Intrauterine Insemination (IUI): What to Know

Apr 16, 2024


Alto Pharmacy

Intrauterine insemination (IUI) is a form of artificial insemination in which sperm is placed directly into the uterus, making it easier to fertilize an egg. Less invasive and less expensive than in vitro fertilization (IVF), it is considered a first-line treatment for unexplained infertility.

While many people try IUI before considering IVF, it is more effective at treating certain types of infertility than others. Your care team can provide more information about the best options for your diagnosis.

IUI at a glance

In the process of IUI, sperm is collected, washed, and concentrated and then placed directly into the uterus. The steps of washing and concentrating ensure that only high-quality sperm are available for fertilization.

The insemination itself is a simple, fast, and non-invasive procedure in comparison to more intensive fertility treatments like IVF. (In IUI, fertilization still occurs inside the body in the fallopian tubes. In IVF, sperm and egg are fertilized outside the body.) Some people take fertility medications during an IUI cycle to induce the development of follicles — fluid-filled sacs inside the ovaries in which eggs grow. IUI can also be performed without the use of medication in what is referred to as a natural or unmedicated cycle.

Although IUI is a simpler treatment than IVF, it is typically performed under the care of a fertility specialist rather than an OB/GYN.

IUI and the chance of twins or multiple births

Many people wonder if conceiving through IUI increases the chance of twins or multiple pregnancies. There is a slightly increased possibility of multiples with a medicated IUI cycle since it involves the use of fertility medications that can potentially stimulate multiple eggs to mature. (While similar medications are taken during IVF, you have more control over the fertilization process and can decide to transfer only one embryo, which eliminates the chance of twins or multiples.)

Your doctor will closely monitor your progress with ultrasounds prior to insemination to determine how many eggs you’ve produced. If there are three or more follicles and a doctor is concerned about the possibility of multiples, they may recommend canceling the insemination.

An unmedicated IUI cycle does not have a greater chance of twins or multiple pregnancies than conceiving naturally.

Fertility medications used during IUI

Ovarian stimulation medications

If you are using medications during IUI, you will likely take clomiphene (Clomid®) or letrozole (Femara®). Both are oral medications that alter your body’s estrogen levels to ultimately stimulate egg production and maturation. You will start taking these medications at the beginning of your menstrual cycle, typically two to five days after your period starts.

Some people experience mild side effects when taking clomiphene or letrozole. Common side effects associated with clomiphene include:

  • Hot flashes

  • Headaches

  • Bloating

  • Nausea

  • Mood changes

  • Breast tenderness

  • Blurred or double vision

Common side effects associated with letrozole include:

  • Hot flashes

  • Back pain

  • Joint or muscle pain

Follicle-stimulating hormone (FSH) (Gonal-f®) is sometimes taken during IUI to support ovarian stimulation, but it is less commonly used than clomiphene and letrozole.

Trigger medications

A medicated IUI cycle typically also includes a “trigger shot” of human chorionic gonadotropin (hCG), which prompts the ovaries to release one or more mature eggs during ovulation. There are several injectable fertility medications containing hCG: Ovidrel®, Novarel®, and Pregnyl®. Ovidrel is most commonly prescribed for IUIs.

Known side effects of these medications include:

  • Injection site reaction (soreness, redness, or mild bruising)

  • Bloating

  • Cramping

  • Headaches

  • Nausea

  • Mood swings

  • Breast tenderness (less common)

In cycles that include a trigger shot, insemination is typically scheduled for 24-36 hours after the shot.

Some people also take progesterone during IUI to support a healthy pregnancy.

When is IUI recommended?

IUI is often performed when certain types of fertility issues are present, including:

  • Issues with the cervix, such as thick cervical mucus that interferes with sperm movement

  • Low sperm count or issues with sperm quality or motility

  • Ejaculation or erection dysfunction

  • Unexplained infertility

It is also an option for conceiving with donor sperm.

IUI is less effective for other types of fertility issues like moderate to severe endometriosis or fallopian tube disorders.


IUI is less expensive and less invasive than IVF, and many people pursue IUI before exploring other options. However, IUI is less effective for some types of fertility issues than others. In some cases, a doctor may recommend trying multiple rounds of IUI. In others, your best option may be to move forward with IVF without trying IUI. Your doctor will be able to advise you on your options and make tailored recommendations.

Next steps

As a non-invasive procedure, insemination does not require anesthesia, and there are no restrictions on activities afterwards. Some people experience mild cramping or spotting for 1-2 days.

A pregnancy test is taken two weeks after insemination. Stress and anxiety are natural during this waiting period, so plan ahead to make sure you have what you need to take care of yourself physically and mentally.

Choose the right fertility pharmacy

Alto is with you at every step of your fertility journey. We offer reliable same-day delivery of your medications, fertility resources like personalized injection guide videos, and access to fertility-trained pharmacists.

Interested in learning more about how Alto can support your treatment? Request a price quote online or reach out through secure in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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