Associate Director, REI, Weill Cornell Medical Center
Former President, ASRM
Director, Male Fertility, Stanford School of Medicine
Division Chief, Johns Hopkins School of Medicine
Founder & Medical Director, Colorado Center for Reproductive Medicine
Professor of OBGYN, Columbia University Medical Center
Intrauterine insemination (IUI), sometimes referred to as “artificial insemination,” is the process of placing sperm in a woman’s uterus. This procedure delivers sperm past the vagina and cervix, both harsh environments for sperm, and into the uterus near the fallopian tubes, thereby raising the chances sperm will fertilize a woman’s egg.
IUI is often (but not always) supplemented with medications that can help induce ovulation or grow multiple eggs, namely letrozole, clomid, or gonadotropins.
IUI is able to enhance results for specific patient types, but does little address those with poor egg supply (Diminished Ovarian Reserve), severely reduced sperm count (oligospermia or azoospermia), or an unfriendly uterine environment (where a pregnancy needs to take place).
In the continuum of fertility care, IUI represents a “middle ground,” being more successful and costly than simply taking medication, while being inferior to and cheaper than IVF.
The worrisome health risk associated with IUI is that 8 - 30% of pregnancies result in twins or triplets. This “multiples risk” is more easily controlled in IVF. The reason twins and triplets are problematic is that they increase the risks to both mother and offspring, as shown below.
However, because the odds of pregnancy are relatively low with IUI, the odds any given IUI cycle leads to a multiple birth are low on an absolute basis, roughly 0.5% - 2.5%.
The rate of success and risk with IUI is often determined by the the woman’s age and which drugs (if any) she takes during the cycle.
Below is data from over 17,000 IUI cycles which demonstrates how IUI success rates decline with age. You’ll note that this phenomenon also applies to IVF, which still drastically outperforms IUI at every age interval.
Similarly, success rates also very much depend on which drugs a woman takes in accompanying her IUI cycle. Below are data amalgamated from two superb studies on couples with unexplained infertility that elucidates the point.
IUI is the process of injecting sperm directly into the uterus to increase the likelihood an egg is fertilized and leads to a healthy live birth
IUI is not a practical option for women with severely diminished ovarian reserve, two blocked fallopian tubes, an inhospitable uterus, or use with men who suffer from an extremely low sperm count
IUI leads to a live birth in 5 - 15% of cycles & suffers from a high multiple-birth-to-pregnancy-ratio (8 - 30% of IUI pregnancies are twins or more) but is 5 - 40x cheaper than IVF
IUI success rates vary depending upon the woman’s age (diminish as a woman ages) and the drugs, if any, that accompany treatment
When IUI is used with drugs like gonadotropins there is a higher rate of success. But including gonadotropins increases the risk of multiples-per-pregnancy and the total cost. As such, letrozole and clomid are often preferred