IUI Process

IUI Procedure Step-by-step explanation

Understanding the IUI procedure can help reduce anxiety and make you feel more prepared for your treatment. At Ferty9, the IUI process is designed to be simple, quick, and comfortable. It is an outpatient procedure, meaning you do not need to be admitted to the hospital and can go home the same day.

Here is a detailed, step-by-step guide to how an IUI cycle works, from the first day of your period to the pregnancy test.

Phase 1: Pre-IUI Evaluation (Before the Cycle Starts)

Before beginning the actual IUI cycle, your doctor will ensure that your body is ready. This usually happens in the month prior to treatment.

• For the Female Partner: We perform a baseline scan and blood tests to check hormone levels. Crucially, we ensure that your fallopian tubes are open (usually via an HSG test), as the sperm and egg must meet there naturally.
• For the Male Partner: A semen analysis is done to confirm that there is a sufficient count of healthy sperm available for the process.

Phase 2: Ovarian Stimulation (Growing the Eggs)

An IUI cycle typically begins on Day 2 or Day 3 of your menstrual period.

1. Medication

Even if you ovulate naturally, your doctor may prescribe mild fertility medications (like Clomiphene Citrate or Letrozole tablets) or low-dose hormone injections.

• Goal: To stimulate your ovaries to produce 1 or 2 mature, healthy eggs (follicles) instead of just one, or simply to make the timing of ovulation more predictable.

2. Follicular Monitoring (Tracking Growth)

You will visit the clinic for ultrasound scans every few days, starting around Day 8 or 9 of your cycle. This is called Follicular Monitoring.

• We measure the size of the follicles (fluid-filled sacs containing the eggs) and the thickness of your uterine lining (endometrium).
• We are looking for the “dominant follicle” to reach an ideal size of roughly 18mm to 20mm.

Phase 3: The Trigger Shot (Timing Ovulation)

Timing is everything in IUI. Once the monitoring scans show that the egg is mature and ready to be released, and the uterine lining is thick enough:

• The HCG Injection: You will be given an injection of hCG (Human Chorionic Gonadotropin). This is commonly known as the “trigger shot.”
• What it does: It signals your ovaries to release the egg (ovulate) within a specific timeframe.
• Scheduling the IUI: The insemination procedure is typically scheduled approximately 36 hours after this injection to coincide perfectly with ovulation.

Phase 4: Sperm Collection and Preparation (On the Day of IUI)

On the morning of the scheduled IUI procedure:

1. Sample Collection

The male partner provides a fresh semen sample. This is done via masturbation in a private, sterile collection room at our centre. We recommend abstaining from ejaculation for 2-3 days before this day to ensure the best sample volume.

2. Sperm Washing (Lab Processing)

This is a critical step. The raw semen is not put directly into the uterus. Instead, it goes to our Andrology lab for “Sperm Washing.”

• The Process: Using special techniques, we separate the sperm from the seminal fluid. We filter out dead sperm, debris, and slow-moving sperm.
• The Result: We are left with a small, highly concentrated amount of the fastest, healthiest, and most active sperm. This process takes about 60 to 90 minutes.

Phase 5: The Insemination Procedure

This is the main event. It is quick, safe, and usually painless.

1. Preparation: You will lie down on an examination table, similar to a routine gynaecological check-up or Pap smear. A speculum is gently inserted to keep the vagina open and view the cervix.
2. Insertion: The doctor uses a very thin, flexible tube called a catheter. The concentrated sperm sample is loaded into this catheter.
3. Insemination: The catheter is gently guided through the cervix and into the uterus. The sperm is then released high inside the uterine cavity, close to the fallopian tubes.
4. Completion: The catheter and speculum are removed. The actual insemination takes only 5 to 10 minutes. No anesthesia is required.

Phase 6: Post-Procedure Care

Immediate Rest

After the procedure, you will remain lying down on the table for about 15 to 20 minutes. This is just a precaution to let the sperm start their journey; you do not need to worry about the sperm “leaking out” when you stand up.

