Intrauterine insemination (IUI) places washed, concentrated sperm directly into the uterus in a 5-10 minute procedure that costs $300-$1,000 per cycle in the US and produces a pregnancy in 10-20% of attempts. For patients under 35, three cumulative cycles reach a 40-50% success rate, which is why most reproductive societies advise 3-4 IUI cycles before moving to IVF.
What Happens During an IUI Procedure?
IUI is performed around ovulation, when motile sperm are placed directly inside the uterine cavity, bypassing the cervix. It requires no anesthesia, no surgery, and no egg retrieval — the least invasive assisted reproduction option available.
The in-clinic visit follows this sequence:
| Step | What happens | How long |
|---|---|---|
| 1. Sperm collection | Partner provides a semen sample at the clinic | 10-15 min |
| 2. Sperm washing | Lab concentrates motile sperm and removes seminal fluid | 45-60 min |
| 3. Insemination | Thin catheter passes sperm through the cervix into the uterus | 5-10 min |
| 4. Rest | You lie still briefly, then resume normal activity | 10-30 min |
| 5. Pregnancy test | Blood or urine hCG test about 14 days later | — |
Because it is also the cheapest fertility treatment worldwide, IUI is typically attempted before IVF.
IUI Procedure Step by Step
Step 1: Initial Workup — Cycle Day 2-5
Before your first IUI, the clinic confirms you are a good candidate. The standard workup includes:
- Blood tests: hormone panel (FSH, AMH, estradiol) for the female partner; infectious disease screening for both partners.
- Ultrasound: baseline scan of ovaries and uterus to rule out cysts or fibroids.
- Tubal patency check: an HSG (hysterosalpingogram) or saline sonogram confirming at least one open fallopian tube — essential, since IUI relies on egg and sperm meeting inside the tube.
- Semen analysis: for the male partner, or review of the donor sperm profile.
If testing reveals blocked tubes, severe male factor, or very low ovarian reserve, your doctor may recommend skipping IUI and going straight to IVF. We analyze that decision in our IUI vs IVF comparison guide.
Step 2: Cycle Monitoring — Cycle Day 3-12
Most IUIs run in a “medicated” cycle to improve timing and modestly increase the number of eggs:
- Natural cycle: no medication; ovulation tracked with urine LH kits, with the visit 1-2 days after the surge. Suitable for women with regular ovulation.
- Oral medication cycle (most common): clomiphene or letrozole for 5 days starting around day 3, then ultrasound every 2-3 days from day 10 to watch follicle growth.
- Injectable gonadotropin cycle: low-dose FSH for a stronger response. Higher pregnancy rates, but higher cost ($1,500-$3,000 per cycle) and a higher twin rate.
Step 3: Trigger Shot — Approximately Cycle Day 12-14
When the leading follicle reaches 18-20 mm on ultrasound, you inject hCG (brands such as Ovidrel or Pregnyl) — the “trigger shot.” Ovulation follows 36-40 hours later, and insemination is scheduled inside that window.
This is the most timing-critical step of the whole process. Clinics schedule IUI 24-36 hours after the trigger; some add a second insemination 12-24 hours later to widen the fertile window.
Step 4: Sperm Collection and Washing — Day of IUI
On procedure morning, the male partner produces a sample at the clinic after 2-5 days of abstinence. The lab then performs sperm washing:
- The sample is mixed with a special medium and centrifuged to separate sperm from seminal fluid.
- The most motile sperm are concentrated into a tiny volume (0.3-0.5 ml).
- Washing strips out prostaglandins and other seminal-fluid substances that would trigger strong uterine cramping if injected directly.
Washing takes 45-60 minutes in total. An ideal post-wash sample contains 5-10 million motile sperm; below 1 million, success rates drop sharply.
Step 5: The Insemination — 5-10 Minutes
You lie on an exam table in the same position as a gynecological exam, and the doctor:
- Inserts a speculum to visualize the cervix.
- Threads a very thin, soft catheter through the cervical canal into the uterus.
- Slowly injects the washed sperm.
- Removes the catheter and speculum.
Most women feel mild pressure similar to a Pap smear rather than pain. From cleaning to catheter removal the procedure stays under 10 minutes; after 10-30 minutes of rest you resume normal activity.
