Intrauterine Insemination (IUI): The Complete Scientific Guide

What is IUI? Understanding the Fundamental Procedure

Intrauterine insemination, commonly known as IUI or artificial insemination, is a fertility treatment that involves placing washed and concentrated sperm directly into a woman's uterus during her ovulation period. IUI is performed in approximately 15-20% of all fertility treatments globally, making it one of the most frequently utilized assisted reproductive technologies.

The procedure differs fundamentally from natural conception by eliminating several potential barriers to fertilization. During natural intercourse, sperm must travel through the cervical mucus, which can be hostile to sperm, especially in certain hormonal conditions. By placing sperm directly into the uterine cavity, IUI circumvents these barriers and concentrates the most motile sperm in the optimal location for fertilization.

Historical Evolution: From Ancient Practices to Modern Science

Early Beginnings: The First Documented Cases (1780s-1800s)

The concept of artificial insemination dates back to ancient civilizations, but the first documented successful human artificial insemination was reported in 1884 by Dr. William Pancoast in Philadelphia. However, this early procedure was performed without the woman's knowledge or consent, highlighting the ethical complexities that would evolve with the technique.

Early attempts at artificial insemination were crude by modern standards, often involving simple injection of fresh semen into the vagina or cervix. Success rates were extremely low, and the procedures carried significant risks of infection due to limited understanding of sterile technique and sperm preparation methods.

The Scientific Revolution: Sperm Processing and Technique Refinement (1930s-1960s)

The mid-20th century marked a turning point in artificial insemination with the development of sperm processing techniques and improved understanding of female reproductive cycles. The introduction of sperm washing and concentration methods in the 1940s significantly improved success rates and reduced complications.

The development of ovulation prediction methods, including basal body temperature tracking and later luteinizing hormone (LH) detection, allowed for more precise timing of insemination procedures. This timing optimization was crucial for improving success rates and establishing IUI as a viable fertility treatment.

Modern Era: Technological Advancement and Standardization (1970s-Present)

The 1970s and 1980s saw the introduction of controlled ovarian hyperstimulation (COH) combined with IUI, dramatically improving success rates. The development of fertility medications like clomiphene citrate and later gonadotropins allowed physicians to control and optimize the ovulatory process.

Modern IUI protocols incorporate sophisticated sperm preparation techniques, precise ovulation monitoring using ultrasound and hormone levels, and evidence-based timing strategies. The introduction of intrauterine catheter systems designed specifically for IUI has further improved success rates and patient comfort.

The Science Behind IUI: Biological Mechanisms and Rationale

Sperm Transport and Cervical Barrier Bypass

During natural intercourse, only 1-5% of ejaculated sperm successfully traverse the cervical mucus and reach the uterine cavity. Cervical mucus acts as both a filter and a barrier, allowing only the most motile sperm to pass while blocking abnormal or less viable sperm. However, in certain conditions—such as previous cervical surgery, infections, or hormonal imbalances—this barrier can become impermeable even to healthy sperm.

IUI bypasses this natural selection process by placing prepared sperm directly into the uterine cavity, where they can immediately begin their journey toward the fallopian tubes. This bypass is particularly beneficial for couples with cervical factor infertility, unexplained infertility, or mild male factor infertility.

Sperm Capacitation and Preparation

The sperm preparation process for IUI involves several crucial steps that enhance sperm function and remove potentially harmful components. Sperm washing removes seminal plasma, which contains prostaglandins and other substances that can cause uterine cramping and immune reactions if introduced directly into the uterus.

The preparation process also separates motile sperm from non-motile sperm, cellular debris, and abnormal forms. Techniques such as density gradient centrifugation and swim-up procedures select the most motile and morphologically normal sperm, concentrating them in a small volume of culture medium optimized for fertilization.

Optimizing Sperm-Egg Interaction

By placing prepared sperm directly into the uterine cavity, IUI positions sperm closer to the fallopian tubes where fertilization occurs. This proximity reduces the time and energy sperm must expend traveling through the reproductive tract, potentially improving their viability when they reach the egg.

Indications for IUI: When is Treatment Recommended?

Unexplained Infertility

Couples with unexplained infertility have normal ovulation, patent fallopian tubes, and normal semen parameters, yet fail to achieve pregnancy after 12 months of regular unprotected intercourse. IUI with ovarian stimulation is often the first-line treatment for these couples, as it addresses potential subtle defects in sperm-cervical mucus interaction or sperm transport.

