IUI
IUI, intrauterine insemination, is the simplest and gentlest fertility treatment there is. A sperm sample is washed and concentrated in the laboratory, the best-moving fraction is drawn into a fine catheter, and it is placed straight into the uterus at the point in your cycle when an egg is about to be released.
What that achieves is a head start. It skips the cervix and most of the journey, and it puts a far denser sample much closer to the target. The rest happens naturally. An egg has to be released, a tube has to catch it, fertilisation has to occur where it always would, and the embryo has to implant unaided.
The procedure is the easy part. The thing to plan is time. The chance per attempt is modest and it falls with age, but most of IUI's success comes in the first few rounds. So the key decision on this page is how many rounds to give it before moving to IVF, and settling that at the start is what makes IUI work well for you.
At a glance
- Also known as
- Intrauterine insemination, artificial insemination, donor insemination, IUI
- Stages
- 1 cycle, though most people who succeed have needed more than one
- Appointment time
- A few minutes for the insemination; 2–3 weeks for the cycle around it
- Back to normal
- Same day
- Typical cost
- $500–$1,500 per cycle, plus $100–$1,000 drugs and monitoring (United States, self-pay)
- Usually preceded by
- Fertility Testing, Tubal Patency Testing, Semen Analysis
Figures reviewed .
On this page
Who it’s for
IUI needs three things to be worth doing. Tubes that are open, confirmed on a tubal patency test. Ovulation that happens, either on its own or on tablets. And a sperm sample with enough moving sperm in it after washing, which is what a semen analysis tells you.
Given those, it suits unexplained infertility, mild sperm problems, difficulty with intercourse, and cervical factors. It is also the default first route for donor sperm, which in practice means most single women and female couples. When the sperm comes from a screened donor and the rest of the picture is normal, IUI has little to overcome, and this is where it works best.
Two groups are better served going straight to something else. If the tubes are blocked or absent, or the sperm count and motility are low, IVF or ICSI is the treatment that addresses it. And past the late thirties, IVF's higher odds per attempt usually make it the better use of your time.
Eligibility is light compared with IVF. Clinics want recent tests on both sides, infectious disease screening, a BMI range, and smoking stopped. See eligibility across fertility treatment.
Before you agree to the first round
Agree out loud how many attempts you are giving this, and write the number on the fridge. Setting it at the start, with a clear head, is the single best way to make IUI work for you.
How it’s done
The first decision is whether the cycle is stimulated. In a natural cycle nothing is given to your ovaries. The clinic tracks the follicle you were going to grow anyway, and the insemination is timed to it. In a stimulated cycle you take tablets or low-dose injections to recruit a follicle or two more. That raises the chance per attempt, and raises the chance of twins along with it.
Monitoring is how the timing gets found. Ultrasound scans every few days once the follicle is growing, sometimes with blood tests. Either the clinic waits for your own hormone surge, picked up on a urine or blood test, or it gives a trigger injection to set the time itself. Insemination is booked roughly a day to a day and a half after that.
On the day, the sample is produced at the clinic or thawed if it is frozen donor sperm. Washing takes about an hour. It removes the seminal fluid, which would cause cramping, and separates out the sperm that are moving well, leaving a small volume of concentrated sample.
The insemination itself is undramatic. A speculum brings the cervix into view, a soft catheter passes through it, and the concentrated sample is released high in the cavity. It takes a couple of minutes, needs no anaesthetic, and feels like a smear test with a cramp on the end. You lie down for ten minutes because the clinic likes you to, then you leave and get on with your day.
The week the monitoring starts
Find out how much notice you will get for the insemination day and warn work that a morning will move. Scan results can bring the date forward by a day, and a little flexibility makes sure you are there when the timing is right.
After IUI
There is nothing to recover from. An hour or two of cramping, occasionally a trace of blood afterwards, and nothing else at all. People go back to work the same afternoon and are told, correctly, to carry on as normal.
If the cycle was stimulated you will feel that rather than the insemination. Bloating and tenderness through the tablets or injections, and on the higher doses a few days of feeling heavy afterwards. Progesterone support is sometimes prescribed for the two weeks that follow. That brings tender breasts and fatigue of its own, which can be confused with early pregnancy signs, so try not to read too much into them.
