FAQ - IUI - Intra Uterine Insemination
IUI stands for intrauterine insemination. This is a simple procedure in which sperm is collected, concentrated, and injected back into the woman’s uterus with a small catheter. This bypasses the sperm needing to pass the cervix, and leads to higher odds of conception and birth than intercourse.
For more information about IUI and other treatment options, watch our YouTube video: What is Timed Cycle, IUI & IVF, and what treatment types may be available to me?
The two main risks in an IUI cycle are:
Ovarian hyperstimulation syndrome (OHSS) which is an exaggerated response to excess hormone-based medications. It typically occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries, but could happen with oral medications as well. OHSS causes ovarian swelling, pain, nausea, and can lead to more serious risks requiring hospitalization. That said, OHSS, especially a serious case of ovarian hyperstimulation is incredibly rare with IUI due to the low doses of these hormone-based medications. The risk can be further reduced with careful monitoring, and appropriate protocol dosing. With the close attention given by CNY Fertility providers to the various risk factors, OHSS can be avoided for IUI procedures.
Multiple Gestation. If doing a medicated IUI cycle, there is a chance that the body develops and ovulates an increased number of mature eggs. This is especially the case with injectable medications (but still readily happens with oral medications). Because all the mature eggs that are ovulated have the potential for fertilization, there is a risk for twin or even higher order pregnancies. Because there is a substantial risk to both the mother and the growing fetuses with higher order pregnancies, cycles with too many follicles (which house the eggs) developing may need to be converted to IVF or cancelled all together. The risk of both a multiple gestation and a cancelled or converted cycle can be largely reduced by the use appropriately dosed medications, especially for younger women, those with high AMHs, or those with PCOS.
Dr Kiltz recommends keeping a “low and slow” approach, keeping the body at a state of rest and avoiding any strenuous exercise.
- You can have intercourse while in your IUI preparation, however, it is recommended your partner abstain for 2-5 days prior to the scheduled IUI.
- Dr Kiltz recommends a diet high in fat and low in carbohydrates. Be sure to remain hydrated. It is best to abstain from alcohol, smoking, or any other harmful substances.
- Check out our Family Building Guide for more information on dietary and lifestyle recommendations!
The exact process of an IUI treatment cycle is largely determined by two decisions: which (if any) drugs are used and whether or not office monitoring is done. Despite the slight differences, all IUI processes follow the same general biological and procedural stages.
Day 1 of cycle
Reach out to your nursing team via the patient portal or call our office to schedule your first appointment. If your period falls outside of office hours, please await a portal response once the office is open or call during regular office hours.
If you do not get periods, please reach out when you have medications and are ready to begin. We will schedule an appointment to see where you are at in your cycle and create a plan from there.
Day 2-5
Your first appointment will be scheduled during this time frame. We call this your baseline appointment. Once results are received from this appointment, you will be provided with your medication protocol. If any testing comes back abnormal, we will inform you and update your plan accordingly.
Day 2-12
Follicular, Egg, and Lining Development
The first phase of an IUI is the development of your follicles/eggs and uterine lining. As mentioned above, this can be done with or without medications but is most often done with medications to help egg development, increase the odds of conception, and thus the odds of a live birth.
Letrozole is usually taken for 5 days. Gonadatropins (injectable medications) are usually taken for around 7-10 days.
Blood and ultrasound monitoring often accompany this part of the cycle to help us determine the follicular and lining growth, adjust medications if necessary, and ensure the cycle is conducted in a safe and calculated way.
Day 13(ish)
Determining Ovulation
An IUI is performed as close to the day of ovulation as possible. This is best done with ultrasound and blood tests to measure hormone levels and follicular development, most times followed by a trigger shot when appropriate.
If anovulatory, it would be necessary to take a trigger shot. Alternatively, the timing of your ovulation can be measured (though not as accurately) with an ovulation predictor kit.
Your IUI procedure will be scheduled 12-36 hours after your trigger injection or positive test on your ovulation predictor kit.
Day 14(ish)
Sperm Preparation
Sperm can be collected at the office, collected fresh at your home, frozen at another facility and shipped to our centers (*please note sperm needs to be in house prior to starting your IUI cycle), or ordered and sent to our office from a donor agency (*please note sperm needs to be in house prior to starting your IUI cycle).
If using an unprocessed sample (a fresh collection), our team of andrologists will prepare the sperm inside our laboratory resulting in a concentration of active sperm.
The Insemination
During the procedure, the registered nurse, NP/PA, or physician will use a speculum to locate your cervix. Once located, they will slide the catheter (loaded with concentrated motile sperm) past the cervix and into the uterus. The sperm is then injected into the uterine cavity and the catheter is removed. This simple procedure only takes a few minutes and does not require any type of anesthesia. Once completed, you will rest in your treatment room for about 10 or so minutes before being able to go home. Usually, the procedure does not result in much discomfort, however, some mild cramping can be expected.
Syracuse, Albany, and Buffalo NY, Sarasota FL, Colorado Springs CO, and Norfolk VA
This will all depend on your consultation with the provider team. There are several protocols for IUI including:
- Natural Cycle – this type of cycle is completely unmedicated and is based around your natural ovulation.
- Triggered Cycle – this type of cycle will still be based around your natural follicular growth, but we will use an injection called a “trigger shot” when you have a mature follicle. This will help us to time your IUI to be booked the day after you trigger.
- Oral Medication Cycle – this type of cycle uses a medication called Letrozole, which stimulates the release of FSH and LH in your body. These hormones are responsible for follicular and egg development. In most cases, we still utilize the trigger shot once your follicles are at a mature size to help time your IUI. Oral medication cycles have the benefit of increasing conception and live birth rates over natural cycles, but have less risk of multiples than an injectable medication cycle.
- Injectable Medication Cycle – Injectable gonadotropin medications are used for IUI procedures (typically after having a previous failed IUIs) to stimulate the ovaries further and improve the odds of conception. The increased odds of conception come with the risk of increased odds of multiples and must be managed carefully through ultrasound and blood work monitoring to ensure too many follicles are not developing. While still relatively uncommon, cycle cancelations or IVF conversions are more common when using injectable medications compared to when oral medications like letrozole are used. In most cases, we still utilize a trigger shot once your follicles are at a mature size to help time your IUI.