Studies demonstrate that IUI combined with ovarian stimulation increases pregnancy rates in unexplained infertility from 3-5% per cycle with expectant management to 15-20% per cycle with treatment. The cumulative pregnancy rate over 3-4 cycles reaches 40-50% for couples with unexplained infertility.

Mild Male Factor Infertility

IUI is particularly effective for men with mild oligospermia (low sperm count), asthenospermia (poor motility), or teratospermia (abnormal morphology). The sperm preparation process concentrates the best sperm and places them in the optimal location for fertilization, compensating for mild deficiencies in sperm parameters.

Specific parameters that predict IUI success include total motile sperm count (TMSC) after preparation >5 million, progressive motility >30%, and normal morphology >4% using strict criteria. Men with severe oligospermia (<5 million total motile sperm) or severe asthenospermia (<10% motility) typically have better success with IVF.

Cervical Factor Infertility

Cervical factor infertility occurs when the cervical mucus is hostile to sperm penetration or when anatomical abnormalities prevent normal sperm transport. Causes include previous cervical surgery, cervical stenosis, chronic cervicitis, or hormonal deficiencies affecting mucus production.

Ovulatory Disorders

Women with ovulatory disorders, particularly polycystic ovary syndrome (PCOS), may benefit from IUI combined with ovulation induction. The combination of controlled ovarian stimulation and IUI can be particularly effective when ovulation can be successfully induced with medications.

For women with PCOS, IUI combined with ovulation induction using clomiphene citrate or letrozole achieves pregnancy rates of 15-25% per cycle, compared to 5-10% with ovulation induction alone.

IUI Procedure: Step-by-Step Scientific Analysis

Pre-Cycle Evaluation and Preparation

The evaluation process begins with confirming tubal patency through hysterosalpingography (HSG), sonohysterography, or laparoscopy. At least one patent fallopian tube is essential for IUI success, as fertilization must occur within the tube. Studies show that bilateral tubal occlusion reduces IUI success rates to nearly zero.

Ovarian reserve assessment using anti-Müllerian hormone (AMH), antral follicle count (AFC), and day 3 FSH levels helps predict ovarian response to stimulation medications. Women with diminished ovarian reserve may require higher medication doses or may be better candidates for IVF.

Ovarian Stimulation Protocols

Natural Cycle IUI

Natural cycle IUI involves monitoring the woman's natural ovulation cycle without medications. Ovulation is tracked using urinary LH kits, serial ultrasounds, and/or serum LH monitoring. The insemination is timed to occur 12-36 hours after the LH surge, coinciding with ovulation.

Natural cycle IUI is appropriate for women with regular ovulation who want to avoid fertility medications or have contraindications to ovarian stimulation. While success rates are lower than stimulated cycles, the procedure is simpler and carries no risk of multiple pregnancies.

Clomiphene Citrate Stimulation

Clomiphene citrate is a selective estrogen receptor modulator that induces ovulation by blocking estrogen receptors in the hypothalamus, leading to increased FSH and LH release. Typical dosing ranges from 50-150 mg daily for 5 days, starting on cycle day 3-5.

Clomiphene citrate has anti-estrogenic effects on the endometrium and cervical mucus, which can potentially impair implantation and sperm transport. However, these effects are outweighed by the benefits of controlled ovulation and the bypass of cervical mucus through IUI.

Letrozole (Aromatase Inhibitor)

Letrozole is an aromatase inhibitor that blocks estrogen production, leading to increased gonadotropin release and ovulation induction. Studies show that letrozole may be superior to clomiphene citrate for ovulation induction, particularly in women with PCOS.

Letrozole has fewer anti-estrogenic effects on the endometrium and cervical mucus compared to clomiphene citrate, potentially improving implantation rates. The typical dosing is 2.5-7.5 mg daily for 5 days, starting on cycle day 3-5.

Gonadotropin Stimulation

Gonadotropins (FSH and LH) provide direct ovarian stimulation and are used when clomiphene citrate or letrozole are ineffective or contraindicated. Injectable gonadotropins allow for precise control of follicular development and can achieve higher pregnancy rates than oral medications.

Gonadotropin protocols require careful monitoring with serial ultrasounds and estradiol levels to prevent overstimulation and multiple pregnancies. The typical starting dose is 75-150 IU daily, with adjustments based on ovarian response.

