Understanding the IUI process can make the journey feel a bit less daunting. Whether you’re navigating fertility treatment with a partner or as a solo parent by choice (SPBC), there are some basic truths that can help you feel more prepared. In this guide, we walk through the process of intrauterine insemination (IUI) step by step, from initial consultations to post-treatment care.

Pre-IUI Consultation

The first step in the IUI journey is an initial consultation with your fertility specialist. During this visit, you and your partner (if applicable) will discuss your medical history, previous fertility testing, and treatment options. Your doctor may recommend IUI for several reasons, including unexplained infertility, mild male factor infertility, or if you’re using donor sperm.

You may undergo blood tests and an ultrasound to check your hormone levels and ovarian reserve. You and your partner may provide a semen sample, which will be analysed for sperm count, motility, and morphology. If you’re using donor sperm, this will have been done before the sperm was donated to make sure the quality was ‘up to scratch’. 

Questions to ask in your pre-IUI consultation:

• What are my chances of success with IUI based on my specific circumstances?
• What tests do I need before starting the IUI process?
• Are there lifestyle changes my partner and I can make to improve our chances?

Ovarian Stimulation

For most people undergoing IUI, ovarian stimulation will be part of the process. This involves taking fertility medications like Clomiphene Citrate (Clomid) or Letrozole to encourage your ovaries to produce more eggs than they normally would. You may also need injectable gonadotropins to further stimulate your ovaries.

You’ll have regular monitoring appointments during this phase to track how your follicles (the sacs containing your eggs) are growing. This is typically done via ultrasound. The goal is to stimulate the ovaries to release one or two mature eggs at the right time for insemination.

Questions to ask about ovarian stimulation:

• How many follicles are we aiming to mature for this IUI cycle?
• What are the risks of ovarian hyperstimulation syndrome (OHSS), and how can we prevent it?
• How often will I need monitoring during ovarian stimulation?

Timing the Trigger Shot

When the ultrasound shows that your follicles have reached the right size (around 18–20 mm), your doctor will give you a “trigger shot” of human chorionic gonadotropin (hCG). This injection triggers ovulation, releasing the eggs so they can be fertilised. The timing of this shot is crucial, as IUI needs to be done within a precise window to maximise the chances of success.

Typically, insemination is scheduled for 24 to 36 hours after the trigger shot. It’s important to follow your clinic’s guidance carefully to ensure that the procedure happens at the optimal time.

The IUI Procedure

On the day of the procedure, you, your partner (or donor sperm) will provide a semen sample, which is then “washed” to separate the sperm from the seminal fluid. This process ensures that only the healthiest sperm are used for insemination. If you’re using donor sperm, it will have already been washed and prepared.

During the IUI, a small catheter is inserted through the cervix into the uterus, and the prepared sperm is injected directly into the uterine cavity. This is typically a quick procedure and is usually painless, though some women experience mild cramping.

After the procedure, you’ll rest for a short time before heading home. Most people can resume normal activities afterward.

Questions to ask about the IUI procedure:

• How should I prepare for the IUI procedure?
• Are there any restrictions on activity or diet after insemination?
• How long should I rest after the procedure?

The Two-Week Wait

Once the insemination is complete, the waiting begins. The two-week wait (2WW) is the period between the IUI procedure and when you can take a pregnancy test. It’s often the most emotionally challenging part of the process, as you may be hyper-aware of every twinge or symptom, wondering if it’s a sign of pregnancy.

During this time, try to focus on self-care, relaxation, and doing things that help take your mind off the waiting. Some clinics recommend light activity during this period, but it's best to avoid intense exercise and heavy lifting. We have some more advice on this period in our blog on the Two-Week-Wait. 

Questions to ask during the TWW:

• When should I schedule my follow-up appointment or home pregnancy test?
• What symptoms should I expect during the two-week wait?
• Is there anything I can do to improve implantation success during this time?

Testing for Pregnancy

About 14 days after your IUI procedure, you’ll take a pregnancy test to determine whether the insemination was successful. This can be done either at home or at your clinic with a blood test. If the test is positive, your clinic will schedule follow-up blood work and an ultrasound to confirm the pregnancy.

If the test is negative, your doctor will discuss the next steps. This might include trying another IUI cycle or moving on to other treatments like in vitro fertilisation (IVF).

Questions to ask about pregnancy testing:

• What should I do if my pregnancy test is negative?
• How soon can I try another IUI cycle?
• Are there additional tests we should consider before trying again?

IUI Success Rates and Considerations

The success rates for IUI vary depending on factors such as age, diagnosis, and whether fertility medications are used. According to a study by Verma et al. (2020), the average success rate for IUI ranges from 10% to 20% per cycle. Multiple cycles may be necessary before achieving a successful pregnancy. Additionally, research shows that combining IUI with ovarian stimulation can significantly increase the chances of success for many patients (Cohlen et al., 2018).

It's important to manage expectations and work closely with your fertility team to understand what might work best for your unique situation.

Key Takeaways on IUI

This guide aims to demystify the IUI process and help you feel more empowered as you go through treatment. Remember, the journey is unique for everyone, and you’re not alone. If you have any questions or concerns, don’t hesitate to reach out to your GP or fertility specialist.

• IUI is non-surgical fertility procedure in which sperm is injected into a uterus through a catheter.
• The procedure is timed with ovulation, which may be stimulated.
• It takes a few minutes to perform and doesn’t cause pain (although you may feel some slight cramping… what’s new)
• Success rates vary from 10-20% per cycle