IUI is the next step up from Clomiphene and Letrozole, and it can be used for quite a wide range of causes of infertility. As the name suggests, intrauterine insemination involves preparing sperm in the lab, then putting the best sperm directly into the uterus in a procedure that’s a bit like having a cervical smear.

In nature, only one in a hundred sperm that are ejaculated reach the uterus, so IUI works by giving sperm a head start in their journey to the egg.

IUI is usually combined with a medication like Clomiphene to increase the number of eggs ovulated from one to two or three.

IUI cycles typically involve:

• some blood tests

• 1-2 ultrasound scans

• injections, which people usually give themselves at home.

IUI is usually offered as a course of up to four cycles. Around 40–50% of women aged 37 and younger have a child within four cycles, and the main side effect is a 10-15% chance of twins.

There aren’t any tests to predict the right dose of clomiphene for a particular woman having IUI. Common problems are:

• The initial dose of clomiphene isn’t high enough to produce more than one follicle. If this happens, we will give you the choice of continuing treatment or stopping and trying again at a higher dose of medications.
• The initial dose of medications causes too many follicles to grow, increasing the risk of multiple pregnancy such as twins or triplets. If this happens we will stop treatment and ask you not to have sex or to use barrier contraception such as a condom or diaphragm. A lower dose of medications will be used in the next cycle. Although we can count the number of sperm we place in the uterus, we can’t be sure they actually reach the egg(s) and lead to fertilisation. Because of this, we usually recommend that you consider moving to IVF if you do not become pregnant after 4 cycles of IUI using partner’s sperm, or after 6 or more cycles if you are using donor sperm.

Multiple pregnancy

Blood tests and ultrasound scans give a good idea about how many follicles are growing in the ovary in a particular month of treatment but they are not perfect. About, 10-15% of pregnancies from IUIS treatment are twins and about 1% are triplets. Quadruplets or more are possible but very rare. Twins are associated with 2-3 times more risk for both the mother and children for a wide range of adverse outcomes, from maternal death to cerebral palsy.

Ectopic pregnancy

When an embryo implants in the Fallopian tube, the cervix or the abdomen it is called an ectopic pregnancy. Ectopic pregnancies can be dangerous because the placenta can burrow into a blood vessel and cause major internal bleeding. IUI probably doesn’t increase the risk of ectopic pregnancy, but all women having fertility treatment need to be aware of the possibility of ectopic pregnancy. We can usually detect an ectopic pregnancy by the level of hCG in the pregnancy test and an early ultrasound scan, but not always. Symptoms include severe, localised abdominal pain.

Ovarian Hyper-Stimulation Syndrome (OHSS)

The low dose of medications used means that OHSS is very rare in IUIS. The IVF section covers OHSS in detail.

Vaso-vagal reaction

There is a small chance of a vaso-vagal reaction at the time of insemination when the catheter is placed in the uterus. The vaso-vagal reaction is a reflex that causes the heart to slow, blood pressure to drop, and fainting. If this happens the insemination would be stopped and done at a later time.

Infection after insemination

Infection can occur when bacteria that are present in the vagina are transferred into the uterus during the insemination procedure. It probably happens in about 0.3% of cycles. Infection nearly always settles with antibiotics, but there have been rare cases of damage to the uterus or Fallopian tubes. Call the clinic if you feel sore, feverish or unwell within a few days of insemination.

Bleeding after insemination

Occasionally there is a little bleeding from the cervix the day of insemination or the day after. It is unlikely to affect the chance of pregnancy.

Pain

Pain is your body’s way of saying that something may be wrong. We need to know about any symptoms that might be concerning you.

It is important to contact the clinic the same day if you have any of the following symptoms:

• Abdominal pain or discomfort;
• Abdominal bloating or swelling;
• Nausea or vomiting;
• Decreased urine output;
• Shortness of breath or difficulty breathing;
• Severe headache;
• Pain, bleeding or cramping after the insemination.

Pain is your body’s way of saying that something may be wrong. We need to know about any symptoms that might be concerning you.

It is important to contact the clinic the same day if you have any of the following symptoms:

• Abdominal pain or discomfort;
• Abdominal bloating or swelling;
• Nausea or vomiting;
• Decreased urine output;
• Shortness of breath or difficulty breathing;
• Severe headache;
• Pain, bleeding or cramping after the insemination.

If you or your partner are concerned about producing a semen sample on the day of your treatment or that you might be away, we can usually freeze a back-up sample. You need to arrange this well in advance so we can see how well your sperm survive freezing and thawing. There is a separate charge for sperm freezing. If you are having IVF with frozen back-up sperm, we suggest you consider using ICSI to maximise the fertilisation rate of the eggs.

Sperm will only be frozen if you request this service and complete a consent form for sperm freezing.

Good to know

The medications used in IUI have been used over 40 years without any evidence of an increased risk of birth defects. Long-term follow up studies have failed to show any association between fertility treatment and ovarian or breast cancer. Pregnancy provides some degree of protection against ovarian cancer.