Ovulation Monitoring and Timing

Ultrasound Monitoring

Transvaginal ultrasound monitoring tracks follicular development and determines optimal timing for insemination. Mature follicles typically measure 18-24 mm in diameter and contain mature eggs ready for ovulation. The presence of multiple mature follicles increases pregnancy rates but also increases the risk of multiple pregnancies.

Hormone Monitoring

Serum estradiol levels reflect follicular development and help assess the risk of ovarian hyperstimulation. Estradiol levels typically rise progressively during stimulation, reaching 200-400 pg/mL per mature follicle. Extremely elevated estradiol levels (>2500 pg/mL) may indicate increased risk of OHSS.

LH monitoring detects the natural LH surge that triggers ovulation. Some protocols rely on the natural LH surge for timing, while others use hCG trigger injections to precisely control ovulation timing.

Sperm Collection and Preparation

Sperm Collection Methods

Sperm collection typically occurs through masturbation into a sterile container, ideally at the clinic to minimize transport time and temperature exposure. For men who cannot produce samples through masturbation, alternative collection methods include special condoms for intercourse or surgical sperm retrieval in cases of ejaculatory dysfunction.

The timing of sperm collection is crucial. Samples should be processed within 1-2 hours of collection to maintain optimal sperm viability. Longer delays result in decreased motility and increased DNA fragmentation, which can reduce IUI success rates.

Sperm Preparation Techniques

Density Gradient Centrifugation

This technique uses gradients of different densities to separate motile sperm from non-motile sperm and debris. The sperm sample is layered over density gradients and centrifuged, with the most motile sperm penetrating to the bottom layer. This method removes most abnormal sperm and cellular debris while concentrating the best sperm.

Swim-Up Technique

The swim-up technique relies on the natural swimming ability of motile sperm to separate them from non-motile sperm and debris. The sperm sample is overlaid with culture medium, and motile sperm swim upward into the medium, leaving non-motile sperm and debris at the bottom.

This technique is gentler than density gradient centrifugation and may preserve sperm function better, but it typically recovers fewer total sperm and may not be suitable for samples with very low sperm counts.

The Insemination Procedure

Catheter Selection and Placement

IUI catheters are specifically designed for intrauterine insemination, with soft, flexible tips that minimize trauma to the cervix and uterus. The catheter is inserted through the cervix into the uterine cavity, typically 4-6 cm from the external cervical os, positioning the sperm in the uterine fundus.

Studies show that difficult catheter insertion, requiring multiple attempts or force, is associated with lower pregnancy rates. The presence of blood or mucus on the catheter after insertion may indicate cervical trauma, which can trigger uterine contractions and potentially expel the sperm.

Sperm Delivery and Volume

The prepared sperm sample is slowly injected into the uterine cavity over 1-2 minutes. The typical volume ranges from 0.3-0.5 mL, containing the concentrated sperm in a small volume of culture medium. Larger volumes may cause uterine cramping and potentially expel the sperm.

Post-Procedure Care

After insemination, patients typically remain supine for 10-15 minutes to minimize sperm loss. However, studies show that immediate ambulation does not significantly affect pregnancy rates, and prolonged bed rest is not necessary.

Patients may experience mild cramping or spotting after the procedure, which is normal and typically resolves within a few hours. Severe pain or heavy bleeding may indicate complications and should be reported to the medical team immediately.

Success Rates and Prognostic Factors

Overall Success Rates

Success rates for IUI depend on multiple factors including patient age, diagnosis, ovarian reserve, and sperm parameters. Young couples with unexplained infertility have the highest success rates, while older couples or those with multiple fertility factors have lower rates.

Age-Related Success Rates

Maternal age is the most significant predictor of IUI success, with pregnancy rates declining dramatically after age 35. This decline reflects both decreased egg quality and quantity, as well as increased risks of chromosomal abnormalities that can lead to pregnancy loss.

The age-related decline in IUI success rates parallels the decline in natural fertility, with the most significant drop occurring after age 38. Women over 42 have very low success rates with IUI and may be better candidates for IVF with genetic testing.

Diagnostic Category Impact

Unexplained Infertility

Couples with unexplained infertility have the highest IUI success rates, typically 18-25% per cycle with ovarian stimulation. The success reflects the absence of major fertility defects and the ability of IUI to overcome subtle barriers to conception.

