IUI (intrauterine insemination): What men need to know

If you and your partner are having trouble conceiving, there are a few treatments that might help. Which one is suitable depends on what’s causing the fertility problem and factors affecting both of you. One option you might hear about is intrauterine insemination, or IUI. It involves placing prepared sperm directly into your partner’s uterus around the time of ovulation. Here’s what you should know if you and your partner are considering IUI, and whether it’s the right option for male infertility.

What is IUI?

IUI is a type of fertility treatment that helps high-quality sperm get into the uterus and fallopian tubes, where fertilisation can occur.

A semen sample is collected and processed in a laboratory to prepare the sperm for treatment. The prepared sperm is then placed directly into your partner’s uterus using a thin tube.

Unlike IVF and intracytoplasmic sperm injection (ICSI), an egg isn’t removed from the body and fertilised in a laboratory. With IUI, sperm still need to reach and fertilise an egg inside the female body.

When might IUI be used?

Whether IUI is worth trying depends on why you and your partner are having difficulty conceiving.

IUI may be considered when there are minor problems with sperm quality or quantity, or in some cases of unexplained infertility.

IUI isn’t suitable for every fertility problem. Your fertility specialist will consider the results from your semen analysis, your partner’s fertility and other factors when discussing whether IUI, IVF, ICSI or another approach is likely to be appropriate.

What will I need to do?

For most men using their own sperm, the main physical part of an IUI cycle is providing a semen sample by masturbation.

Your fertility clinic will tell you when and how the sample needs to be collected. The laboratory then processes it before the insemination.

Exactly how sperm are prepared varies, but the aim is to prepare a sample containing motile sperm suitable for insemination.

If you’re uncomfortable or worried about providing a semen sample at a fertility clinic, tell the clinic beforehand. They can explain the collection process and what options are available.

What will my partner experience?

Most of the medical procedures involved in an IUI cycle are performed in the female partner.

The clinic needs to time the insemination around ovulation. Depending on the treatment plan, this might involve monitoring your partner’s natural menstrual cycle or using fertility medication to stimulate or control ovulation. If medication is used, monitoring can include blood tests and vaginal ultrasounds.

For the insemination itself, your partner will usually lie on an examination table and have a speculum inserted into the vagina, similar to what happens during a cervical screening test. A thin tube is passed through the cervix and the prepared sperm are injected through the tube into the uterus.

The procedure itself is usually quick. Many women find it painless or experience only mild discomfort, although some have cramping during or shortly after it. Most can return to their usual activities afterwards.

If fertility medication is used to stimulate the ovaries, there are additional risks and side effects to consider. Ovarian stimulation can increase the chance of more than one egg developing, which increases the chance of a multiple pregnancy. Your partner’s fertility specialist should explain the treatment plan and its risks before you start.

After insemination, there’s then a wait to find out whether pregnancy has occurred. The clinic will tell you when your partner should have a pregnancy test.

It can be useful to know what your partner is going through, particularly if your physical involvement in treatment is mostly limited to providing the semen sample. Fertility treatment involves both of you, even when most of the medical procedures happen to one partner.

Does sperm count affect whether IUI will work?

It can.

A low total motile sperm count, confirmed on repeated semen analyses, may reduce the chance of IUI succeeding.

Total motile sperm count takes into account how many sperm are present and how many are moving.

If your total motile sperm count is consistently low, the guidelines recommend considering IVF or ICSI because they are likely to be more effective than IUI.

The results from one semen analysis can’t tell you whether IUI will or won’t work. Semen quality can vary, which is why an abnormal result usually needs to be confirmed with another test at least six weeks later. Your results also need to be considered alongside your partner’s fertility.

If you’ve had an abnormal semen analysis result, read more about male infertility and talk to your doctor or fertility specialist about what it means for you.

How is IUI different from IVF and ICSI?

The main difference is where and how fertilisation happens.

With IUI, prepared sperm are placed directly into the uterus. Sperm still need to travel through the uterus and fallopian tubes to reach and fertilise an egg

With IVF, eggs are collected from the ovaries and brought together with sperm in a laboratory. If fertilisation occurs and an embryo develops, it can then be transferred to the uterus.

With ICSI, a single sperm is injected directly into an egg in the laboratory. If an embryo develops, it can then be transferred to the uterus. ICSI can be used for some severe male-factor fertility problems.

How successful is IUI?

There isn’t one IUI success rate that applies to everyone.

The chance of pregnancy depends on the cause of the fertility problem experienced by you and your partner, and other factors affecting fertility. Your partner’s age is particularly important, as is sperm quality. Whether fertility medication is used can also affect the chances of pregnancy.

For men with a low total motile sperm count, Australian guidelines advise that IUI may be less successful than other types of assisted reproductive techniques. Your fertility specialist can consider your semen analysis alongside your partner’s assessment to help you decide whether IUI is worth trying or another treatment is more likely to help.

Be careful when comparing success rates between fertility clinics or online. Check what the number actually measures — for example, pregnancy or live birth rates — and which patients and treatment cycles are included.

What if IUI isn’t the right option?

IUI is one option; not necessarily the first or best option for every couple.

If your semen analysis results are part of the reason you’re considering fertility treatment, ask your doctor or fertility specialist to explain what your semen analyses show and how they affect your options.

Being advised to consider IVF or ICSI instead doesn’t necessarily mean your fertility problem is more serious. It can mean another approach is more likely to overcome the particular fertility problem you and your partner are dealing with.

Fertility treatment can take a toll beyond the medical procedures. There can be appointments to organise, costs to manage, uncertainty while you wait for results and disappointment when a cycle doesn’t work. Talking with your partner about what each of you needs can make it easier to approach treatment as a team.