Intrauterine insemination (IUI) doesn’t have the greatest reputation in the fertility community, mainly because of its low success rates. But that doesn’t mean people trying to conceive should dismiss this procedure out of hand. IUI remains a good option for a number of reasons, such as if you’re using donor sperm or experiencing unexplained infertility.
In addition, IUI is a minimally invasive, lower-cost alternative to in-vitro fertilization (IVF), making it a more appealing choice for those who may not be ready to invest in more expensive fertility treatments.
After years of unexplained infertility, I finally got pregnant on my third IUI, so I can attest that this option does work, even if IVF boasts higher success rates.
Although there are plenty of available resources explaining what happens before and during an IUI, it’s just as important for patients to know the ins and outs of what happens after insemination. Read on to learn more about those crucial days following an IUI treatment.
What is IUI (intrauterine insemination)?
IUI is a procedure that places separated sperm directly into a woman’s uterus while she is ovulating. The patient typically takes oral medication prior to the IUI to increase the number of eggs growing each month. Following an ultrasound around day 9 or 10 of the woman’s cycle, the patient will likely inject a “trigger shot” of human chorionic gonadotropin (hCG) to help the egg complete its maturation process. The IUI itself is then usually performed by a reproductive endocrinologist at a fertility clinic, with the insemination taking place in the 24-36-hour window of the post-luteinizing hormone (LH) surge.
What happens after an IUI, day by day?
Here is a rough timeline of what exactly occurs in the body during the 14 days post-IUI, according to Jessica Ryniec, MD, a reproductive endocrinologist with CCRM Boston:
Day 1 is the day of the IUI: The procedure itself is fairly short and involves a speculum exam to visualize the cervix, and then a thin catheter is used to place the sperm sample high up in the uterus to be closer to the egg. Most do not feel anything, although some people may have some cramping. The goal is for the IUI to be timed during ovulation so that the sperm is available when the egg is released.
Days 1-3: Some people may experience some light cramping and/or spotting. However, most people will have no symptoms at this point. The next step inside the body at this point is for the sperm to fertilize the egg. This typically occurs within 12-24 hours of ovulation. The fertilized egg or zygote then develops into an embryo over the next few days.
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Around Day 6: The embryo becomes a blastocyst, which is capable of implanting into the wall of the uterus.
Around Day 9: Implantation happens by the 9th day in the majority of women who become pregnant after ovulation and IUI. Some people experience symptoms of ovulation – spotting (typically light pink or light brown) or cramping (although only about 30% of people report this).
Days 10-14: Once implantation occurs, HCG starts to be released into the bloodstream and this is the earliest you might see a positive home pregnancy test. However, for many, a test may not become positive until 12-14 days after the IUI or at the time of the missed period.
So what should you do in the meantime?
The 14 days post-IUI – aka, the two-week wait
You may already be familiar with this particular timeline: Many in the fertility community call it the “two-week wait.” During this time – 14 days following the IUI – patients are advised to “proceed as if pregnant, as they are ‘pregnant until proven otherwise, or PUPO,’” says Dr. Ryniec. Therefore, she advises patients “modify lifestyle habits that aren’t safe in pregnancy” – like abstaining from drinking alcohol – and following the post-IUI instructions from the patient’s fertility clinic.
Adopting a PUPO lifestyle can be challenging for patients, especially before they have confirmation of an actual pregnancy. But Dr. Ryniec says these conservative guidelines have a mental health component as well: “We know unsuccessful people often feel self-blame (which they shouldn’t!), so we try to help avoid that by giving restrictions.” The good news is, there’s usually no reason to sit around worrying about that upcoming pregnancy test. It’s safe for patients to continue regular endorphin-producing activities like exercise and sex after having an IUI, says Dr. Ryniec. In fact, having sex the day of and/or the day after the IUI increases your chances of getting pregnant.
Between the stress of waiting, and possible light cramping after the IUI, it’s imperative to take care of both your body and mind during this period. “When undergoing fertility treatments, women are often focused on physical health, but don’t put enough energy into their mindset,” says Sara Celik, ND, a licensed naturopathic doctor based in Toronto, Ontario.
Dr. Celik recommends patients get lots of rest post-IUI, limit their caffeine intake, and avoid intense workouts (yes, exercise is safe, but keep it light). If possible, she also recommends they take a few days off work.
“I highly encourage daily fertility meditations; nourishing foods like bone broth and warm stews, and doing things that create a feeling of joy,” she says. “The last recommendation can help take a woman’s mind off the stressful two-week wait.”
How soon can you test after an IUI?
As tempting as it may be to take a pregnancy test soon after your IUI, Dr. Ryniec advises sitting tight. “The first day that you can trust an at-home pregnancy test following an IUI would be 14 days later,” she says. She warns that it is possible to get a positive test about one-week post-IUI, but “you can’t trust a negative test until 14 days after ovulation (or until you get a period).” So for the most accurate result, it’s best to wait the full 14 days post-IUI. Some clinics may call you on the first day you can test – that’s how I found out I was pregnant from my IUI.
Your pregnancy test is positive – now what?
Don’t start calling friends and family just yet: Your fertility team is going to want to monitor you for a little while longer to confirm your pregnancy and ensure everything is moving along smoothly.
The first step if your at-home pregnancy test is positive is to reach out to your fertility clinic and schedule an HCG blood test. “If [the blood test] is positive as well, it is likely that pregnancy hormone levels will be followed for one-to-two more levels to make sure it is rising appropriately, which is about double every two-to-three days,” says Dr. Ryniec. So be prepared for multiple blood tests.
Then, the patient will undergo their first ultrasound at around six weeks. While protocols vary by clinic, Dr. Ryniec says patients should expect to “be seen [by their fertility specialist] for two-to-three blood tests and then one-to-two ultrasounds before ‘graduating’ to their OB-GYN.”
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.