Male Factor Infertility

Success rates correlate strongly with post-preparation sperm parameters. Total motile sperm counts >10 million are associated with optimal success rates, while counts <5 million have significantly lower rates and may warrant consideration of IVF.

Ovulatory Disorders

Women with ovulatory disorders, particularly PCOS, achieve good success rates with IUI when ovulation can be successfully induced. Success rates range from 15-25% per cycle, depending on the woman's age and response to ovulation induction.

Cumulative Success Rates

The cumulative success rate represents the total likelihood of pregnancy over multiple treatment cycles. Studies show that success rates plateau after 3-4 IUI cycles, with little additional benefit from further cycles in most cases.

For couples who do not achieve pregnancy after 3-4 well-timed IUI cycles, advancing to IVF is typically recommended. The decision depends on the couple's age, diagnosis, and individual circumstances, but prolonged IUI treatment beyond 4-6 cycles is generally not recommended.

Optimizing IUI Success: Evidence-Based Strategies

Timing Optimization

Studies comparing different timing strategies show that insemination 12-36 hours after the LH surge achieves optimal pregnancy rates. Earlier insemination (before the LH surge) results in lower success rates, while very late insemination (>48 hours) also reduces success due to egg aging.

The use of hCG trigger injections allows for precise control of ovulation timing, with insemination typically scheduled 36-40 hours after the trigger. This approach may achieve slightly higher success rates than relying on natural LH surge detection.

Single vs. Double Insemination

Early studies suggested that performing IUI on consecutive days might improve success rates by ensuring sperm presence regardless of exact ovulation timing. However, larger randomized controlled trials have consistently shown no significant benefit from double insemination, with pregnancy rates remaining similar to single insemination.

The lack of benefit from double insemination likely reflects the fact that prepared sperm can survive in the female reproductive tract for 24-48 hours, providing adequate coverage for the fertile window with a single well-timed insemination.

Luteal Phase Support

Ovarian stimulation can disrupt normal luteal phase function, leading to inadequate progesterone production and potential implantation failure. Luteal phase support with progesterone supplementation helps maintain the endometrium and supports early pregnancy development.

Studies show that luteal phase support with progesterone (vaginal suppositories, oral capsules, or injections) can improve pregnancy rates by 10-15% in stimulated IUI cycles. The benefit is most pronounced in cycles with multiple follicles or higher estradiol levels.

Lifestyle Modifications and Adjuvant Therapies

Nutritional Optimization

Preconception nutrition can significantly impact IUI success rates. Folic acid supplementation (400-800 mcg daily) is essential for preventing neural tube defects and may improve oocyte quality. Antioxidant supplementation, including vitamins C and E, may benefit both male and female fertility.

Weight Management

Both underweight and overweight conditions can negatively impact IUI success rates. Obesity (BMI >30) is associated with decreased ovarian response to stimulation medications, increased risk of pregnancy complications, and lower live birth rates. Weight loss of even 5-10% can significantly improve fertility outcomes.

Stress Reduction

Chronic stress can affect reproductive hormones and potentially impact IUI success rates. Stress reduction techniques, including meditation, yoga, acupuncture, and counseling, may improve treatment outcomes and overall well-being during fertility treatment.

Risks and Complications of IUI

Multiple Pregnancies

The risk of multiple pregnancies increases with the number of mature follicles at the time of insemination. Cycles with 2-3 mature follicles have multiple pregnancy rates of 20-30%, while cycles with 4 or more mature follicles have rates exceeding 40%.

Multiple pregnancies carry significant risks for both mothers and babies, including increased rates of preterm birth, low birth weight, pregnancy complications, and neonatal intensive care unit admissions. The long-term health and developmental consequences for multiple birth children are also significant concerns.

Ovarian Hyperstimulation Syndrome (OHSS)

OHSS is a potentially serious complication of ovarian stimulation, occurring in 1-5% of stimulated IUI cycles. Mild OHSS causes abdominal bloating and discomfort, while severe cases can involve significant fluid shifts, kidney dysfunction, and blood clotting abnormalities.

Risk factors for OHSS include young age, PCOS, previous history of OHSS, and high estradiol levels during stimulation. Prevention strategies include careful monitoring, dose adjustments, and cycle cancellation when appropriate.

