Intrauterine Insemination (IUI) Treatment in Turkey

What Is Insemination (IUI)?

Insemination (IUI) is a treatment in which sperm cells are processed, and the higher-quality, faster-moving ones are collected and delivered into the uterus through a thin catheter inserted via the cervix.

The first step of IUI treatment is ovarian stimulation. The ovaries may be stimulated with oral medications or injections; however, pregnancy rates are higher when injections are used. The goal of ovarian stimulation is to grow one or at most two follicles. After approximately 10–12 days of stimulation, when one or two follicles reach 17 mm or larger, a trigger injection is administered, and insemination is performed 24–40 hours later.

Especially in cycles where injections are used for ovarian stimulation, it has been shown that providing progesterone support after insemination increases pregnancy rates. This hormonal support continues until the pregnancy test. If the test result is positive, support is extended until the 9th week of pregnancy.

Why Is Insemination (IUI) Performed?

Insemination is performed after 1–2 eggs are matured with ovulation-inducing medications or injections, and at the time of ovulation, processed sperm from the partner is placed into the uterus using a thin catheter. The purpose of the treatment is to increase the pregnancy chance by ensuring that more motile sperm are present near the egg at the time of ovulation.

The treatment begins with ovarian stimulation; medication or injection type is selected according to the patient’s age, weight, and ovarian reserve, and follicle development is monitored with ultrasound. When the follicles reach the desired size, a trigger injection is given. Approximately 36–40 hours later, sperm is washed and prepared in the laboratory and placed into the uterus. A pregnancy blood test is performed 14 days after insemination.

Pre-Treatment Preparation and Evaluation

Before deciding on insemination or IVF for infertile patients, ultrasound evaluation of the uterus and ovaries, hormonal testing, and semen analysis are required.

A history of ectopic pregnancy, abdominal surgery involving the uterus or ovaries, or infections affecting these organs increases the risk of tubal blockage. In such cases, a hysterosalpingogram (HSG) is recommended.

In patients without these risk factors, it can generally be assumed that the tubes are open in about 95% of cases, and HSG can be skipped. However, in younger patients with a short duration of infertility, confirming tubal patency may be appropriate, especially if a period of spontaneous conception is planned. The increased rate of spontaneous pregnancy in the first three months after HSG can also be beneficial in this group.

How Is Insemination (IUI) Performed?

IUI is an assisted reproductive treatment in which specially prepared sperm is delivered into the uterus using a thin catheter.

The process starts with preparing the woman for her ovulation period. If needed, mild oral medications or injections are used for ovarian stimulation, and follicle growth is monitored with transvaginal ultrasound. When the follicles mature, a trigger injection is administered, and after approximately 34–37 hours, sperm is washed and prepared in the laboratory. This process selects and concentrates healthy, motile sperm.

The prepared sperm is then transferred into the uterus through the vagina and cervix using a catheter. The procedure takes only a few minutes and does not require anesthesia. After the procedure, the patient may rest briefly; mild cramping or light spotting may occur and is considered normal.

The sperm then move from the uterus to the fallopian tubes, where fertilization occurs if a mature egg is present. The embryo then travels toward the uterus and implants in the uterine lining within 5–7 days. A blood pregnancy test is performed approximately 14 days after IUI.

Insemination is a less invasive, simple, and lower-cost method, making it one of the first treatment options for suitable patients. Pregnancy success depends on factors such as the woman’s age, sperm quality, and tubal condition.

For women over the age of 35 and for couples with infertility lasting longer than two years, IVF generally provides a higher chance of pregnancy compared to IUI.

In patients with polycystic ovary syndrome (PCOS),if excessive ovarian stimulation occurs during an IUI cycle—meaning multiple follicles develop—the risk of multiple pregnancy increases. In such cases, switching to IVF and collecting the growing eggs through an egg retrieval procedure is recommended.

In patients who have undergone more than two unsuccessful IUI cycles, continuing with further inseminations does not improve pregnancy outcomes. Therefore, transitioning to IVF is considered more appropriate.

Factors That Increase the Success of Insemination

One of the most important factors affecting IUI success is the number of progressively motile sperm with normal morphology. As these values increase, pregnancy rates also rise. Adopting a healthy lifestyle, quitting smoking and alcohol, and using antioxidant supplements that support sperm quality can also improve success rates.

In cases with poor sperm motility and morphology, selecting higher-quality sperm using microchip technology—which mimics the cervical canal—can increase pregnancy chances. In unexplained infertility, maturing two eggs and using supplements to support egg quality are also approaches that may enhance success.

