The What, When and Why of IUI

Shannon M. Clark, MD
September 24, 2021
The What, When and Why of IUI

The Basics of IUI

While many people conceive a baby spontaneously after a few months of trying. For others, the path is not so straightforward, and intrauterine insemination (IUI) is a common route to successful conception. I recently spoke with Reproductive Endocrinology and Infertility specialist, Dr. Kenan Omurtag, about the what, when and why of IUI. IUI is also known as artificial insemination. It’s a type of fertility treatment that involves placing sperm inside the uterus closer to the fallopian tubes at the right time to help increase the chance of conception around the time of ovulation.

Medicines exist that can be used with IUI to help increase the likelihood of conception. One such medicine is Clomid—a non-steroidal fertility medicine. It works by tricking the brain into thinking there is no estrogen, so the brain releases more follicle stimulating hormones (FSH). In patients that don’t ovulate, this helps them recruit a follicle. In patients who do ovulate, it helps them superovulate to recruit more than one follicle.


Dr. Omurtag and I discuss this and more in our chat, including:

  • The process of IUI with a spontaneous menstrual cycle
  • The best candidates for IUI
  • IUI plus clomid, letrozole and injectables
  • Using IUI to prepare someone for IVF
  • Ovarian hyperstimulation syndrome (OHSS)
  • How many follicles can be expected with the different IUI protocols
  • Use of ovulation prediction kits (OPKs)
  • Use of ultrasound for ovulation prediction
  • How many IUI cycles before moving on to IVF
  • Use of supplements to improve fertility in both partners

If you are doing IUI and not conceiving, at what point do you consider moving onto IVF?

At minute 39:40, we discuss this. 3-4 IUI cycles is where you get your peek success rate. So if you haven’t had success conceiving at 3 IUI cycles, consider seeing a fertility specialist. If you haven’t had success conceiving at 6 IUI, definitely see a fertility specialist.  

There are several factors that can cause IUI to not work. One such factor might be an underlying condition that is leading to irregular menstruation and/or ovulation. For a person who is having irregular menstruation and trying to conceive, before any kind of fertility treatment is sought, you really need to work with your healthcare providers to find out what the underlying cause of the irregularity. For example, a patient seeing a fertility specialist who is having only 2-3 periods a year should have a full blood work-up. Like I say at minute 44:00, regular menstrual cycles are part of a person’s overall health and if they are not regular, then the underlying cause should be investigated. Finally, an underlying condition like PCOS is important to assess and appropriately treat before pursuing IUI and IVF.

For those who are considering IUI or are just starting out on the process, this discussion with Dr. Omurtag, is a must watch. You can also learn more about IUI and IVF in his extremely helpful videos on IGTV!

Shannon M. Clark, MD

Shannon M. Clark, MD

Shannon M. Clark, MD, MMS is a double board certified ObGyn and Maternal-Fetal Medicine Specialist, and founder of Babies After 35. In her roles as a clinician, educator and researcher at UTMB-Galveston, she focuses on the care of people with maternal and/or fetal complications of pregnancy. Dr. Clark has taken a special interest in pregnancy after the age of 35, which according to age alone, is considered a high-risk pregnancy.

Follow Shannon on TikTok @tiktokbabydoc, Facebook @babiesafter35, and Instagram @babiesafter35.

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