Then the wait, which is worth planning for. Nothing to monitor, nothing to do, and a test at the end of it. Ring the clinic, rather than waiting to see, for pain on one side, bleeding heavier than spotting, or a temperature.
| Cycle day 1 | You ring the clinic on the first day of bleeding. Tablets or injections start in the first few days if the cycle is stimulated. |
|---|---|
| Days 8–12 | Scans every two or three days to watch the follicle grow and count how many are developing. |
| Surge or trigger | Either your own hormone surge is detected or a trigger injection is given at a set time. |
| Insemination day | Sample produced or thawed, washed for about an hour, then a few minutes in a treatment room. Back to work afterwards. |
| Days 1–10 after | Nothing happens. Progesterone pessaries if the clinic prescribed them; otherwise no monitoring at all. |
| Days 12–16 | A pregnancy test, blood or urine depending on the clinic. A trigger injection can make an early home test read wrongly. |
| The next cycle | If it was negative, a round can usually start again straight away. This is the point to check the plan against the number you agreed. |
In the two-week wait
Put something in the diary for the week of the test that has nothing to do with fertility. The wait has no tasks in it, which is exactly why it expands to fill everything, and having one ordinary thing to turn up to helps more than it sounds like it should.
Risks and complications
The main risk to know about is multiple pregnancy, and it comes from stimulation rather than from insemination. Push the ovaries to produce two or three follicles and you raise the chance of twins well above the natural rate. Twins are the most common serious complication of fertility treatment, for the babies more than for anyone else, so careful monitoring matters. A clinic aiming for one or two follicles, and willing to cancel a cycle that has recruited four, is managing that well.
Ovarian hyperstimulation is possible but uncommon at IUI doses, and usually mild when it happens. Clomifene and letrozole bring hot flushes, headaches and mood effects in some people. Low-dose injections bring bloating.
The procedure itself is close to risk-free. Cramping for an hour, spotting, and a small chance of infection introduced through the cervix. Ectopic pregnancy remains possible, as it is with natural conception, because the embryo still travels through a tube.
The last thing to manage is time. Most of IUI's success comes in the first three or four rounds, so agreeing a limit keeps you moving forward.
IUI results
IUI figures are quoted per cycle, so compare them with other IUI figures rather than with IVF cycles. Broadly, published figures for a stimulated IUI cycle sit somewhere in the region of one in ten to one in five for women under thirty-five with a favourable picture. Unstimulated cycles come in lower. By the early forties with your own eggs it is into low single figures.
Where IUI looks best is donor sperm in an otherwise normal picture, and there the figures sit at the upper end of that range. With a poor sperm sample or borderline tubes, IVF or ICSI is usually the better first choice.
Cumulative chance is the figure that matters, and it is front-loaded. Most of the success that IUI produces arrives in the first three or four attempts. After that the curve flattens, which is why the usual advice is to move up to IVF rather than book a fifth. What I would want from a clinic is its own insemination figure for your age band, together with the number of cycles behind it, so you know how solid the figure is.
Alternatives to IUI
Below IUI sits timed intercourse with ovulation tablets and monitoring, which costs far less and is a reasonable first move where ovulation is the only identified problem. It is not much less likely to work than an unstimulated insemination.
Above it sits IVF, which has clearly higher odds per attempt. At the same age an IVF cycle is roughly two to three times as likely to produce a baby as a stimulated IUI cycle, and several times the price. Sperm that is too poor for insemination is usually fine for ICSI, because a single sperm per egg is all that step needs.
The choice between them is mostly about how much time you have. If you are under thirty-five with open tubes and normal sperm, three or four rounds of IUI first is a sensible use of a few months. If you are forty, or the tests have already found the reason, going straight to IVF is usually the cheaper route to a baby even though it is the dearer route to a cycle.
IVF
Conventional IVF, where the ovaries are stimulated to produce a batch of eggs, the eggs are collected under sedation and mixed with sperm in the laboratory, and one embryo is transferred. The core treatment that the other pages in this group are variations on.
