Intrauterine Insemination (IUI)

Intrauterine Insemination (IUI) is a fertility treatment in which prepared sperm is placed directly into the uterus around the time of ovulation. By bypassing the cervix and placing sperm closer to the egg, IUI increases the chances of fertilization, especially when combined with fertility medications.

How is IUI Performed? 

1. Ovarian Stimulation – The woman is given fertility medications to stimulate the development of multiple follicles (fluid-filled sacs in the ovaries that contain eggs). These may include oral medications such as Clomiphene (Clomid) or Letrozole (Femara), or injectable medications known as gonadotropins.

   • Pregnancy rates per cycle:

     • Oral medications: 10-15%

     • Injectable gonadotropins: 15–20% (slightly higher risk of multiple gestations)

   • Success is also age-dependent and may be as low as 5% for women over 40.

2. Semen Preparation – A semen sample is collected and carefully processed in the laboratory. The seminal fluid, which makes up about 98% of the sample, is separated from the sperm. The sperm is then “washed” and prepared in a medium that supports survival and function, enhancing its fertilizing potential.

3. Insemination – The enhanced sperm is drawn into a thin catheter and gently placed through the cervix into the uterus, timed a few hours before anticipated ovulation. In some cases, a second insemination may be performed the following day, after ovulation has occurred.

The entire procedure is simple, generally painless, and performed in the office.

Who is a Candidate for IUI?

IUI is often recommended for:

• Mild male factor infertility (low sperm count or motility, but not severe)

• Unexplained infertility

• Women with cervical mucus problems

• Couples using donor sperm

Limitations: IUI is not usually effective for severe male factor infertility, where the total motile sperm count is under five million. In such cases, IVF with intracytoplasmic sperm injection (ICSI) provides significantly higher pregnancy rates.

Pre-Treatment Evaluation

Before beginning IUI, both partners undergo evaluation to rule out infections, hormonal imbalances, or structural problems that could interfere with conception. Recommended tests may include:

• Hormonal testing

• Semen analysis

• Hysterosalpingogram (HSG): an X-ray test to check if the fallopian tubes are open

• Laparoscopy: in some cases, to directly view pelvic anatomy

IUI vs. IVF

Because IVF is more effective but also more expensive, many couples choose to try IUI first. Most fertility clinics recommend no more than 3–4 IUI cycles before moving on to IVF, as success rates with IVF are substantially higher. At times, based on diagnosis, sperm count, quality, and age, IVF may be the best first option. Especially in women near or at age 40 who desire more than one pregnancy as IVF can result in frozen embryos for the future.

Donor Insemination

Donor insemination using sperm from a donor unrelated to the husband has been safely practiced worldwide for many years. It has given countless women the opportunity to achieve motherhood when pregnancy would otherwise have been impossible.

The most common reasons for using donor sperm include:

• Male factor infertility, such as the absence of sperm (azoospermia) or very low sperm count (severe oligospermia)

• Genetic concerns, where the male partner carries a severe inherited disorder that he does not wish to pass on

Donor Screening and Safety

Because of the risk of infectious diseases such as HIV, hepatitis, chlamydia, syphilis, and gonorrhea, modern donor insemination programs follow strict safety protocols.

• Donors are extensively tested for infectious diseases before any sperm is collected.

• Semen samples are then frozen in liquid nitrogen and quarantined for six months.

• After this period, the donor undergoes repeat testing. Only if all tests remain negative are the samples released for use.

This process ensures the highest level of patient safety.

In addition to infectious disease screening, sperm banks also require:

• A three-generation genetic history from the donor

• Genetic testing for common conditions (donors are excluded if there are serious inherited or psychiatric illnesses, alcoholism, or other concerning family history)

• Semen analysis to confirm normal sperm quality and the ability of sperm to survive freezing

Choosing a Donor

Most sperm banks provide detailed donor profiles, which may include physical characteristics, education, occupation, and other background information. Couples or individuals can select a donor that best suits their preferences. All donors sign legal releases disavowing any parental rights or responsibilities.

In North Carolina and many other states, the husband is legally recognized as the father of any child born to the couple.

The Insemination Process

Donor insemination is a simple and painless procedure. In a natural cycle, women track ovulation using a home ovulation detection kit. Insemination is typically performed within 12 hours of detecting the ovulation surge.

The pregnancy rate depends on the woman’s age and overall reproductive health. For healthy women under 35, success rates are about 15% per cycle. As age increases, the chances decline, as with all fertility treatments. Clomid may also be used in conjunction with donor insemination.

If pregnancy is not achieved after 2-3 cycles, additional testing or IVF may be recommended to improve success.

Inclusivity at NCCRM

While some clinics limit donor insemination to married women, NCCRM has long welcomed both married and single women. If any abnormalities are suspected, additional testing—such as confirming open and healthy fallopian tubes—is often recommended before starting treatment.

Donor insemination is a safe, effective, and inclusive option for women and couples who wish to grow their families. At NCCRM, we are dedicated to delivering compassionate care and guiding you through every step of the process.