Key facts regarding Intrauterine Insemination
- In intrauterine insemination (IUI), prepared sperm is placed directly into the uterus through a thin catheter at the time of ovulation.
- With partner sperm, about 9 in 100 cycles result in a birth. After three to four attempts, the chances barely increase.
- For unexplained infertility, IUI with mild ovarian stimulation is the first treatment step. After three to six unsuccessful cycles, IVF usually follows.
- In Austria, IUI costs around €660 to €910 per cycle if you pay privately. The Austrian IVF Fund does not cover it.
Many couples first hear the word insemination at their initial consultation at a fertility clinic, often along with a lot of other medical terms. Yet it is the gentlest form of assisted reproduction: a short procedure without anaesthesia that costs far less than IVF.
Here you can read how IUI works, who it is suitable for, what the realistic chances are and what you can both do in the months before.
What is IUI and who is it for?
In an insemination, the doctor brings the sperm closer to the egg. Fertilisation itself happens in the fallopian tube, just as it would naturally. That is why at least one fallopian tube must be open.
IUI is most often recommended when sperm quality is slightly reduced, or when all tests are normal and pregnancy still does not happen. It can also help with cycle disorders such as PMOS (formerly PCOS), usually combined with mild hormone stimulation. Other reasons are cervical mucus that slows sperm down, or treatment with donor sperm, for example for lesbian couples.
If both fallopian tubes are blocked or sperm quality is severely reduced, IUI has little chance of success. In that case, IVF or ICSI is the better option. From 40, many clinics also advise trying only a few inseminations and moving on sooner.
The IUI process step by step
An IUI cycle takes around four weeks from the start of your period to the pregnancy test. The insemination itself only takes a few minutes.
- Mild hormone stimulation: Usually from day two to five of your cycle, you take tablets or inject a low dose of hormones so that one or two follicles mature. Some clinics also work in a natural cycle without hormones.
- Ultrasound monitoring: In the first half of the cycle, follicle growth is checked two or three times by ultrasound. If too many follicles mature, the cycle is often cancelled to avoid a multiple pregnancy.
- Triggering ovulation: Once a follicle has reached about 18 mm, an injection triggers ovulation. The insemination follows about 24 to 36 hours later.
- Sperm preparation: On the morning of the insemination, your partner gives a semen sample. In the lab, the most motile sperm are separated out, which takes one to two hours. Many clinics recommend two to five days without ejaculation beforehand.
- The insemination: The sperm is placed into the uterus through a thin, soft catheter. It feels similar to a smear test and needs no anaesthesia. Afterwards you can lie down briefly and then carry on with your day as normal.
- Luteal phase support: You often receive progesterone, usually as vaginal pessaries, to support the uterine lining for implantation.
- Pregnancy test: About 14 days after the insemination, a blood or urine test shows whether it has worked.
You can read more about how the uterine lining prepares for implantation in Promoting Embryo Implantation.
IUI success rates
With partner sperm, about 9% of IUI cycles result in a birth. This is shown by the European registry covering almost 148,000 inseminations (Smeenk et al., 2023). An analysis of 1,437 inseminations at the Medical University of Innsbruck shows how the chances develop over several attempts (Zippl et al., 2022):
|
Attempt |
Pregnant in this attempt |
Pregnant in total |
|---|---|---|
|
1 |
10.2% |
10.2% |
|
2 |
11.1% |
16.2% |
|
3 |
10.3% |
18.6% |
|
4 |
8.9% |
19.3% |
The study counted a positive pregnancy test, not a birth. From the fifth attempt onwards, hardly any further pregnancies occurred.
Individual chances depend mainly on three things: the woman's age, the number of motile sperm after preparation and the ovarian reserve. In Innsbruck, women aged 35 and over became pregnant much less often than younger women, as did couples with fewer than 5 million motile sperm or an AMH level below 1 ng/ml (Zippl et al., 2022). From 40, the birth rate per cycle is usually only around 4% (Nesbit et al., 2022).
How many attempts make sense?