Going Home

You can leave the clinic immediately after the rest period. You can drive, work, and resume your normal daily activities. There is no need for bed rest.

Luteal Phase Support (Progesterone)

Your doctor will likely prescribe progesterone supplements (usually vaginal capsules or oral tablets) to be taken daily for the next two weeks. This hormone helps keep the uterine lining thick and supportive for a potential pregnancy.

Phase 7: The Result

The Two-Week Wait

This is often the hardest part—waiting. We advise against taking home pregnancy tests too early, as the “trigger shot” can stay in your system and give a false positive result.

The Beta HCG Test

You will be asked to come back to the clinic or go to a lab for a Beta HCG blood test exactly 14 days after the IUI procedure. This is the most accurate way to confirm if the treatment was successful and you are pregnant.

Is the IUI Procedure Painful?

One of the most common fears patients have is whether the procedure will hurt. The honest answer is that for most women, IUI is not painful, though it can be slightly uncomfortable.

• The Speculum: You may feel pressure when the speculum is inserted to open the vagina, exactly like during a Pap smear test.
• The Catheter: When the thin tube is passed through the cervix, you might feel a pinch or a mild cramp, similar to menstrual pain. This lasts only for a few seconds.
• After the Procedure: Some women experience mild abdominal cramping for a few hours after the procedure, which is normal and usually resolves on its own.
• No Anesthesia Needed: The procedure is so quick and tolerable that no pain relief or anesthesia is required.

What Happens After Your IUI Procedure?

Once you leave the clinic, life goes back to normal, but your body is working hard. Here is what you might experience in the days following the procedure:

• Spotting: You might see a small amount of light pink or brown spotting on your underwear. This is caused by the catheter irritating the cervix and is not a sign that the procedure failed or that the sperm has leaked out.
• Wetness: You may feel some vaginal wetness. This is usually the saline solution used to clean the cervix or cervical mucus, not the sperm sample.
• Mild Bloating: If you took medication to stimulate egg growth, your ovaries might still be slightly swollen, causing a feeling of heaviness or bloating in your lower belly.
• Side Effects of Support Medication: The progesterone supplements prescribed after IUI can mimic pregnancy symptoms. You might feel breast tenderness, nausea, or fatigue. Do not assume these are sure signs of pregnancy until you take the test.

How Will the Results Be Determined?

The “result” of an IUI cycle is determined by the Beta HCG blood test performed 14 days after the procedure.

• Why wait 14 days? It takes time for a fertilized embryo to implant and produce enough pregnancy hormone (hCG) to be detected. Testing too early can give you a “false negative” (you are pregnant, but the test doesn’t show it yet) or a “false positive” (the trigger shot is still in your system).
• If the result is Positive: Congratulations! We will schedule an ultrasound scan about 2 weeks later to confirm the heartbeat and location of the pregnancy. You will continue your progesterone support medications.
• If the result is Negative: We understand this is disappointing. You will stop the progesterone medication, and your period will typically start within a few days. We will then consult with you to review the cycle and plan the next steps.

How Many Cycles of IUI Should You Try Before IVF?

IUI is not an endless journey. While it is a great first step, it does have a “success ceiling.”

• The General Rule: Most fertility specialists recommend trying 3 to 4 cycles of IUI.
• Cumulative Success: Statistics show that most couples who will get pregnant with IUI do so within the first three tries. After the 3rd or 4th attempt, the success rate for further IUI cycles drops significantly.
• Moving to IVF: If IUI has not worked after 3-4 attempts, it is usually recommended to move on to IVF (In Vitro Fertilization). Moving to IVF sooner rather than later saves time, emotional energy, and money in the long run, offering a much higher success rate for difficult cases.
• Age Matters: For women over 35 or 40, doctors may suggest fewer IUI cycles (or skipping IUI entirely) to move quickly to more aggressive treatments like IVF.