Intrauterine insemination (IUI) is a fertility treatment that places specially prepared sperm directly into the uterus, bypassing the cervix to give sperm a shorter path to the egg. It’s one of the least invasive fertility treatments available, typically costing $500 to $4,000 per cycle, and the procedure itself takes only a few minutes. For many couples and individuals struggling to conceive, IUI is the first step before considering more complex options like IVF.
How IUI Works
The core idea behind IUI is simple: get more healthy sperm closer to the egg at the right time. In natural conception, sperm have to travel through the vagina, past the cervix, through the uterus, and into the fallopian tubes. Many sperm don’t survive that journey. IUI shortens the trip by placing a concentrated sample of the healthiest sperm directly into the uterus using a thin, flexible tube called a catheter.
Before the procedure, the sperm sample goes through a process called “washing.” The lab separates highly active, healthy sperm from lower-quality sperm and removes other components in the semen that could cause severe cramping if placed directly in the uterus. The washing process uses centrifugation, essentially spinning the sample through a filter medium to isolate the best sperm. What remains is a small, concentrated dose of the most motile sperm available.
During the procedure itself, a doctor or nurse threads the catheter through the vagina and cervix, then pushes the prepared sperm sample into the uterus. Most people describe it as feeling similar to a Pap smear. It’s done in a clinic, takes a few minutes, and you can typically go home right after.
What a Full IUI Cycle Looks Like
Each IUI treatment follows your menstrual cycle from start to finish. The process begins on day one of your period, when you call your clinic to schedule a baseline ultrasound, usually between cycle day 2 and 5. This ultrasound checks that your ovaries are at a good starting point for the cycle.
If your doctor recommends medication to stimulate ovulation (more on that below), you’ll typically take pills from day 2 through day 6. Around cycle day 12, you’ll have another ultrasound to check whether a follicle (the fluid-filled sac containing an egg) has reached the right size. Once it has, you’ll be instructed to take a “trigger shot,” a hormone injection that tells your body to release the egg. The insemination is then scheduled about 36 hours later, timed to coincide with ovulation.
After the procedure, you wait. A home pregnancy test can be taken 14 days after the IUI. It’s important not to test earlier, because the trigger shot contains the same hormone that pregnancy tests detect, and it takes time to clear your system. Testing too soon can produce a false positive.
Who Benefits From IUI
IUI is commonly recommended for several situations. Couples with mild male factor infertility, where sperm count or motility is somewhat below normal, often benefit because the washing process concentrates the strongest sperm. It’s also used when cervical mucus is too thick or hostile to sperm, since the catheter bypasses the cervix entirely.
Single individuals and same-sex couples using donor sperm frequently choose IUI as a first-line approach. It’s also an option for couples with unexplained infertility, where standard testing hasn’t revealed a clear cause for difficulty conceiving. For people with mild endometriosis or ovulation irregularities, IUI combined with ovulation-stimulating medication can improve the odds.
IUI is not typically effective for people with blocked fallopian tubes, severe endometriosis, or significant sperm abnormalities. In those cases, IVF is usually the better path.
Medications Used During IUI
Some IUI cycles are done on a “natural cycle” with no medication, relying entirely on your body’s own ovulation. But many cycles include oral medications to stimulate the ovaries to produce one or two mature eggs, improving the chances of conception.
The two most common medications are clomiphene (often called Clomid) and letrozole. Both are taken as a daily pill for five days early in the cycle. Clomid typically starts at 50 mg per day, while letrozole starts at 2.5 mg. These medications are relatively inexpensive, usually $50 to $150 per cycle. Clomid is generally recommended for no more than 6 to 12 cycles total.
Some cycles use injectable hormones called gonadotropins, which are more powerful and more expensive ($1,500 to $2,500 per cycle). These stimulate the ovaries more aggressively, which can improve pregnancy rates but also increases the risk of multiple pregnancies. Nearly all IUI cycles also include a trigger shot to precisely time ovulation, costing $50 to $250.
Success Rates by Age
IUI success rates are modest per individual cycle, which is why most doctors recommend trying for several cycles before moving on. The live birth rate per cycle for unstimulated IUI is around 3.5%. With medication-stimulated cycles, that rises to about 7% per cycle.
Age plays a major role. A large study of over 10,000 insemination cycles found that cumulative live birth rates (across multiple cycles) for partner sperm were 27.6% for women under 35, 23% for ages 35 to 37, 13.7% for ages 38 to 39, and just 6.9% for women 40 and older. With donor sperm, rates were higher across the board: 61.5% for women under 35, dropping to 11.8% for women 40 and older. The higher donor sperm rates likely reflect that donor samples are pre-screened for quality.
These numbers mean IUI works best as a cumulative strategy. Any single cycle has a relatively low chance of success, but the odds add up over three to six cycles, particularly for younger patients.
Risks of Multiple Pregnancies
The biggest risk specific to medicated IUI is carrying twins or higher-order multiples. A study of over 50,000 IUI cycles found that the number of mature follicles at the time of insemination dramatically affects this risk. For women under 38, having just one mature follicle resulted in a 0.6% chance of multiples per cycle. With three or more follicles, more than one quarter of all resulting pregnancies were multiples.
Critically, adding more follicles beyond two didn’t meaningfully increase the chance of a singleton pregnancy (14.1% with one follicle vs. 16.4% with five). The extra follicles mostly just raised the multiple pregnancy rate. For this reason, most clinics will cancel an IUI cycle or advise caution if ultrasound monitoring shows more than two or three mature follicles in women under 40.
What It Costs
The total cost of an IUI cycle in the United States ranges from $500 to $4,000, depending on how much monitoring and medication is involved. A natural cycle IUI with minimal intervention runs $500 to $1,500. Adding oral medications like Clomid or letrozole brings it to $1,000 to $2,000. Cycles using injectable medications can reach $2,500 to $4,000 or more. If you’re using donor sperm, add another $1,000 to $2,500 per cycle.
Monitoring accounts for a significant chunk: expect 2 to 4 ultrasound visits at $150 to $300 each, plus blood work to track hormone levels. With insurance coverage, out-of-pocket costs can drop to $300 to $1,000 per cycle, though coverage varies widely by state and plan. Since most people need multiple cycles, budgeting for three to six attempts is realistic.
How IUI Compares to IVF
IUI and IVF occupy very different positions on the fertility treatment spectrum. IUI is simpler, less invasive, and far less expensive per cycle. IVF involves stimulating the ovaries to produce many eggs, surgically retrieving those eggs, fertilizing them in a lab, and transferring an embryo back into the uterus. A single IVF cycle typically costs $12,000 to $20,000.
The tradeoff is effectiveness. A full IVF cycle has a live birth rate of about 19% across all ages, compared to 3.5% to 7% for IUI. For couples with unexplained or mild male factor infertility, research has found that going directly to IVF can actually be more cost-effective than doing several rounds of IUI first and then moving to IVF after those fail. That said, many people prefer to start with IUI because of the lower cost, simpler process, and fewer side effects before escalating to IVF.
Recovery and Activity After the Procedure
Recovery from IUI is minimal. You can resume most normal activities the same day, though light activity is preferred over anything strenuous. Avoid heavy lifting during the two-week wait, as it can cause cramping and potentially affect the uterine lining. Light exercise like walking is considered safe and even encouraged.
Swimming should be avoided for at least 48 hours after insemination. Long-distance travel is generally discouraged during the two-week wait as well. Beyond these precautions, daily life continues as normal. There’s no bed rest requirement, and most people return to work the same day or the next.