Step 6: Luteal Support and the Two-Week Wait — Days 1-14 After IUI
Progesterone support (oral or vaginal) is commonly prescribed after IUI to sustain the uterine lining. You can return to normal activity immediately — studies have not shown bed rest to improve pregnancy rates — though heavy exercise and hot tubs are best avoided for a few days.
A blood hCG test is done 14 days after insemination. Home pregnancy tests can give false negatives before then.
IUI Success Rates: What the Data Actually Shows
IUI outcomes depend heavily on age, diagnosis, and medication use. Representative per-cycle rates drawn from SART and HFEA data:
| Female age | Per-cycle success (medicated IUI) | Cumulative after 3 cycles |
|---|---|---|
| Under 35 | 15-20% | 40-50% |
| 35-37 | 10-15% | 30-40% |
| 38-40 | 8-12% | 20-30% |
| Over 40 | 5-8% | 10-15% |
Diagnosis matters as much as age:
- Unexplained infertility: 12-15% per cycle with oral medication.
- Mild male factor: 10-13% per cycle.
- Ovulation disorders (e.g., PCOS): 15-20% per cycle — among the best IUI candidates.
- Cervical factor: 15-20% per cycle.
- Severe male factor or moderate-severe endometriosis: 3-7% per cycle — IVF is usually the better first choice.
Our IUI vs IVF success rates analysis compares these numbers with IVF in depth.
How Much Does an IUI Cycle Cost?
Cost is the main reason couples try IUI first: one cycle runs a small fraction of an IVF cycle.
| Country | Cost per IUI cycle (without medication) | Oral medication |
|---|---|---|
| United States | $300 - $1,000 | + $50 - $200 |
| United Kingdom (private) | £500 - £1,000 | + £100 - £200 |
| Thailand | $400 - $900 | + $50 - $150 |
| Japan | ¥50,000 - ¥150,000 | + ¥10,000 - ¥30,000 |
| Spain | €400 - €800 | + €50 - €150 |
For comparison, a single US IVF cycle costs $15,000-$30,000 — 20 to 50 times more. Some US states mandate insurance coverage for IUI, and many clinics discount multi-cycle packages.
Considering treatment abroad? Our hospital directory lists fertility centers in Thailand, Japan, the United States, and Europe with transparent pricing and verified patient reviews.
Who Is a Good Candidate for IUI?
IUI works best when the “plumbing” is intact and the problem is timing, mild sperm issues, or a cervical barrier.
Good candidates:
- Unexplained infertility with normal ovarian reserve
- Ovulation disorders that respond to oral medication
- Mild male factor (count and motility only slightly reduced)
- Cervical mucus problems or cervical scarring
- Same-sex female couples using donor sperm
- Single women using donor sperm
Poor candidates:
- Both fallopian tubes blocked or severely damaged
- Severe male factor (post-wash count under 1 million motile sperm) — see our male infertility guide
- Moderate to severe endometriosis
- Female age over 40 (most clinics advise going straight to IVF)
- Pregnancy not achieved after 3-4 well-timed IUI cycles
For same-sex couples and single women, donor sperm IUI is usually the first-line treatment before IVF — details in our donor sperm IVF guide.
When Should You Move From IUI to IVF?
“IUI should be considered a first-line treatment for couples with unexplained infertility, mild male factor, or ovulatory dysfunction. After 3-4 cumulative cycles, the decision to proceed to IVF should be individualized.” — American Society for Reproductive Medicine (ASRM), 2024
Most reproductive societies, including ASRM, advise 3-4 IUI attempts before escalating. The logic is statistical: if IUI is going to work for you, it usually works within the first 3-4 cycles; beyond that, each extra cycle adds cost and delay while the chance of success keeps shrinking.
You may consider moving to IVF sooner if:
- You are 38 or older
- Your diagnosis is one where IVF clearly outperforms IUI (tubal factor, severe male factor, need for genetic screening)
- Your insurance covers IVF
- You value the higher per-cycle success rate and the option of embryo testing (PGT-A)
The full decision framework — with side-by-side cost and timeline comparisons — is in our IUI vs IVF comparison guide.
Real Patient Experiences
The following stories are shared with consent; names and identifying details have been changed to protect privacy.