Bed rest after IUI does not increase pregnancy rates; therefore, patients may return to their normal daily activities. However, heavy exercise, sudden jumping, or lifting heavy objects is not recommended. In women who undergo ovarian stimulation, hormonal support after IUI is often advised as it increases pregnancy rates.

The Importance of Follicle Monitoring and Timing of Insemination

Close monitoring of follicle development is essential to prevent multiple follicle growth and ovarian hyperstimulation syndrome, and to allow early detection and dosage adjustments if necessary. Monitoring also ensures early ovulation is detected. The timing of IUI is planned according to follicle development and the risk of premature ovulation. Insemination is typically performed 24–40 hours after the trigger injection. Since sperm can survive in the female reproductive tract for up to 72 hours, the timing window for IUI is flexible.

Methods Used to Improve Sperm Quality for IUI

Several methods are used to obtain the highest-quality sperm for insemination. These include sperm washing, swim-up, density gradient methods, microchip sperm selection, MACS, and PICSI. The appropriate method is chosen based on sperm count, motility, and morphology.

Post-IUI Follow-Up and Recommendations

Bed rest after IUI has not been shown to improve pregnancy rates; therefore, patients can resume their normal daily routines. However, heavy exercise, lifting heavy objects, and jumping-type activities are not recommended. In women who undergo ovarian stimulation with injections, uterine-supporting hormonal treatment after IUI is recommended, as it has been shown to increase pregnancy rates.

Frequently Asked Questions About Insemination (IUI) Turkey

How Many Times Can IUI Be Performed?

Although there is no strict upper limit for the number of IUI attempts, it is generally recommended to move on to IVF after two unsuccessful IUI cycles rather than continuing with additional IUI treatments. In some cases, IUI may be skipped entirely. Even if a patient is suitable for IUI, it is not a mandatory step before IVF. Especially in women of advanced reproductive age, in couples with long-standing infertility, or in those seeking a treatment with higher success rates, it is appropriate to proceed directly to IVF without attempting IUI.

Who Is IUI Recommended For?

IUI is recommended for:

• Patients with ovulation disorders who ovulate with medication but still cannot conceive
• Women with polycystic ovary syndrome (PCOS) who do not achieve pregnancy despite ovulation induction
• Couples diagnosed with unexplained infertility
• Couples with mild sperm count or motility problems
• Couples facing sexual dysfunction, such as vaginismus or erectile dysfunction

IUI may be the first-line treatment for unexplained infertility in women under 35 with good ovarian reserve. However, for women over 35 or couples with infertility lasting 2 years or longer, IVF is generally the more appropriate option.

Differences Between IUI and IVF

Although both IUI and IVF/ICSI require ovarian stimulation, they differ significantly in procedure and success rates.

In IUI:

• Typically one or two eggs are matured.
• After the trigger injection, prepared sperm is placed directly into the uterus.
• Fertilization occurs inside the fallopian tube, and the embryo must travel to the uterus to implant.
• Egg, sperm, and embryo quality cannot be directly assessed.
• Success rates are modest: ~20% in unexplained infertility for women under 30 ~25% in women with ovulation disorders

In IVF:

• Multiple eggs are collected in the laboratory.
• Eggs are fertilized with sperm outside the body.
• Embryo development is monitored.
• High-quality blastocysts are selected and transferred.
• With ICSI, sperm is injected directly into the egg, overcoming fertilization issues.
• IVF success rates are 3–4 times higher than IUI.
• Blastocyst transfer (day 5) has pregnancy rates around 60%.

IVF allows direct evaluation of the cervix, fertilization process, and embryo quality, enabling precise treatment planning. Additionally, medication doses in IVF are higher to stimulate multiple eggs, whereas in IUI lower doses are used to minimize the risk of multiple pregnancy.

Which Patients Should Choose IUI and Which Should Choose IVF?

Since every couple is unique, treatment should be individualized based on infertility history.

IUI may be preferred for:

• Younger women
• Normal sperm parameters
• Ovulation disorders
• Open fallopian tubes
• Shorter infertility duration

IVF is recommended for:

• Women over 35
• Long-standing infertility
• Unexplained infertility lasting longer than 2 years
• Poor sperm parameters
• Previous failed IUI attempts

In this patient group, IUI pregnancy rates are around 10%, while IVF with the transfer of two blastocysts offers pregnancy rates of approximately 50%.