Intrauterine insemination (IUI) is an assisted reproductive technology that helps a woman become pregnant by placing the sperm directly into the uterus. The procedure does not require making incisions into the body and is not associated with severe side effects. However, any procedure can be associated with some degree of side effects. Examples of these side effects include cramping and/or some mild bleeding. These symptoms may last anywhere from 24 to 48 hours after the IUI process.
Side Effects of IUI and Fertility Drugs
Sometimes a doctor will prescribe fertility drugs before a round of IUI. This is to encourage a process known as hyper-ovulation, where a woman will release more than one egg during ovulation. Although this has the beneficial side effect of more eggs for sperm inserted into the uterus to fertilize, taking fertility drugs can cause a condition known as ovarian hyperstimulation syndrome. The condition causes the ovaries to become enlarged, which can result in a number of symptoms. Examples of these symptoms include:
- Ascites or fluid in the peritoneal cavity
- Blood clots
- Decreased urine production
- Pleural effusions (buildup of liquid in the lungs)
- Respiratory distress
- Stomach pain
Ovarian hyperstimulation can cause symptoms that range from mild to severe. Severe symptoms affect a woman’s ability to breathe, darkened urine, and severe abdominal pain. These symptoms should not be ignored. If a woman finds she is gaining weight very quickly, this can be a symptom of ovarian hyperstimulation.
Treatments for the condition include stopping taking the fertility medications as well as draining any excessive fluid that may have built up in the peritoneal cavity. Most commonly, the symptoms will subside when a person stops taking the medication and with time.
Multiple Pregnancy Risks
In addition to the health risks associated with IUI and taking fertility medications, a woman is also at greater risk for having multiple pregnancies. This is because fertility medications can lead to hyperovulation where a woman releases multiple eggs. Because the sperm injection contains multiple sperm, it’s possible the sperm could fertilize more than one egg, resulting in a multiples pregnancy. While multiples are not necessarily a problem, a multiples pregnancy is associated with greater risks for miscarriage. It’s important that a woman weigh these risks with her partners and doctor. Other potential risks associated with a multiples pregnancy include:
- Increased risk for gestational diabetes
- Low birth weight baby
- Greater risk for preeclampsia (high blood pressure in pregnancy)
- Greater likelihood for requiring bed rest during pregnancy
According to Attain Fertility, an estimated 10 percent of women who take drugs intended to stimulate ovulation will have a multiples pregnancy. An estimated 30 percent of women who take gonadotropins for fertility will become pregnant with multiples.
Risks the IUI Procedure May Not Work
One of the greatest risks associated with IUI is that it may not result in a pregnancy, which is the goal for treatment. According to RESOLVE, the National Infertility Association, the success rates of IUI couples with fertility drugs have improved pregnancy rates compared with women just undergoing IUI. Examples of these medications include Clomiphene, letrozole, or human menopausal gonadotropins.
Much of the success associated with IUI depends on a partner’s sperm quality and the woman’s age. For example, a fertility doctor will often recommend testing to ensure the man has sperm that have at least 5 percent normally shaped sperm. If a man does not, the likelihood of a successful pregnancy with IUI in a woman under age 35 is 7 percent. This number increases to 13 percent likelihood for conceiving if the man’s sperm morphology is greater than 5 percent and the woman is older than age 35.
According to Attain Fertility, the more IUI cycles a woman undergoes, the more likely she is to get pregnant. For example, between three and six IUI cycles is associated with pregnancy rates that near 80 percent. According to Attain Fertility, the likelihood for pregnancy for all women who undergo IUI is:
- 10 to 20 percent in women under age 35
- 10 percent in women between the ages of 35 and 40
- 2 to 5 percent in women ages 40 and above
If a woman has tried six IUI cycles, she should contact her fertility specialist or endocrinologist as she may need to try a different fertility treatment.
Unfortunately, the likelihood for IUI success in a woman who has had trouble conceiving and is older than age 35 is almost zero. Therefore, women may wish to try in vitro fertilization as an alternative to IUI due to the likelihood they won’t conceive. A woman should always discuss the individual likelihood she will conceive using fertility treatments with her doctor. While IUI is not as costly as in vitro fertilization treatments can be, it still represents a cost. If the treatment is unlikely to work, a woman may wish to direct the funds toward other treatments.
Understanding the IUI Process
IUI involves taking sperm from a man and “cleaning” them to ideally make them more effective in fertilizing an egg. The process will start by meeting with a fertility specialist or endocrinologist. This doctor will likely conduct testing that can determine the health of a man’s sperm and/or to identify the potential reasons why a woman may be experiencing infertility. If the doctor recommends moving forward, they may prescribe medications to enhance fertility. These medications are designed to stimulate a woman’s body to release more than one egg, thus enhancing her chances of success when ovulating.
A doctor will conduct blood tests, ultrasound scans, and even temperature monitoring to determine when a woman is ovulating or may start ovulating. This is important because the only time a woman can get pregnant is when she is ovulating.
When a woman is ovulating, her partner will be asked to donate a sperm sample. This is usually accomplished through masturbation. The sperm are then taken to a laboratory where they are prepared for the insemination process. The “washing” process involves exposing the sperm to special chemicals that are able to separate the stronger sperm from the weaker ones. This process also removes toxins from the sperm that are associated with potentially causing an allergic reaction that impairs pregnancy.
Once the sperm has been prepared, a woman returns to her doctor’s office for the insemination. The procedure is similar to a Pap smear. A doctor will insert an instrument called a speculum into the woman’s vagina. Using a small, thin tool called a catheter, the doctor will insert the semen through the vagina and cervix and into the uterus. A woman will usually be asked to sit in the treatment room for anywhere from 30 to 45 minutes. This allows the sperm to stay in position for a longer amount of time. Ideally, this will result in the sperm fertilizing the egg. The IUI procedure itself will typically take anywhere from 10 to 15 minutes and the process of waiting at the doctor’s office afterward will take about one hour.
Sometimes a doctor may recommend coming back to the office the following day for an additional IUI treatment. This can increase the likelihood that an IUI treatment will be effective.
Conclusions on IUI Side Effects
Fortunately, IUI side effects are considered very minimal. A woman may expect to experience some mild bleeding and cramping after the procedure. However, some women may experience side effects from taking medications to stimulate fertilization, such as gonadotropins. This includes ovarian hyperstimulation syndrome, which can cause severe effects from ovarian swelling in some instances.
If a woman has unanticipated effects after undergoing IUI, she should contact her doctor. Seeking treatment as quickly as possible is associated with having the greatest treatment results.
American Pregnancy: Intrauterine Insemination (IUI)
Human Fertilization & Embryology Authority: Intrauterine Insemination (IUI) – The Risks
Human Fertilization & Embryology Authority: What Is Intrauterine Insemination and How Does It Work?
Mayo Clinic: Intrauterine Insemination (IUI)