Intrauterine insemination (IUI) is an affordable and less invasive alternative to in vitro fertilization (IVF). For women who are good candidates, success rates are slightly lower than those associated with IVF, but still quite high. In the days following an IUI procedure, you may be overwhelmed by feelings of anxiety and eager anticipation as you await your pregnancy test (sometimes called a beta). Here’s what to expect in the days and weeks following an IUI procedure.
IUI: An Overview
To understand what happens after IUI, you must first understand what IUI is and how it works. Intrauterine insemination is a procedure that implants semen directly into the uterus at a time when the woman is likely to be fertile. This shortens the journey the sperm has to make to the egg. It also ensures that sperm is in the body at the best possible time for conception. Combining these two factors greatly increases the odds of a successful pregnancy.
Prior to an IUI procedure, a woman may take fertility medications to increase the number of eggs she produces or to induce ovulation. While a woman does not have to use fertility drugs to try IUI, these medications can greatly increase the chances that an IUI procedure will be successful.
After the procedure, though, the rest is up to nature. To create a pregnancy, the sperm must fertilize the egg. The egg must then implant in the wall of the uterus, and the body must produce enough hormones to sustain the pregnancy. In some cases, your doctor might recommend that you take a hormone medication -- if it is found that your body doesn’t naturally produce sufficient levels of the proper hormones.
IUI is a great option for people with a wide variety of fertility issues, including:
- Low sperm count or motility -- IUI is a great aid to these issues since the sperm does not have to travel as far.
- Infrequent ovulation -- IUI increases the chances of successful fertilization since IUI medications can induce ovulation.
- Unexplained infertility -- IUI eliminates several variables.
- Structural or sexual problems that make fertilization difficult -- for example, if a man cannot ejaculate, a doctor can surgically remove semen and then implant it directly into the woman’s body.
- Immune system issues -- that cause the woman’s body to attack the man’s sperm.
Additionally, IUI can be a good option for people who do not want to try IVF, who cannot afford IVF, or who have objections to the IVF process.
IUI cannot treat all infertility issues, especially implantation issues or recurrent miscarriages. So it’s important to get a comprehensive workup from a fertility specialist. Ask lots of questions about whether IUI is the right options for you. A skilled fertility specialist can help you determine whether IUI is a good choice, and should be able to help you assess the odds of success.
What to Do After IUI
Meticulous timing is key to the success of IUI. The procedure occurs roughly in the middle of your cycle, when you ovulate. If you are having a medicated cycle, you’ll use drugs to trigger ovulation. Otherwise, a provider will test for ovulation and time the procedure accordingly.
After IUI, you should feel fine. The procedure is not dangerous and under most circumstances will not require sedation. This means you can drive yourself home and return to your usual activities right away.
Following an IUI procedure, it’s important to act as if you are already pregnant. This ensures that, if the implantation is successful, the pregnancy gets the best possible start. Talk to your doctor about any medications you take, especially prescription drugs that can affect pregnancy. Additionally, do the following:
- Avoid alcohol, illegal drugs, and cigarettes.
- Eat a healthy, balanced diet that is rich in protein.
- Drink plenty of water.
- Get enough sleep.
- Remain physically active, but do not try to lose weight or start an overly intense exercise routine.
- Find ways to manage stress.
- Take a prenatal vitamin containing folic acid or folate.
It’s helpful to develop a plan for managing the two-week wait -- the two-week period between IUI and your first pregnancy test. A vacation, a new hobby, fun dates, and meaningful activities can help distract you. While it may be tempting to spend all of your time contemplating a potential pregnancy, it’s important to manage your emotions no matter the outcome.
3 Days After IUI: Symptoms to Expect
Some women experience spotting immediately after an IUI procedure. This is due to irritation of the delicate tissue of the cervix and vagina, and is not implantation bleeding. Implantation bleeding occurs later, usually 7-11 days after the procedure, when the egg implants in the wall of the uterus.
By about three days, any initial spotting will have stopped. If you are still bleeding, experience cramping, or are in pain, contact your doctor. Because it is impossible to be pregnant this early in the process, you will not have any pregnancy symptoms. Consider keeping a list of any symptoms you experience during the first dew days. This gives you an idea of what’s normal for your body, and can help you decide what is and is not a pregnancy symptom down the road. For instance, if you experience breast tenderness, you’ll know that breast tenderness is a typical symptom for you and not necessarily a sign of pregnancy.
6 Days After IUI: Implantation and Beyond
At the six day mark, you may be approaching implantation. Implantation typically occurs about a week after the IUI procedure, so now is the time to begin monitoring for signs of implantation. If you notice some light spotting, this could be implantation bleeding. Some women also experience cramping at implantation. However, most women do not experience implantation bleeding, and do not have any symptoms this early. So the absence of symptoms does not necessarily mean you’re not pregnant, or that the procedure failed. Moreover, some women experience implantation much later -- at 11 or 12 days after IUI. So you may have to wait several more days for any noticeable implantation or pregnancy symptoms.
