Tips for IUI Success
Today we’re going to talk about intrauterine insemination (IUI) fertility treatment and how to maximize your chances for success.
As a reproductive endocrinologist and fertility specialist, I’ve specialized in helping people build their families for over 15 years. I know that undertaking the IUI journey can feel intimidating. Perhaps you're reading this after doing an IUI or two without success, and you want to learn how you can improve your odds. Or, maybe you’re just beginning your fertility journey and want to learn as much as possible in case you do this treatment someday. Either way, I aim to help you fully understand your IUI options so that you can make the most of every treatment.
By the end of this article, you’ll have a more in-depth understanding of:
The ins and outs of intrauterine insemination
The many ways you can improve your odds for success
The success rates for this particular fertility treatment
Let’s get started!
What is an IUI?
Intrauterine insemination is a type of fertility treatment colloquially referred to as the “turkey baster.” This is because the treatment involves washing and prepping ejaculated sperm and placing it into the uterine cavity around ovulation.
Regarding fertility treatments, IUI is considered fairly “low-tech” because your body takes over the rest of the fertility process after insemination.
IUI vs IVF
Sometimes, people can confuse IUI and IVF with each other.
While IUI refers to placing sperm into the uterine cavity around the time of ovulation, IVF is a different fertility treatment that uses in vitro fertilization. With IVF, medications are typically used to recruit a large number of eggs that can be extracted from the body through a simple procedure called an egg retrieval. Then, the egg and sperm are fertilized outside the body, and when the embryo is ready, it gets placed back into the uterine cavity.
Why choose IUI treatment?
There are many reasons why people choose IUIs. For instance, if you’ve chosen to conceive with donor sperm, then an IUI is a great way to help get that sperm near where it needs to be. The same goes with cases where there is mild male factor infertility (low sperm count or motility).
During an IUI cycle, the primary focus is on timing the placement of sperm around ovulation. Some people follow their cycles with ovulation predictor kits, so they can call the clinic with a positive kit and do the insemination the next day. Others use ultrasounds to help monitor when ovulation will occur. In some cases, patients will utilize trigger shots to help trigger ovulation and assist with timing insemination correctly.
When is IUI not a good fit?
Every patient is different, but IUI might not be the best course of action of fertility treatment for some. For IUI, there needs to be a certain amount of sperm. Occasionally, I see patients with a low sperm count (under 2-3 million total motile sperm count in the ejaculate), and in those cases, pregnancy via IUI is unlikely to be successful.
If there's little to no available sperm, then IUI isn’t your best option, and patients may choose to go straight to IVF. If you’re trying to determine which course of action is right for you, your doctor will be able to help you review your options.
Before you get started
Here are three things to think about before you get started with IUI treatment:
1. Get tested.
Although you may not have symptoms or risk factors, sometimes you might unknowingly have a symptomless fertility issue at play. For instance, blocked fallopian tubes can be present without symptoms. This is why it’s helpful to talk to your doctor before your first IUI about whether you should do a Hysterosalpingogram (HSG) test to determine whether there might be blockages. Additional concerns like azoospermia (low sperm count) and uterine anatomic issues are also helpful to be aware of before you begin treatments.
2. Review your goals with your doctor.
Talk to your fertility doctor about your family goals.
Some of my patients bypass doing IUI and go straight to IVF because of their situation. If they want to have multiple children and start their fertility treatments later in life, IVF might be a good option.
3. Make a plan.
Not every IUI is going to be successful. That’s why it's a great idea to talk to your doctor about how many inseminations you’re thinking of trying. This way, you can devise a plan and consider moving on to IVF or another treatment if the IUI doesn’t work out as hoped. You certainly don’t have to stick to your original plan, but making one will decrease your stress before starting your treatment.
Five tips to maximize your success with IUI treatments
1. Think about adding medication.
You're most likely ovulating if you have regular, predictable menstrual cycles. However, adding a simple medication to help recruit the best eggs at the beginning of your cycle can optimize your chances of success.
Talk to your doctor about using either Clomid (or Clomiphene) or Letrozole (also known as Femara). These two medications are pills that you can take for about five days toward the beginning of your menstrual cycle to help with egg recruitment. These medications also typically optimize hormones in the luteal phase, giving you a higher chance of implantation.
Personally, if I had to choose between Clomid and Letrozole, I often opt for Letrozole, which generally has fewer side effects. Clomid can often result in headaches, mood swings, and sometimes even vision changes. Plus, it can build up in your system over time and cause an increased risk of ovarian cysts or thin endometrial lining.
2. Consider monitoring your cycle with ultrasounds
Ovulation predictor kits are much less expensive than ultrasounds and can be a great way to decrease care costs.
However, I often talk to my patients about doing ultrasounds because they're more thorough. An ultrasound in the middle of your cycle ensures a mature follicle with a mature egg, and it also gives us a clearer picture of what’s happening anatomically, such as uterine lining thickness.
If the ovulation predictor kits are not working for you, or if you want to gain more knowledge and optimize your timing, it’s worthwhile to strongly consider ultrasounds.
3. Think about adding a trigger shot to your regimen
In the middle of your cycle, the pituitary gland creates luteinizing hormone (LH), which then causes the ovary to ovulate. In many cases, our body is already doing a great job of that.
Adding a trigger shot to your IUI treatment can help your doctor time ovulation and, as a result, Intrauterine Insemination. Trigger shots also encourage your ovaries to make more progesterone for at least a week after the shot. Overall, trigger shots help optimize the luteal phase (or the second half of the cycle) when an embryo is implanting.
4. Optimize sperm counts and sperm parameters
If you’ve chosen to do IUI to address mild or moderate male factor infertility, this is an opportunity to improve sperm parameters through lifestyle changes.
For people with sperm, you might want to consider hormone testing or seeing a male fertility urologist. Consider limiting tobacco, alcohol, and cannabis, which can decrease sperm count and motility. Lastly, ensure you get enough sleep and manage your stress levels. When you prioritize optimizing your health, you give yourself a better chance of success with IUI.
5. Optimize overall health
It’s also important for the person carrying the baby to think over how they might optimize their health. Your overall health can greatly impact your reproductive health.
Let’s recap.
While IUI is straightforward as a fertility treatment, you can take several steps to optimize your chances of success:
Try medication like Letrozole or Clomid.
Monitor your follicle size and uterine lining with mid-cycle ultrasounds.
Add a trigger shot to improve estrogen, progesterone production, and implantation timing.
Optimize sperm health if you're doing IUI for mild male factor or unexplained infertility
Optimize overall health for both partners. Reproductive health is essential. Think about how you can optimize your health to improve your chances of success with IUI.
Conclusion
The chances of success with one IUI range from 15 to 20%, which might be even lower in certain circumstances. As the eggs and sperm age (particularly closer to 40), success chances might drop to less than 5%. That’s why it’s important to set your expectations for the chances of success.
I want all my patients to get pregnant and have a baby with their first IUI, but it’s important to recognize that it might take more than one treatment. Remember: Don't be discouraged if the first one doesn't work. Talk to your doctor about your options because they might recommend trying again. I wish you luck, and I truly hope this treatment is a successful one for you. If you have any questions, comment in my YouTube video.