Best for: anyone whose tubes, sperm or time make natural conception unlikely, and who wants the treatment with the best odds per attempt
Mini-IVF
A conventional IVF cycle with the stimulation turned down, usually tablets plus a low dose of injections, aiming at a handful of eggs rather than a batch. Cheaper and gentler per cycle, with fewer eggs collected, and the right choice for some people.
Best for: poor responders, anyone at real risk of hyperstimulation, and people who would rather take fewer drugs
Combining IUI with other treatment
IUI is almost always combined with something, which is why cycles are described so differently between clinics. Ovulation induction with clomifene or letrozole is the common pairing. Low-dose injections are the next step up. A trigger injection is added to fix the timing, and progesterone support is sometimes given afterwards.
Donor sperm is the other thing routinely wrapped around it. Frozen samples are quarantined, screened and thawed on the day, and the straws are bought and stored separately from the treatment fee. Where a male partner's sample is difficult to produce on demand, it can be frozen in advance and thawed for the insemination instead. That takes the pressure off the day.
IUI cost
IUI is priced per cycle, and it is worth knowing what the quoted figure covers. The fee normally covers the sperm wash and the insemination. Scans, blood tests, the drugs and the trigger injection are often billed separately, and in a monitored stimulated cycle those additions can approach the cost of the procedure itself.
Donor sperm sits outside all of it. Straws are bought per vial from a bank, and clinics often want two per attempt. Shipping, storage and the bank's own registration fees are their own line, and for many people using a donor they are the largest part of the bill.
The number to ask for is the cost of four monitored cycles with drugs, not just one. That is how IUI is planned, and set beside a single IVF cycle it gives you a clear, fair comparison.
| Country | Self-pay | Public / insurance |
|---|---|---|
| United States Donor sperm typically $1,000–$1,500 per vial on top, often two per attempt | $500–$1,500 per cycle, plus $100–$1,000 drugs and monitoring | Some plans cover IUI and many require several rounds before they will fund IVF |
| United Kingdom Drugs £50–£300; donor sperm roughly £900–£1,500 per vial plus storage | £700–£1,600 per cycle, including monitoring | NHS funding exists in some areas, commonly a few cycles before IVF; criteria vary locally |
| Europe Spain and Czechia treat single women and female couples; some countries do not | €400–€1,200 per cycle | Often funded alongside IVF where a state system pays, with an age limit |
| Thailand Rarely worth travelling for on its own, since a round needs monitoring across two weeks | $400–$1,000 per cycle | Self-pay only for international patients |
Read more: IVF
Choosing a clinic for IUI
The insemination itself is simple. What you are choosing is how well the cycle around it is run, and a clear plan for when to move on. The two numbers I would ask for are the live birth rate per IUI cycle started in your age band, and how many of the clinic's IUI patients go on to IVF. The second one is rarely advertised, and it is very useful to know.
Then ask about follicles. How many they aim for, what they do if four are growing, and whether they would cancel. A clear cancellation policy is a good sign that the clinic takes twin risk seriously. Ask who performs the insemination, because in most places it is a nurse and that is entirely fine.
The question that reveals the most is how many rounds they would recommend before moving on, asked before you have had any. A clinic that names a number is planning a course of treatment with you, which is what you want.
At the consultation
Ask what would be included in the quoted cycle fee and what would arrive as a separate bill. Scans, drugs and the trigger are the usual extras, and hearing the list before the first cycle lets you budget with confidence.
Clinics that do IUI
Frequently asked questions
How likely is IUI to work?
Modestly, per attempt, and it depends heavily on age and on why you need it. Most of the success comes in the first three or four rounds. See results.
Does it hurt?
Not much. A speculum, a couple of minutes and a cramp afterwards, with no anaesthetic and no time off. See afterwards.
Should I have a stimulated or a natural cycle?
Stimulation raises the chance per attempt and raises the twin risk with it. Which one suits you depends on whether you ovulate reliably. See how it's done.
How many rounds before we move to IVF?
Commonly three or four, because the cumulative curve flattens after that. Agree the number before you start rather than during. See alternatives.
Can I use donor sperm for IUI?
Yes, and it is the usual route. Frozen screened samples are thawed on the day, and the vials are bought and stored separately from the treatment fee. See donor sperm treatment.