By MD, FACOG, FACS, FACE (reproductive endocrinologist), MD, MSc (gynecologist) and BSc, MSc (embryologist).
Last Update: 01/08/2019

Intrauterine insemination (IUI) is a fertility treatment that involves a low level of complexity. Due to the simplicity of the process, in general it is the first option to try to get pregnant when a couple has infertility issues.

However, the success rates of IUI ranges between 5.4% to 10.8% (live birth rate) based on the woman’s age. For this reason, it is crucial that you meet a series of basic requirements to guarantee the maximum chance of success.

Requirements for IUI

When it comes to undergoing IUI, it is necessary that both the man and the woman meet the following requirements to guarantee a minimum chance of success:

In case that you do not meet these requirements, the most advisable is to turn to In Vitro Fertilization (IVF), as the success rate is higher than that of IUI.

On the other hand, to make sure if the other member of the couple meets these requirements as well, the doctor will recommend a series of fertility tests. Then, we are going to explain in more detail each one of the factors examined with these tests.

Tubal patency assessment

In IUI procedures, the egg-sperm binding (fertilization) occurs in the Fallopian tubes of the woman. Thus, it is crucial that the woman has tubal patency, which is to say, that her tubes are not blocked.

The egg, once ovulation is induced, travels through the Fallopian tube and remains there waiting for a sperm cell to fertilize it. In IUI procedures, the semen sample is inserted in the woman’s uterus using a catheter, but sperm must travel on their own to hit the egg.

If the tubes are blocked, egg and sperm will be unable to meet each other, and pregnancy will never occur.

For all these reasons, carrying out a tubal patency test is essential. There exist two techniques:

Hysterosalpingography (HSG)
A radiologic procedure in which the female reproductive system is analysed after injecting a liquid to intensify the image and see the contrasts.
Hysterosalpingosonography (sono-HSG)
A saline solution or gel foam is inserted through the cervix, allowing the specialist to see the uterus and tubes in real time through ultrasound.

Additionally, these tests provide information on the presence of potential uterine abnormalities that might be preventing fertilization, embryo implantation, or pregnancy.

ExEm Foam Kit is a new product used to carry out a hysterosalpingosonography (sono-HSG) in a simpler way. It has multiple advantages, such as being easy and comfortable to use, painless, with a reduced chance of causing allergy in the woman, it provides very clear images of the uterus, etc.

Age and ovarian reserve

As explained above, the maximum age recommended for a woman to undergo IUI is 36 years. From this age on, the success rate starts diminishing dramatically due to a diminished ovarian reserve.

Moreover, and regardless of age, all women have to undergo a series of blood tests to get their hormone levels checked, including an AMH test (anti-Müllerian hormone test).

A hormone panel, along with a transvaginal ultrasound, will allow your doctor to evaluate your ovarian reserve and menstrual cycle.

Also, both members of the couple have to do a series of serologies to make sure there is no risk of infectious or viral disease transmission, including hepatitis B, hepatitis C, HIV, rubeola, toxoplasmosis and syphilis, which can be transmitted to the unborn baby.

Sperm quality

As for the male partner, the main test used to determine if performing an IUI is possible or not is a Motile Sperm Concentration (MSC) test.

In the words of Dr. Valeria Sotelo, OB/GYN specialized in Reproductive Medicine:

The motile sperm concentration test must be done post sperm capacitation, that is, after having processed the sample, and the sample must contain at least 3 million sperm.

After placing the sperm into the uterus in a IUI procedure, sperm must be able to reach the egg cell without further assistance. To this end, it is essential that the man has good motility and concentration.

After completing a male fertility test, the result of the MSC test must be equal to or above 3 million sperm for an IUI to be possible. In other words, it means that at least 3 million sperm must be able to move forward.

If the only requirement that is not met is related to the quality of the semen, you can opt for Artificial Insemination by Donor (AID) or move on to IVF.

Cost of IUI

The cost of Intrauterine Insemination (IUI) depends on each clinic and the country where it is performed. In general, the total cost never includes the cost of medications needed for mild ovarian stimulation.

