IUI

Intrauterine insemination places prepared sperm directly inside the womb at the moment the egg is released. It removes the journey through the cervix, and it concentrates the sample, so a much larger number of moving sperm arrive near the egg than would after intercourse.

The preparation is done in the laboratory on the day. The semen sample is washed and spun to separate the actively swimming sperm from the fluid, dead cells and debris, and the final volume placed into the womb is well under a millilitre of that concentrated fraction.

It is usually combined with mild stimulation and scan tracking, so the insemination can be timed to within a few hours of ovulation. It asks nothing of you on the day beyond a few minutes on the couch, and no anaesthetic is involved.

The cycle is monitored with scans, and once the follicle is mature you are given a trigger injection. The insemination is booked for roughly 24 to 36 hours later. Your partner produces a sample about an hour and a half beforehand, or a frozen or donor sample is thawed to the same schedule.

On the couch you lie as you would for a smear. A speculum is passed, the cervix is wiped clean, and a very fine soft catheter is threaded through the cervical canal into the cavity of the womb. The sperm is injected slowly and the catheter withdrawn. The whole thing takes a few minutes and most women feel nothing more than a brief period-like cramp.

You rest on the couch for ten minutes and then get up and go about your day. Progesterone support is often started that evening, and a pregnancy test is done two weeks later.

There is nothing to recover from. You can drive yourself home, go back to work the same afternoon, exercise, travel and have intercourse as normal. Bed rest afterwards does not improve the chance of pregnancy. Light spotting and mild cramping on the day are common.

Judged over months, insemination gives roughly a 10 to 15 percent chance of pregnancy per cycle when the tubes are open and the sperm count is reasonable, and lower where either is compromised or where the woman is over 38. Because the per-cycle figure is modest and the cumulative one plateaus, most clinics plan three to four cycles and then reassess honestly instead of continuing. If those cycles pass without a pregnancy, the discussion turns to IVF, and that is a change of plan and not a failure on your part.