Intrauterine insemination (IUI)
IUI vs timed intercourse, best stimulation agent, and when to move to IVF
Last updated: October 2026 — Sources: Cochrane / EAU / ESHRE / WHO / CDC
Key takeaways
IUI is simple and inexpensive, but its value depends entirely on choosing the right case. Evidence does not support it as first-line for every couple, and does support it in defined settings — with a clear time limit.
IUI vs timed intercourse/expectant management in unexplained infertility: uncertain (Cochrane 2020, 15 trials).
Gonadotropins probably raise cumulative live birth vs clomiphene OR 1.37 (1.05–1.79).
Multiple pregnancy is the main risk — monitor follicle count before insemination.
Cap at 3–6 cycles then reassess — no open-ended repetition.
When to evaluate?
- Mild male factor (post-wash concentration >5 million) or unexplained infertility with suitable partner age.
- Cervical factor or mild endometriosis (rASRM I/II).
- Before direct IVF when cost/acceptability is a barrier — as a stepwise option.
What not to do?
- Do not use IUI with bilateral tubal blockage or severe male factor — near-zero yield.
- Do not stimulate without monitoring — multiple pregnancy risk is high.
- Do not repeat beyond 6 cycles without reassessment — success probability declines.
Healthcare-professional notice
This hub is independent of NPF products and does not promote them. It is informational only and does not replace individual clinical judgment. Surrogate outcomes (SDF, motility, HOMA, IIEF) are never converted into pregnancy/cure promises, and GRADE certainty is quoted as published.
Binding rule: surrogate outcomes are never converted into patient outcomes. Every certainty grade and limitation is quoted as published.
Deep dive
Who actually benefits?
Best candidates: patent tubes, age <35–38, shorter infertility duration, mild male factor.
Least benefit: advanced age, low reserve or long-standing infertility — direct IVF is preferable.
Which stimulation agent?
Clomiphene/letrozole are simpler and cheaper, but letrozole is better specifically in PCOS.
Gonadotropins are stronger but costlier with higher multiple-pregnancy risk — use after simpler agents fail.
Evidence in this domain
Each study broken into five questions: why it was run, who was studied, how it was done, the finding, and why it came out that way — then the clinical takeaway and limits, as published.
FAQ
Is IUI painful?
Usually a quick procedure similar to a cervical swab; may cause mild cramping for hours.
Notice: this reference is informational only and not a substitute for medical advice. Consult your doctor before making any treatment decision.