Sarah, 34 — Unexplained infertility, pregnant on the third IUI, Austin, Texas
Sarah and her husband tried for 18 months before their workup came back “unexplained,” and their clinic recommended three letrozole IUI cycles.
“I was terrified the actual insemination would hurt, and it honestly felt like a smear test — over before I knew it. The hard part was the waiting. The first cycle failed, the second failed, and I remember crying in the clinic parking lot after the second negative test, convinced we would never have a baby.”
Their third cycle succeeded, and Sarah is now 24 weeks pregnant. Total cost for three cycles including medication was $4,200 — still far below one IVF cycle in Texas.
Ravi and Priya, 36 and 35 — Mild male factor, two IUIs then IVF, Toronto, Canada
Ravi’s semen analysis showed mildly low motility, and the clinic recommended two IUI cycles before IVF; both failed.
“The washing report said we had 8 million motile sperm, which everyone told us was ‘fine,’ so the failures felt confusing. Only later did we learn that 8 million is the borderline zone where IVF with ICSI becomes the statistically smarter choice. I wish someone had shown us that math before we spent six months.”
They moved to IVF with ICSI and conceived on their first transfer. Their advice: get the post-wash count in writing and check it against the benchmark before paying for another IUI.
Lin, 32 — Donor sperm IUI abroad, Bangkok, Thailand
Lin, a single woman from Shanghai, chose Bangkok for donor sperm IUI — a service restricted for single women in parts of mainland China and priced far below US levels.
“The whole process felt very organized: the clinic handled my cycle monitoring remotely, I flew in for the trigger and insemination, and stayed four days. The insemination itself was five minutes. I paid about 40,000 THB (roughly $1,100) for the cycle including medication.”
Her first cycle failed; the second led to a confirmed pregnancy. She shortlisted the clinic through ProIVF’s hospital directory by comparing verified patient reviews.
FAQ
Q: Does the IUI procedure hurt?
No. Most women describe mild pressure rather than pain — similar to a Pap smear — with discomfort lasting a few seconds to about 1 minute when the catheter passes the cervix.
No anesthesia is needed.
Q: How long does the IUI procedure take?
The insemination itself takes 5-10 minutes. Counting sperm washing and the rest period, plan on 1.5-2 hours at the clinic on the day.
Q: What should I do after IUI to improve my chances?
Resume normal activity. No study shows bed rest improves pregnancy rates after IUI, and doctors typically prescribe progesterone support for the 14 days before the blood test.
Q: How many IUI cycles should I try before IVF?
Most guidelines recommend 3-4 cycles. Under age 35 with unexplained infertility, 3-4 medicated cycles give a cumulative success rate of 40-50%.
Q: Can I have sex after the IUI procedure?
Yes. Some clinics recommend intercourse the evening of the IUI or within the next 24 hours, adding a natural-conception chance on top of the insemination.
Q: What are the early signs that IUI worked?
None you can rely on. Implantation cramping and light spotting overlap heavily with normal premenstrual symptoms, so the only confirmation is the blood hCG test 14 days after insemination.
Q: Is IUI painful for the male partner?
No. The male partner only provides a semen sample by masturbation in a private collection room — usually after 2-5 days of abstinence — with no medical intervention involved.
How to Plan Your IUI Journey
IUI is the gentlest entry point into fertility treatment: a 5-10 minute procedure, minimal medication, and a per-cycle cost that makes “try again next month” realistic. Before starting, confirm three things with your clinic — your post-wash sperm benchmark, your tubal status on imaging, and an explicit agreement on how many cycles to attempt before reassessing the IUI vs IVF choice.
If you are comparing clinics at home or abroad, browse verified hospital reviews or contact our team for matching advice based on your diagnosis, budget, and destination.
Data in this article comes from CDC Assisted Reproductive Technology reports, ASRM guidelines, SART clinic data, and HFEA treatment reports.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Fertility treatment decisions should be made with a licensed reproductive specialist based on your individual diagnosis and history. Success rate figures are population averages and do not predict individual outcomes.
This article was written by the ProIVF Medical Editorial Team and reviewed by the ProIVF Medical Advisory Board, based on publicly available data from the CDC, ASRM, SART, and HFEA.
Last updated: September 7, 2026