When Do Pregnancy Symptoms Appear?
The Internet is full of misleading advice. You’ll find people on message boards claiming they had pregnancy symptoms the day after an IUI procedure, or insisting that fertilization begins a pregnancy. This can be confusing and frustrating when you’re trying to understand what you can expect. The simple truth is this: you are not pregnant until implantation occurs, and it can take quite a while after implantation for the body to display any obvious signs of pregnancy.
Implantation marks the medical beginning of pregnancy. It is impossible to get a positive pregnancy test before implantation occurs because implantation causes the body to begin producing HCG, the pregnancy hormone that pregnancy tests measure. Because HCG production only begins at implantation, and because you are not pregnant until implantation occurs, it is impossible to experience pregnancy symptoms before implantation.
Most people do not begin experiencing symptoms until several days after implantation, when HCG levels begin to rise rapidly. And some people do not experience any pregnancy symptoms until well after they get a positive pregnancy test. So don’t let an absence of symptoms deflate your hopes.
Early signs of Pregnancy
The early signs of pregnancy are often subtle. For many women, they’re similar to the signs that their period is coming. So it's helpful to track your symptoms over time so you can better understand your body’s patterns. A deviation from the norm is the biggest sign that you could be pregnant.
The most common early symptoms of pregnancy include:
- Stomach discomfort such as diarrhea or stomach pain
- Nausea, dizziness, and vomiting
- Breast tenderness
As HCG levels rise, these symptoms tend to become more intense. However, by that point you will have already been able to get a positive pregnancy test. The truth is that for most women, early pregnancy symptoms take several weeks to become noticeable, so don’t count on your body to immediately indicate that you’re pregnant. For many women, the first symptom of pregnancy is a missed period.
The Pregnancy Test
About two weeks after the IUI procedure, you’ll go back to your doctor for a pregnancy test. It’s tempting to take home tests before this point, and there’s no harm in doing so. However, it’s important to note that false negatives are very common with early pregnancy tests, before HCG levels have risen sufficiently for the test to pick them up. You’ll get a more accurate result at the doctor, since your provider will likely perform a blood test.
If the first pregnancy test is negative and you don't get your period a day or two later, the doctor may test again. Sometimes HCG levels rise slowly or implantation occurs later than expected, delaying a positive result.
Your provider may monitor HCG levels, since this can provide important information about whether a pregnancy is progressing normally. Falling or slowly rising HCG levels may mean there is a problem, and your doctor might recommend more tests. But if all seems well, then pregnancy becomes a waiting game. You’ll transition to a traditional OB or midwife near the end of your first trimester. By this point, the chances of having a miscarriage are very low, and you can feel confident that this is really happening!
What if IUI Doesn’t Work?
Sometimes an initial test is positive, and then a few days later it is negative. This typically means you had a very early miscarriage. While a miscarriage can be agonizing, it's usually due to a chromosomal anomaly -- not something you did wrong. It’s not your fault, and most women who have miscarriages go on to have healthy and happy pregnancies the next time around. If you experience a miscarriage, ask your doctor about your options. In many cases, another cycle of IUI is the best choice.
If the first IUI procedure fails, you’ll meet with your provider to discuss your options going forward. It’s important to know that a single failed IUI procedure does not typically mean anything about your ability to get pregnant. Just as trying the old fashioned way fails more often than it succeeds, IUI often fails before it succeeds. So if everything went well and you are still a good candidate for IUI, your provider might recommend trying another IUI cycle. If you opted not to use fertility drugs for your first IUI cycle, your provider might recommend using them next time. Your doctor may also conduct blood tests to ensure that other issues, such as low progesterone, does not interfere with the success of IUI.
Choosing the right fertility specialist is key to maximizing your odds of success. The right provider can assess your overall health, recommend the right drugs for intrauterine insemination, and prepare you for the process.
At the Center of Reproductive Medicine, we specialize in IUI and other artificial reproductive technologies. Our success speaks for itself, and we pride ourselves on helping couples and individuals get pregnant as quickly as possible. We work with every patient to identify treatment strategies that work with their needs, treatment goals, values, and budget. We also understand that you are more than just an infertility case. You’re a person with needs and feelings.
We know how painful infertility can be, and we aim to make the journey a little less painful. We can connect you to support groups and other resources, and we’ll handle your concerns with compassion and gentleness. We’re here for you. We get it. And we can help. Make an appointment with the Center of Reproductive Medicine if you’re ready to make a plan for becoming a parent.