IUI Procedure Step-by-Step: How It Works and What to Expect

What is IUI and How Does It Work?

IUI is a fertility treatment that places washed and concentrated sperm directly into your uterus during your fertile window. The procedure bypasses the cervix and positions sperm closer to the fallopian tubes, where fertilisation occurs.

During natural conception, the sperm must travel through the cervix and uterus to reach the egg. The IUI procedure shortens this journey by placing millions of healthy sperm directly where they need to be. This is helpful for people facing challenges such as cervical mucus issues, mild male factor infertility, or unexplained fertility concerns.

Who Should Consider IUI Treatment?

IUI might be suitable for you if you are suffering from unexplained infertility, whereby no particular cause has been identified, even after extensive testing. The treatment also works for couples who are struggling with mild male factor infertility, which may include low sperm count or reduced sperm motility. IUI success rates usually run between 10% and 20% per cycle, depending on several factors, including age and underlying fertility issues.

If you have cervical factor infertility, where cervical mucus hinders sperm, IUI bypasses that. It's also used by single women or female couples with donor sperm.

However, IUI is not recommended for patients with blocked fallopian tubes, severe endometriosis, or significant male factor infertility. Your gynaecologist will assess your individual situation to determine whether IUI is the right approach for you.

What Are the Steps of the IUI Procedure?

Step 1: Cycle Monitoring and Timing

Your fertility team monitors your menstrual cycle closely through blood tests and ultrasounds, using appointments measuredly begin around day 3 of your cycle and continue tracking for a few days until your follicles are ready.

When monitoring shows that ovulation is imminent, you'll receive a trigger injection. The IUI procedure is then scheduled 24 to 36 hours after this injection, coinciding with ovulation for optimal timing.

Step 2: Sperm Collection and Preparation

The sperm sample is collected and brought to the laboratory on the morning of your IUI procedure. If you are using donor sperm, the frozen sample is thawed and prepared using the same washing technique. The laboratory team evaluates sample quality, counting the total number of motile sperm and their movement patterns. Generally, a post-wash count of at least 5 million motile sperm is considered ideal, although pregnancy can be achieved with lower numbers.

Step 3: The Insemination Process

The IUI procedure itself takes only about 5 to 10 minutes and can be done in your doctor's office. You will lie on an examining table, just as you would for a routine gynaecological exam.

Your doctor inserts a speculum to visualise your cervix, then gently cleans the cervical area. A thin, flexible catheter containing the prepared sperm sample is carefully threaded through your cervix into your uterus. The sperm is slowly deposited, and the catheter is removed.

The procedure is usually painless, although you may feel some mild cramping, similar to menstrual cramps. No anaesthesia is needed, and most women report sensations identical to those felt during a cervical smear test.

Step 4: Rest and Recovery

Immediately following the insemination, you will remain on the exam table for approximately 10 to 15 minutes. This permits some time for the sperm to spread throughout your uterus; however, studies indicate that mobility does not usually affect the outcome significantly.

You can resume normal activities right after the procedure. There's no medical need for bed rest, and you may return to work on the same day if you prefer.

What Should You Expect After the IUI Procedure?

Symptoms That are Normal

After your IUI, you might notice mild cramping or spotting. This generally resolves within 24 hours. Some women also experience breast tenderness, bloating, or mood changes, especially if fertility medications were used.

Hormone injections can cause persistent symptoms regardless of conception.

When Can You Take a Pregnancy Test?

The waiting period after IUI can feel lengthy, but testing too early may produce inaccurate results. Most doctors recommend waiting at least 14 days after the procedure before taking a pregnancy test.

If you received an hCG trigger injection, this hormone can remain in your system for up to 10 days, potentially causing a false positive result. Blood tests measuring beta-hCG levels provide the most accurate results and can detect pregnancy earlier than home urine tests.

What Activities Should You Avoid?

Most daily activities can be resumed after IUI. Avoid strenuous exercise or heavy lifting for 24 hours. Sexual intercourse is usually allowed, unless your doctor advises otherwise due to ovarian enlargement or discomfort.

How Successful is the IUI Procedure?

Success rates for IUI depend on factors like age, infertility cause, and use of fertility medications. Women under 35 have a 15-20% success rate per cycle, with rates decreasing as they age.

Using medications improves success rates over natural cycles, and multiple cycles increase cumulative success, often leading to pregnancy within three to six cycles. If pregnancy doesn't occur after that, a fertility specialist might suggest alternative options like IVF.

What are the Risks and Side Effects of IUI?

Are There Any Complications?

The IUI procedure itself carries minimal risks. Infection occurs in less than 1% of cases, which can be prevented through proper sterilisation techniques and preparation methods.

If fertility medications are used, there's a risk of ovarian hyperstimulation syndrome (OHSS), where the ovaries become swollen and painful. Mild OHSS affects about 10-20% of women using injectable hormones, whilst severe cases are rare.

What is the Risk of Multiple Pregnancy?

Using fertility medications during IUI increases the chance of conceiving twins or triplets. The risk depends on the number of mature follicles present at the time of insemination. Approximately 10% of IUI pregnancies result in twins, compared to 1-2% in natural conception.

Your medical team monitors follicle development carefully and may cancel the cycle if too many follicles develop, reducing the risk of high-order multiples (triplets or more).

Conclusion

Understanding the IUI procedure helps you feel prepared and informed in your fertility treatment. From initial monitoring through the brief insemination process and the subsequent waiting period, each step plays a role in optimising your chances of conception.

Although the procedure itself is short, the preparation, timing, and emotional journey require patience and support. Remember that every person's fertility journey is unique. Stay connected with your medical team, ask questions when in doubt.