In the United States, the cost of AIH ranges between $300 ad 1,000. Some fertility clinics, however, offer discounts and special plans or programs for patients who need a second IUI cycle.

As regards Great Britain, the cost is typically £500-1,000 per cycle. One may be eligible for NHS-funded treatment, but it depends on the characteristics of each particular case.

In other international countries like Spain, the price varies from €600 to €1,000. Learn more: Assisted Reproduction in Spain – Everything You Should Know.

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.

FAQs from users

Is there any difference between the requirements to undergo artificial insemination by husband (AIH) and artificial insemination by donor (AID)?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

Intrauterine insemination (IUI) or artificial insemination (AIH) involves the placement of washed sperm into a woman’s uterine cavity using a small catheter during a minor office procedure while the woman is awake.

The sperm are processed in the laboratory to obtain the highest numbers of moving sperm in a small volume as well as enhancing their fertilization potential. The IUI catheter deposits the sperm at a location closer to the fallopian tubes in comparison to intercourse. Following the procedure, the woman can resume all normal activity including intercourse with her partner.

Prior to IUI with partner sperm (AIH) and IUI by donor sperm (AID), the evaluation consists of ensuring the woman ovulates, confirming the fallopian tube(s) is/are open, and the sperm analysis is adequate for IUI. All women desiring pregnancy should undergo prenatal bloodwork including proper blood count, thyroid function, vitamin D level, immunity to the German measles (rubella virus) and chicken pox (varicela virus) as well as an updated Pap smear.

Additional recommendations for women desiring pregnancy with donor sperm include the same infectious disease testing as the donor including cytomegalovirus (CMV) antibody testing. If the woman tests negative for CMV then she needs to select a sperm donor who is also CMV negative to avoid the low but potential risk of infection to the baby. We also advise a psychological counseling session as a consent and for education.

Is there any special requirement for a single woman to undergo IUI?

By Zaira Salvador BSc, MSc (embryologist).

No, a single woman who wishes to become a single mother through AID must meet the requirements already listed above: to have a normal ovarian reserve and tubal patency.

Since donor sperm is used, sperm quality will be excellent and comply with the minimum requirements to being used for an IUI.

Read more: IUI with Donor Sperm – Definition, Process & Success Rates.

Who can use artificial insemination?

By Zaira Salvador BSc, MSc (embryologist).

Patients who turn to artificial insemination to achieve a pregnancy are those with mild infertility issues, including:

Moreover, it is the option of choice for single women and lesbian couples, as long as they meet the requirements explained throughout this article.

Suggested for you

As already explained, a woman must have a good egg count for IUI to be successful. To learn more about the importance of egg quality and quantity, see also: How Many Eggs Does a Woman Have? – Your Egg Count by Age.

As regards sperm quality, it can be assessed with a basic semen analysis. You can get the details of this infertility test in the following post: What Is a Semen Analysis Report? – Purpose, Preparation & Cost.

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.

Alvarez JG: Nurture vs nature: How can we optimize sperm quality? J Androl 24:640–648, 2003.

Keck C, Gerber-Schafer C, Wilhelm C, et al: Intrauterine insemination for treatment of male infertility. Int J Androl 20(Suppl 3):55–64, 1997.

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.

Osuna C, Matorras R, Pijoan JI, Rodriguez-Escudero FJ: One versus two inseminations per cycle in intrauterine insemination with sperm from patients’ husbands: A systematic review of the literature. Fertil Steril 82:17–24, 2004.

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

Sakkas D, Tomlinson M: Assessment of sperm competence. Semin Reprod Med 18:133–139, 2000.

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Authors and contributors

 Mark P. Trolice
Mark P. Trolice
MD, FACOG, FACS, FACE
Reproductive Endocrinologist
Mark P. Trolice is the Director of Fertility CARE – The IVF Center and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine. He is Board-certified in REI and OB/GYN, and maintains annual recertification. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. More information about Mark P. Trolice
License: ME 78893
 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
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV

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