What Are the Potential Risks of Intrauterine Insemination?

By BSc, MSc (embryologist) and MD, MSc (gynecologist).
Last Update: 01/10/2019

Artificial insemination or intrauterine insemination (IUI) is a simple technique, and therefore the number of risks associated is low. Nonetheless, one of the most concerning ones is related to the increased likelihood of having twins, since a multiple pregnancy carries a greater number of complications than a singleton pregnancy for both the mother and the fetus.

Throughout this article, you can find information on this and other mild risks associated with intrauterine insemination.

Potential complications

With the latest advancements in the field of Reproductive Medicine, we have witnessed a major decrease in the number of risks associated with fertility treatments. In spite of that, there are still some things one should keep a close eye on to avoid potential complications.

Intrauterine insemination (IUI) is a very simple technique. Moreover, it is carried out quickly and safely. But, sometimes, complications can arise, and it is important that patients are well informed on the risks associated before getting started.

In IUI cycles, complications can appear at any of the following stages of the procedure:

  • Side effects of ovarian stimulation drugs
  • Risks derived from the insemination procedure
  • Pregnancy complications

Find the details of each in the following sections:

Risks of ovarian stimulation

Although IUI involves just a mild ovarian stimulation cycle that is closely monitored so that only one or two eggs mature, ovarian response varies from woman to woman. For this reason, in some cases, this response is an excessive one, which can lead to complications like:

Multiple pregnancy

When more than one follicle matures, the risk of multiple pregnancy increases. Particularly, the chances of getting pregnant with multiples ranges between 12 to 30% approximately, being especially common in these cases:

  • Young women
  • Women with more than 5 ovarian follicles larger than 16 mm
  • Women inseminated with high-quality sperm (over 30 million sperm/ml)

As explained above, getting pregnant with multiples or more is a dangerous situation for both the health of the mother and the babies. In cases of advanced maternal age, a twin pregnancy could entail even more risks.

To get more data about the potential risks of a twin pregnancy, click here: What Are the Risks of a Multiple Pregnancy?

Ovarian hyperstimulation syndrome (OHSS)

It occurs when the ovary gives an exaggerated response to hormone medications, which increases permeability of blood vessels and fluid extravasation. Some potential effects include:

  • Swollen ovary and abdomen
  • Bloating
  • Nausea and/or dizziness
  • Acute pelvic pain
  • Accumulation of fluid in the abdomen

In the most severe cases, it can lead to liver, renal, and respiratory abnormalities.

According to Dr. Valeria Sotelo, OB/GYN specialized in Reproductive Medicine:

In principle, the ovarian hyperstimulation syndrome is the most concerning of all potential risks associated with intrauterine insemination.

Nevertheless, the ovarian hyperstimulation syndrome is more common with other fertility treatments such as IVF (in vitro fertilization), since the dosage of hormones used for stimulation is greater.

With the first symptoms of OHSS, the cycle must be cancelled at once, whether it is an IUI or IVF cycle, to prevent potential severe consequences.

Risks of insemination

When the insemination procedure is carried out at the doctor’s office, the following complications may occur:

Vaginal or pelvic infections
Due to the use of lab instruments or remainder of seminal plasma. They occur in about 0.07% of the cases per insemination cycle.
Allergic reactions
Although it is very rare, some women develop allergies to some componentes of the seminal washing.
Immune reactions
Some women are allergic to the semen due to the presence of antisperm antibodies in the vaginal discharge. The likelihood is lower than 5%.

These risks occur very rarely and, if any of them appears, the effects are mild.

Did you know that we can help you to choose a fertility clinic for your IUI cycle? All you have to do is get your Fertility Report now. It is an easy-to-use tool that is capable of filtering the best clinics and tailor an individual report exclusively for you with useful tips that will help you make a well informed decision.

Risks of pregnancy

Complications derived from pregnancy after intrauterine insemination are:

Miscarriage
It is more common in the first weeks of pregnancy. The miscarriage rate ranges between 20 and 22%.
Ectopic pregnancy
Embryo implantation occurs in a place other than the womb. In IUI procedures, the chances for an ectopic pregnancy increase because the semen is inserted into the uterus directly. The occurrence rate is 4%, while in natural pregnancies it occurs in 0.8% of the cases.
Multiple birth
Either naturally (identical twins) or after the fertilization of multiple oocytes (fraternal twins), it is considered a high-risk pregnancy, as explained above.

An ectopic or multiple pregnancy can occur naturally as well, though the rate is considerably lower. On the contrary, a miscarriage is an event that occurs in natural pregnancies more often than one might think, since sometimes it occurs when the woman has not even realized she was pregnant.

Home insemination

In home insemination, the potential risks of ovarian stimulation drugs are not present, since the intended mother does not take any fertility drug to get prepared. However, the risks of the insemination stage are the same is in clinical insemination.

On the other hand, one of the main risks of at-home artificial insemination is related to the origin of the semen sample used. In IUI cycles done at fertility clinics, the sample is previously examined. On the contrary, when done at home, the sample is inserted directly, without having examined or washed it.

In case you purchase the sample at a sperm bank, it is crucial that you choose a licensed one. Moreover, you should get informed on the tests run to the donors and quality checks performed to the samples.

Due to the absence of expertise of women who self-inseminate, you might scratch your uterus or damage some part of your reproductive system.

Cancellation of an IUI cycle

Although it is rare, sometimes the patient’s response to ovarian stimulation medications is not the one expected. Some women have an exaggerated response to treatment, which causes the ovary to develop excessively, increasing the risks of getting pregnant with twins and developing OHSS.