Infection Risk

Pelvic infections following IUI are rare but can lead to serious complications including pelvic inflammatory disease, fallopian tube damage, and infertility. Symptoms include fever, severe pelvic pain, and abnormal vaginal discharge occurring within days to weeks after the procedure.

Prevention involves strict sterile technique during the procedure, screening for sexually transmitted infections before treatment, and prompt evaluation of any concerning symptoms following IUI.

Pregnancy Complications

Pregnancies resulting from IUI have slightly higher rates of certain complications compared to natural conception, including ectopic pregnancy (2-3% vs. 1-2%), pregnancy loss (15-20% vs. 10-15%), and preterm birth (8-12% vs. 6-8%).

The increased risks may be related to underlying fertility factors, the effects of ovarian stimulation, or the IUI procedure itself. However, the absolute risks remain relatively low, and most IUI pregnancies result in healthy babies.

IUI vs. Other Fertility Treatments

IUI vs. Timed Intercourse with Ovulation Induction

While timed intercourse with ovulation induction is less invasive and expensive than IUI, it achieves lower pregnancy rates in most diagnostic categories. The exception may be couples with ovulatory disorders and no other fertility factors, where the pregnancy rates may be similar.

IUI is particularly advantageous for couples with mild male factor infertility, cervical factor infertility, or unexplained infertility, where the sperm preparation and intrauterine placement provide specific benefits not achieved with timed intercourse.

IUI vs. IVF

The choice between IUI and IVF depends on multiple factors including patient age, diagnosis, previous treatment history, and personal preferences. IUI is typically recommended as first-line treatment for couples with unexplained infertility, mild male factor infertility, or ovulatory disorders.

IVF may be recommended initially for couples with severe male factor infertility, tubal factor infertility, advanced maternal age (>40), or multiple failed IUI cycles. Some couples may choose to proceed directly to IVF to maximize their chances of success, particularly if they have limited time or resources for treatment.

Cost-Effectiveness Analysis

The cost-effectiveness of IUI versus IVF depends on success rates, number of cycles required, and individual patient factors. For young couples with unexplained infertility, 3-4 cycles of IUI may be more cost-effective than proceeding directly to IVF.

However, for couples with poor prognosis or advanced maternal age, the lower success rates of IUI may make IVF more cost-effective despite the higher upfront costs. Individual counseling and shared decision-making are essential for determining the optimal treatment approach.

Special Considerations and Patient Populations

Age-Related Considerations

Women Over 40

The age-related decline in egg quality becomes particularly pronounced after age 40, with increased rates of chromosomal abnormalities and pregnancy loss. While IUI may still be successful in some cases, the lower success rates and limited time for treatment often make IVF a more appropriate choice.

Preimplantation genetic testing (PGT) can identify chromosomally normal embryos, potentially improving success rates and reducing pregnancy loss rates in older women. However, this technology is only available with IVF, not IUI.

Young Women with Diminished Ovarian Reserve

Young women with diminished ovarian reserve (low AMH or high FSH) may have reduced success rates with IUI due to poor response to ovarian stimulation. However, if they respond adequately to stimulation and produce mature follicles, IUI can still be successful.

These women may benefit from more aggressive stimulation protocols or earlier advancement to IVF if IUI is unsuccessful. The decision should be individualized based on the degree of ovarian reserve reduction and the patient's preferences.

Male Factor Considerations

Severe Male Factor Infertility

Men with severe oligospermia (<1 million total motile sperm), severe asthenospermia (<5% motility), or severe teratospermia (<1% normal morphology) have very low success rates with IUI and are generally better candidates for IVF with intracytoplasmic sperm injection (ICSI).

Sperm DNA Fragmentation

Sperm DNA fragmentation testing may provide additional prognostic information for IUI success. High levels of DNA fragmentation (>30%) are associated with lower pregnancy rates and higher miscarriage rates with IUI.

Treatment options for high DNA fragmentation include antioxidant supplementation, lifestyle modifications, and in some cases, testicular sperm extraction (TESE) for use with IVF/ICSI.

Same-Sex Couples and Single Women

The use of donor sperm eliminates male factor infertility as a variable, often resulting in higher success rates than IUI with partner sperm. Success rates depend primarily on the woman's age and fertility factors, with young women achieving pregnancy rates of 20-30% per cycle.

Donor sperm selection involves extensive screening for infectious diseases, genetic disorders, and physical characteristics. Many sperm banks also provide detailed donor profiles including medical history, education, and interests to help recipients make informed choices.