For unexplained infertility, the European Society of Human Reproduction and Embryology (ESHRE) recommends three to six inseminations with mild stimulation, followed by IVF (Romualdi et al., 2023). From 40, other options usually make more sense after just a few attempts. How many eggs and transfers IVF needs is explained in IVF Success Rates.
Are there any risks?
The insemination itself is very safe. The main risk is a multiple pregnancy caused by hormone stimulation: in Europe in 2019, around 9% of births after IUI with partner sperm were twins (Smeenk et al., 2023). That is why follicle growth is closely monitored by ultrasound.
How much does IUI cost?
In Austria, IUI costs around €660 to €910 per cycle if you pay privately, depending on the clinic and the stimulation. The Austrian IVF Fund does not cover it; it only pays for IVF, ICSI and frozen embryo transfers. If you plan three cycles, expect around €2,000 to €2,700.
Preliminary tests such as hormone levels, ultrasound or a semen analysis may be partly covered by your health insurance, depending on your insurer and doctor. Costs you pay yourself can be claimed as extraordinary expenses (außergewöhnliche Belastung) on your Austrian tax return if you have a doctor's confirmation. You can find all prices compared with IVF in IVF Costs in Austria.
How to prepare for IUI together
Eggs and sperm take around three months to mature. What you change today therefore affects the cells used in your insemination three months from now. Preparation is especially important for the man, because his sperm still has to make its own way to the egg.
For him, this mainly means getting an up-to-date semen analysis. It shows whether IUI makes sense at all. He should also avoid heat: saunas, heated car seats and a laptop on the lap warm the testicles, and sperm prefer it cooler.
For her, professional societies recommend 400 µg of folic acid daily, ideally starting at least four weeks before conception. Ask your gynaecologist to check your thyroid and vitamin D levels too. Being significantly overweight or underweight can affect your cycle and how you respond to the hormones.
And for both of you:
- Stop smoking and cut down on alcohol; both are proven to harm eggs and sperm.
- Eat a balanced diet with plenty of vegetables, whole grains and legumes. You can find tips in Nutrition When Trying to Conceive.
- Get enough sleep and plan breaks on purpose. Fertility treatment takes more energy than most people expect.
- Check your nutrient intake: zinc contributes to normal fertility and reproduction, and selenium contributes to normal spermatogenesis. How to plan this specifically is shown in Pimp my Eggs and Pimp my Sperm.
Our practical tip: You usually only know the exact day of the insemination one or two days in advance, because it depends on the ultrasound. Keep two or three mornings free in your calendar around your expected ovulation, both of you. Ask the clinic for early-morning ultrasound appointments so you can often still get to work on time. Also check in advance whether the semen sample can be collected at home and how quickly it needs to reach the clinic. This takes a lot of pressure off on the day itself.
Frequently asked questions about IUI
Does IUI hurt?
Usually not. IUI feels similar to a smear test and only takes a few minutes. Some women feel a slight pulling sensation in the lower abdomen afterwards, similar to period pain.
What should I do after IUI?
You can carry on with your daily life as normal, including work, moderate exercise and sex. It is important to take any prescribed medication such as progesterone regularly. If you have severe pain or a fever, contact your clinic.
When will I know if it worked?
About 14 days after the insemination. An earlier test is often still negative, or falsely positive because of the trigger injection.
How many IUI cycles make sense?
Usually three to six cycles. After that, the chances barely increase and IVF is the next step. From 40, many clinics advise switching after about three attempts.
IUI or IVF: which is better?
For unexplained infertility or slightly reduced sperm quality, IUI is a sensible and affordable first step. If the fallopian tubes are blocked, sperm quality is severely reduced or you are in your early 40s, IVF usually offers better chances. IVF succeeds more often per attempt, but it is more demanding and more expensive.
Does the Austrian IVF Fund cover IUI?
No. The IVF Fund only covers IVF, ICSI and frozen embryo transfers. You have to pay for IUI yourself. Who is eligible for the Fund is explained in IVF Fund Austria.
Is IUI with donor sperm allowed in Austria?
Yes. Since 2015, it has also been permitted for lesbian couples in Austria. The cost of donor sperm comes on top of the treatment.
References
Kinderwunsch-Clinic Dr. Zech: IVF-Kosten
