations or any medication required.
IUI is a relatively non-invasive way to help people fall pregnant. It's the most successful form of artificial insemination, making it a popular alternative to sexual intercourse.
However, it's not necessarily the most effective option to treat infertility. And you'll need to keep an eye on costs - if you plan to use donor sperm or require multiple cycles, costs can increase quickly.