Intrauterine insemination (IUI) is a procedure that places millions of sperm directly into the upper uterine cavity, near the entrance to the fallopian tubes. By shortening the sperm’s journey, IUI increases the chances of more sperm reaching the egg, improving the likelihood of fertilization.

The IUI process involves several steps to optimize timing and increase the chances of conception.

1. Cycle Monitoring & Medication
2. You will report the first day of your cycle and begin taking the prescribed medications (if applicable).
3. Around Cycle Day 10 or 11 (for a Clomid/Letrozole cycle), you will come in for a mid-cycle ultrasound.
4. Mid-Cycle Ultrasound
5. A vaginal ultrasound is performed to assess:
6. Number of follicles
7. Follicle size
8. Uterine lining thickness
9. This helps determine when to take the Ovidrel (hCG trigger) injection to time ovulation accurately.
10. Trigger Shot & Insemination Appointments
11. You will be instructed on when and how to self-administer the Ovidrel injection.
12. If using a partner’s sperm, you will receive two appointments:
13. Sperm collection (if fresh sample is used)
14. Insemination procedure (IUI)

Your provider will guide you through each step and ensure everything is timed correctly for the best possible outcome.

Medications used during IUI help stimulate ovulation and improve the chances of conception. The most commonly used medications include:

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• Oral Medications: Clomid (clomiphene citrate) or Femara (letrozole)
  • These medications increase the release of FSH (follicle-stimulating hormone) and LH (luteinizing hormone) from the pituitary gland, stimulating follicle development and ovulation.
  • They can be used to induce ovulation in women who do not ovulate on their own.
  • In women who already ovulate, they can be used for superovulation, which encourages the development of 2-3 eggs to improve chances of success.
  • The choice of medication is determined by your doctor based on your individual needs.

Clomid (clomiphene citrate) and Letrozole (Femara) are commonly used oral medications during IUI, and they may cause mild to moderate side effects, including:

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• Headaches (Tylenol is safe to use)
• Mood changes (irritability, moodiness)
• Hot flashes and night sweats
• Ovarian cysts
• Changes in cervical mucus (decreased or increased)

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⚠ Important: If you experience severe headaches or visual disturbances, contact your doctor immediately, as these can be rare but serious side effects.

There are three main types of IUI, depending on the level of medication used:

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• Injectable IUI – Uses hormone injections to stimulate the development of multiple eggs.
• Natural Cycle IUI – Involves little to no medication, relying on the body’s natural ovulation.
• Medicated IUI – Uses oral medications (such as Clomid or Letrozole) to stimulate the development of 2-3 eggs.

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Your doctor will determine the best approach based on your individual needs and fertility goals.

IUI is a generally safe and low-risk procedure, but potential risks include:

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• No response to medication – In some cases, the ovaries may not respond to stimulation, and the cycle may need to be adjusted or repeated.
• Cycle cancellation – If the ovaries over-respond and produce too many follicles, the cycle may need to be canceled to prevent complications.
• Multiple pregnancy – While our goal is a healthy, singleton pregnancy, there is a small risk of multiples.
  • Risk of twins with Clomid/Letrozole is ~5-8%
  • Risk of triplets with Clomid/Letrozole is ~1%
  • Multiples have a higher risk of preterm delivery and complications of prematurity
• Ovarian hyperstimulation syndrome (OHSS) – In rare cases, fertility medications may cause the ovaries to over-respond, leading to bloating, discomfort, and fluid retention.
• Mild cramping or spotting – Some women experience light cramping or spotting after the procedure.
• Infection (rare) – Though uncommon, there is a small risk of infection from the catheter used during IUI.

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Your doctor will carefully monitor your cycle to minimize these risks and ensure the safest possible approach for treatment.

IUI is a quick and simple procedure, usually taking just a few minutes. Most people find it feels similar to a Pap smear, with minimal discomfort.

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Step-by-Step Process:

1. Specimen Verification – Your clinician will show you the sperm sample, labeled with your name and the name of your partner or sperm donor, to confirm accuracy.
2. Speculum Placement – A speculum is inserted into the vagina to allow access to the cervix.
3. Catheter Insertion & Sperm Transfer – A thin, flexible catheter is passed through the cervix and into the uterus, where the sperm is released.

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After the procedure, you may rest briefly before resuming normal activities. Your provider will advise you on any next steps or follow-up care.

The two-week wait after IUI can feel long and emotional, but there are ways to manage stress and take care of yourself during this time.

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Ways to Cope:

• Focus on self-care – Treat yourself by doing things you enjoy the most.
• Practice relaxation techniques – Try guided imagery, meditation, or breathing exercises to stay calm.
• Protect your emotional well-being – Consider limiting the number of people you share your journey with and decide how you want to update them.
• Communicate with your partner – Set aside time to talk about your feelings and agree on how you’d like to receive the news about the cycle.
• Plan ahead for all outcomes – Let your partner know what support you’ll need if the result isn’t positive. [Link to embryo transfer article]

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This is a challenging time, but surrounding yourself with support and prioritizing emotional well-being can help make the wait more manageable.

If you are using frozen donor sperm, you will need to call our Thaw Hotline the morning of your IUI to authorize the thawing process before your procedure.

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Important Steps:

• You must call the Thaw Hotline by 9:00 AM on the day of your IUI. If you do not call, the lab will not thaw your specimen.
• Leave a voicemail with the following details:
  • Full name
  • Date of birth
  • Sperm source (include either your male partner’s full name and DOB or the sperm donor ID/name)
  • Time of your IUI procedure

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After confirming your call, you will come in for your scheduled insemination.