# Intrauterine Insemination

> Intrauterine insemination for NEET-PG Obstetrics and Gynaecology, covering indications, semen preparation, insemination timing and cycle limits.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/intrauterine-insemination
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Dutta's Textbook of Obstetrics; Speroff's Clinical Gynecologic Endocrinology and Infertility
- How to cite: "Intrauterine Insemination", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/intrauterine-insemination

## Direct answer

Intrauterine insemination places prepared, motile sperm directly into the uterine cavity around ovulation, bypassing the cervix. It is used for unexplained infertility, mild male factor and cervical factor, and it requires at least one patent tube. Its pregnancy rate per cycle is modest, which is why it is offered for a limited number of cycles.

## What you must remember

- **Indications:** Unexplained infertility, mild male factor, cervical factor, ovulatory dysfunction with gonadotropin stimulation, and donor sperm use.
- **Tubal requirement:** At least one patent fallopian tube, because fertilisation takes place in the tube.
- **Semen preparation:** Density gradient centrifugation or swim-up separates motile sperm and removes seminal plasma, prostaglandins and leucocytes.
- **Motile sperm target:** A post-wash total motile count of about 5 to 10 million is commonly aimed for.
- **Timing:** Insemination falls within about 24 to 36 hours of the LH surge or around 34 to 36 hours after hCG, usually once or twice.
- **Cycle limit:** Clinics commonly offer about three to six cycles before moving to IVF, depending on age and diagnosis.
- **Multiple pregnancy:** Risk rises when gonadotropins are combined with IUI, so follicle numbers must be monitored.

## A stepwise IUI pathway

The vignette usually gives the diagnosis and the cycle type, and the pathway below shows the order in which decisions are made.

1. **Confirm tubal patency:** Check that at least one tube is patent before committing to IUI, since a bilateral block makes IUI pointless.
2. **Stimulate or monitor ovulation:** Use natural cycle monitoring, clomiphene, letrozole or gonadotropins, with ultrasound tracking of follicles.
3. **Prepare the sample:** Collect after two to seven days of abstinence, then wash and concentrate the sperm by density gradient or swim-up.
4. **Time the insemination:** Inseminate within the window after the LH surge or hCG trigger, usually once or twice per cycle.
5. **Assess the outcome:** Test for pregnancy about two weeks after insemination, then move to IVF if repeated cycles fail.

Success depends on age, the cause of infertility and the number of cycles, so the move to IVF is made after a set number of unsuccessful cycles. Ovulation must be confirmed in each cycle, because insemination outside the window wastes a cycle.

## Where the exam tries to catch you

IUI questions often hinge on whether the correct option is IUI at all, rather than how to perform it.

- **Trap:** Doing IUI when both tubes are blocked. — **Correct:** IUI needs at least one patent tube, and bilateral block requires IVF.
- **Trap:** Using IUI for severe male factor. — **Correct:** Severe oligozoospermia needs ICSI, because IUI cannot overcome a very low count.
- **Trap:** Inseminating raw semen without washing. — **Correct:** Raw semen contains prostaglandins that cause uterine cramping, so the sample is washed first.

## Frequently asked questions

### Which conditions are the usual indications for intrauterine insemination?

Intrauterine insemination is commonly used for unexplained infertility, mild male factor, cervical factor and donor sperm. It requires at least one patent fallopian tube and a reasonable sperm count and motility.

### Why must semen be washed before intrauterine insemination?

Semen must be washed before intrauterine insemination because raw seminal plasma contains prostaglandins that can cause uterine cramping. Washing by density gradient or swim-up also concentrates motile sperm and removes leucocytes.

### How many IUI cycles are usually offered before moving to IVF?

Clinics commonly offer about three to six IUI cycles before moving to IVF, depending on age, diagnosis and ovarian reserve. The exact number varies between centres, so it reflects local practice rather than a fixed rule.

### What is the main risk of combining gonadotropins with intrauterine insemination?

The main risk of combining gonadotropins with intrauterine insemination is multiple pregnancy, including twins and higher-order pregnancies. Close ultrasound monitoring and limiting the number of follicles allowed to ovulate reduce this risk.