Psychological and Emotional Aspects of IUI

Stress and Anxiety During Treatment

The IUI process can be emotionally challenging, involving uncertainty, loss of control, and pressure to achieve pregnancy. The cyclical nature of treatment, with hopes raised and potentially disappointed each month, can be particularly stressful.

Studies show that women undergoing fertility treatment have stress levels comparable to those diagnosed with serious medical conditions like cancer or heart disease. This stress can affect relationships, work performance, and overall quality of life.

Coping Strategies and Support

Effective coping strategies include maintaining open communication with partners, seeking support from friends and family, participating in support groups, and working with mental health professionals who specialize in fertility issues.

Mind-body interventions, including meditation, yoga, and cognitive behavioral therapy, can help reduce stress and improve overall well-being during fertility treatment. These approaches may also have positive effects on treatment outcomes.

Managing Failed Cycles

Failed IUI cycles can be devastating for couples, triggering feelings of grief, disappointment, and uncertainty about the future. It's important to normalize these feelings and provide support for processing the emotional impact of unsuccessful treatment.

Healthcare providers should offer compassionate counseling about next steps, including whether to continue with IUI or advance to other treatments. The decision should be based on both medical factors and the couple's emotional readiness to continue treatment.

Future Directions and Emerging Technologies

Personalized Medicine Approaches

Pharmacogenetic testing can identify how individuals metabolize fertility medications, potentially allowing for more precise dosing and improved treatment outcomes. Genetic testing for thrombophilia and other conditions may also influence treatment protocols.

Biomarker research is investigating various blood and urine markers that may predict ovarian response, egg quality, and implantation potential. These markers could help optimize treatment protocols and identify couples most likely to benefit from IUI.

Improved Sperm Selection Techniques

New sperm selection technologies, including microfluidic devices and advanced microscopy techniques, may improve the selection of high-quality sperm for IUI. These technologies can identify sperm with better morphology, motility, and DNA integrity.

Artificial Intelligence and Machine Learning

AI and machine learning algorithms are being developed to predict IUI success rates, optimize treatment protocols, and identify the best candidates for treatment. These tools can analyze large datasets and identify patterns that may not be apparent to human observers.

AI-powered ultrasound analysis may improve follicle tracking and timing optimization, while machine learning algorithms could help predict the optimal number of cycles to attempt before advancing to IVF.

Global Perspectives and Access to Care

International Variation in IUI Practices

Some countries emphasize natural cycle IUI to minimize costs and risks, while others routinely use ovarian stimulation to maximize success rates. These differences reflect varying healthcare funding models, cultural attitudes toward fertility treatment, and regulatory frameworks.

Success rates also vary internationally, with some countries reporting higher rates due to patient selection criteria, treatment protocols, or reporting methods. Standardization of outcome reporting would improve the ability to compare results across different healthcare systems.

Access and Equity Issues

Insurance coverage for fertility treatment varies widely, with some countries providing comprehensive coverage while others offer minimal or no coverage. This variation creates significant disparities in access to care and treatment outcomes.

Efforts to improve access include advocacy for insurance coverage, development of lower-cost treatment protocols, and programs to provide subsidized care for underserved populations. Telemedicine and remote monitoring technologies may also help improve access in underserved areas.

Evidence-Based Recommendations for IUI Treatment

Long-Term Outcomes and Follow-Up

Obstetric and Neonatal Outcomes

Large cohort studies show that IUI pregnancies have similar rates of major birth defects compared to natural conception. However, there are slightly increased rates of preterm birth (8-12% vs. 6-8%) and low birth weight (6-8% vs. 4-6%), likely related to higher rates of multiple pregnancies.

The long-term health outcomes for children born from IUI appear to be similar to those conceived naturally, with no significant increases in childhood cancers, developmental delays, or other health problems.

Subsequent Fertility

Many couples who require IUI for their first pregnancy may conceive naturally for subsequent pregnancies, particularly if the original diagnosis was unexplained infertility or mild male factor infertility. This suggests that IUI may help overcome temporary or situational fertility barriers.

However, couples with persistent underlying fertility factors may require fertility treatment for subsequent pregnancies. Age-related fertility decline will also affect the likelihood of natural conception for future pregnancies.

The Bottom Line: Making Informed Decisions About IUI

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