Before most couples reach IVF, many try a simpler, less expensive procedure first. IUI, short for intrauterine insemination, places washed sperm directly into the uterus around the time of ovulation. It removes some of the obstacles between sperm and egg, costs a fraction of IVF, and can be done in a brief office visit. For the right diagnosis, it is a reasonable first-line fertility treatment. For others, it adds time and expense without meaningful benefit.
This guide covers who IUI is appropriate for, what a cycle looks like step by step, how success rates vary, what it costs in the US, and when most clinicians recommend moving on to in vitro fertilization. If you are still in the early stages of evaluation, our female infertility overview and the broader medical conditions library are useful starting points.
What IUI Is and How It Differs from IVF
IUI is sometimes called artificial insemination, though the modern procedure uses laboratory-prepared sperm rather than the older approaches of decades past. After a semen sample is collected, the andrology lab “washes” it, removing seminal fluid, dead sperm, and debris. The concentrated motile sperm are then loaded into a thin, flexible catheter and deposited at the top of the uterine cavity, bypassing the cervix.
The contrast with IVF is significant. IUI relies on the body to do most of the work: ovulation happens in the ovary, fertilization happens in the fallopian tube, and implantation proceeds without lab intervention. IVF retrieves eggs surgically and fertilizes them in a dish. Per cycle, IUI succeeds roughly 5 to 20 percent of the time depending on age and diagnosis; IVF runs much higher. But IUI is also far cheaper and less invasive.
Who IUI Helps
The ASRM practice committee recommends IUI for several specific indications: mild male factor infertility (somewhat low count or motility), unexplained infertility, mild endometriosis, cervical factor infertility, ovulatory dysfunction in women without other significant issues, and the use of donor sperm by single women or same-sex couples.
IUI is generally not recommended when both fallopian tubes are blocked, when sperm parameters are severely abnormal (very low count or motility, or significant DNA fragmentation), or when ovarian reserve is markedly diminished. For patients over 38 with unexplained infertility, many reproductive endocrinologists move directly to IVF because time matters and per-cycle IUI rates fall sharply with age.
The IUI Process Step by Step
An IUI cycle takes about two to three weeks from start to pregnancy test. Most cycles include some form of ovarian stimulation, though “natural cycle” IUI without medications is also an option for younger women with regular cycles.
Cycle preparation. Many clinics start with letrozole or clomiphene citrate (oral medications) on cycle days 3 through 7 to encourage one or two mature follicles. Patients with anovulatory diagnoses such as PCOS often respond well. Injectable gonadotropins are sometimes used but raise the multiple pregnancy risk.
Monitoring. Around cycle day 10 to 12, transvaginal ultrasound and sometimes estradiol blood tests confirm follicle development. When a lead follicle reaches roughly 18 to 22 millimeters, patients either receive a trigger shot of hCG or wait for a positive at-home LH test.
The insemination. Roughly 24 to 36 hours after the trigger or LH surge, the sperm sample is collected, washed in the lab over about an hour, and inseminated. The procedure itself takes five to ten minutes, feels similar to a Pap smear, and requires no anesthesia. Most clinics ask patients to lie still for ten to fifteen minutes afterward, though this likely makes little difference.
The two-week wait. A blood pregnancy test (beta hCG) is drawn about 14 days after insemination. Some patients use a home pregnancy test first; the blood test is more reliable.
IUI Success Rates by Age and Diagnosis
Per-cycle live birth rates for IUI are modest. A widely cited dataset from a large multi-center analysis reports approximately 10 to 15 percent live birth per cycle for women under 35 with stimulated IUI, 8 to 12 percent at 35 to 37, 5 to 8 percent at 38 to 40, and 2 to 5 percent at 41 to 42. Donor sperm IUI in fertile women tends to run on the higher end of these bands.
Three to four cycles are typically required to evaluate IUI’s potential. Cumulative pregnancy rates plateau after the third or fourth cycle for most diagnoses, which is why most clinics and the ACOG infertility guidance recommend reassessing after three to four failed cycles. Continuing past that point usually adds little benefit.
What IUI Costs
IUI is one of the more affordable fertility treatments. A single cycle in the US typically costs $300 to $1,000 for the procedure itself, plus monitoring (ultrasounds and bloodwork run roughly $300 to $700 per cycle), medications ($50 to $150 for oral letrozole or clomid, $1,500 to $3,500 for injectable gonadotropins), and the trigger shot ($100 to $250). A stimulated IUI cycle most often lands in the $1,500 to $4,000 range out of pocket.
Insurance coverage is more common for IUI than for IVF because the price tag is lower. Many states with infertility mandates explicitly include IUI. Even without a mandate, some plans cover monitoring and oral medications under the standard gynecology benefit. Donor sperm adds roughly $1,000 to $1,500 per vial from a sperm bank, plus shipping and storage fees if applicable.
Risks and Side Effects
IUI is among the lowest-risk fertility procedures. The most common physical complaints are mild cramping during the insemination, light spotting afterward, and bloating from ovarian stimulation. Pelvic infection is rare (under 1 percent) thanks to sperm washing.
The primary risk is multiple pregnancy. Stimulated cycles, particularly those using injectable gonadotropins, can produce more than one mature follicle. Twin pregnancy rates with stimulated IUI run roughly 8 to 15 percent, and higher-order multiples occur in less than 1 percent. Twin pregnancies carry meaningfully higher risks of preterm labor, preeclampsia, and gestational diabetes. Many clinics cancel a cycle or convert it to IVF if more than three or four mature follicles develop.
When to Move On to IVF
Reasonable triggers for moving from IUI to IVF include: three to four failed IUI cycles, age 38 or older with unexplained infertility, severe male factor infertility identified after a follow-up semen analysis, blocked or damaged tubes, severe endometriosis, or a diagnosis (such as recurrent pregnancy loss or a known genetic condition) that benefits from preimplantation genetic testing.
Some patients also pivot for time and emotional reasons. IUI’s per-cycle rates feel slow when the underlying clock is ticking. A frank conversation with your reproductive endocrinologist about realistic odds at your age and diagnosis is more useful than a fixed cycle rule.
Frequently Asked Questions
How many IUI cycles should I try before switching to IVF?
Most fertility specialists recommend three to four IUI cycles before reassessing. After the third cycle, the chance of success in subsequent cycles drops considerably for most diagnoses. Patients over 38 may switch to IVF earlier given the steeper age effect on egg quality.
Does IUI hurt?
Most patients describe mild cramping during the insemination, similar to a Pap smear. The sensation lasts under a minute. Cramping can persist for a few hours afterward, and some bloating from stimulation medications is common.
Can I do IUI without fertility drugs?
Yes. Natural cycle IUI relies on your own ovulation without medications. It works best for younger women with regular cycles using donor sperm or for couples with mild male factor infertility. Per-cycle success rates are lower than with stimulation, but so is the risk of multiples.
How accurate is the timing for IUI?
IUI is timed to occur roughly 24 to 36 hours after the LH surge or trigger shot, when ovulation is most likely. Sperm survives in the female reproductive tract for up to 72 hours, and the egg is viable for about 12 to 24 hours after ovulation, so the timing window is forgiving as long as insemination happens within that day-and-a-half range.
The Bottom Line
IUI is a sensible first-line fertility treatment for the right diagnoses: mild male factor infertility, unexplained infertility, ovulatory issues, and donor sperm cycles. It is far less expensive and less invasive than IVF, but per-cycle success rates are modest and decline with age. Three to four cycles is generally enough to know whether IUI is going to work for you. If it does not, escalating to IVF preserves time and avoids stacking up expense on a path that has already plateaued.