During ultrasound monitoring visits, your doctor will measure the size of your follicles, which is an indicator of how mature the egg is. If you see more than 2 large follicles (more than 16 mm), it is recommended that the cycle is cancelled, since the likelihood of ovulating multiple eggs is high, which can lead to multiple birth.

Also, hormone medications do not work in some women, or their response is too poor. If the specialist considers that the egg is not maturing adequately, it is likely that ovulation does not occur, or that an immature egg is released. This would lead to the creation of a non-viable embryo after fertilization.

Depending on the impressions provided by the specialist during ultrasound scan visits, he or she will determine whether performing the insemination is worth it, or if the best option would be to cancel the cycle and try again in the next cycle, perhaps with a greater dose of medication, or a different medication protocol.

FAQs from users

How does age affect success of intrauterine insemination? Is there an age limit?

By Andrea Rodrigo BSc, MSc (embryologist).

For artificial insemination to be successful and pregnancy can be achieved, it is necessary for the woman to have a normal ovarian reserve and be able to ovulate naturally, either spontaneously or with the help of hormone medications.

For this reason, in general, women aged more than 37 years are rarely referred to IUI, since the ovarian reserve starts diminishing from age 35 onwards until its complete depletion between 45 and 55.

Another basic requirement for the patient, regardless of whether she is undergoing AIH or AID, is having tubal patency in at least one tube.

What are the potential complications of artificial insemination?

By Andrea Rodrigo BSc, MSc (embryologist).

As explained above, AI is a simple procedure, and therefore the likelihood of problems to occur is low. However, it involves a previous process of ovarian stimulation that can lead to negative effects such as multiple births, with a greater number of risks than a singleton pregnancy, or the ovarian hyperstimulation syndrome (OHSS) due to an exaggerated response to fertility drugs.

Some women develop allergy or infections as well.

In any case, AI is a safe technique that is done under supervision to reduce the chance of complications to the minimum.

Can children born by IUI experience developmental problems?

By Andrea Rodrigo BSc, MSc (embryologist).

IUI is a method to achieve pregnancy. Once this goal is met, the stages and development of the pregnancy is exactly the same as if achieved naturally. Also, there is no reason for the development and education of the child born as a result to be different.

Is the miscarriage rate associated with IUI higher than in natural pregnancies?

By Andrea Rodrigo BSc, MSc (embryologist).

The chances of having a natural miscarriage in young women range between 12 and 15%, and they increase to 25% in women older than 40 years old. In cases of IUI, where the woman is typically younger than 37 years old, the miscarriage rate is about 20%. Thus, the answer is yes, the risk of miscarrying is slightly higher.

Which has more complications associated, AIH or AID?

By Andrea Rodrigo BSc, MSc (embryologist).

The complications associated with AI are the same irrespective of the type chosen. In other words, the origin of the sample does not increase the risk of complications. Thus, the potential risks associated are the same in cases of artificial insemination by donor (AID) and by husband (AIH).

Suggested for you

Throughout this post, we have seen that home insemination carries a greater number of risks than clinical insemination. However, since we skip the ovarian stimulation step when doing it at home, the potential complications associated with fertility drugs are removed, too. Simultaneously, the fact that there is no stimulation reduces the chances of success as well. In short, if you want to get a much deeper insight on DIY insemination, read: What Is Artificial Insemination at Home? – Process Step by Step.

Also, we recommend that you get more info on the intrauterine insemination process with this comprehensive guide in order to understand more clearly the potential risks and complications involved: What Is Artificial Insemination (AI)? – Process, Cost & Types.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Allen NC, Herbert CM 3rd, Maxson WS, et al: Intrauterine insemination: A critical review. Fertil Steril 44:569–580, 1985.

Goldfarb JM, Peskin B, Austin C, Lisbona H: Evaluation of predictive factors for multiple pregnancies during gonadotropin/IUI treatment. J Assist Reprod Genet 14:88–91, 1997.

Hurd WW, Randolph JF Jr, Ansbacher R, et al: Comparison of intracervical, intrauterine, and intratubal techniques for donor insemination.
Fertil Steril 59:339–342, 1993.

Nuojua-Huttunen S, Tomas C, Bloigu R, et al: Intrauterine insemination treatment in subfertility: An analysis of factors affecting outcome. Hum Reprod 14:698–703, 1999.

Plosker SM, Jacobson W, Amato P: Predicting and optimizing success in an intra-uterine insemination programme. Hum Reprod 9:2014–2021, 1994.

Rowell P, Braude P: Assisted conception. I—General principles. BMJ 327:799–801, 2003.

Van Voorhis BJ, Sparks AE, Allen BD, et al: Cost-effectiveness of infertility treatments: A cohort study. Fertil Steril 67:830–836, 1997.

Zayed F, Lenton EA, Cooke ID: Comparison between stimulated in vitro fertilization and stimulated intrauterine insemination for the treatment of unexplained and mild male factor infertility. Hum Reprod 12:2408–2413, 1997.

FAQs from users: 'How does age affect success of intrauterine insemination? Is there an age limit?', 'What are the potential complications of artificial insemination?', 'Can children born by IUI experience developmental problems?', 'Is the miscarriage rate associated with IUI higher than in natural pregnancies?' y 'Which has more complications associated, AIH or AID?'.

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Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
 Valeria Sotelo
Valeria Sotelo
MD, MSc
Gynecologist
Bachelor's Degree in Medicine from the University of Buenos Aires. Specialist in Gynecology & Obstetrics. Master's Degree in Video-laparoscopic Surgery, and Certificate of Specialist in Gynecology. Associate Member of the Spanish Fertility Society (SEF) and the Spanish Society of Gynecology & Obstetrics. More than 10 years of experience in the field of Reproductive Medicine. More information about Valeria Sotelo
License: 030309166

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