When a couple has been trying to conceive for a long time without success, they may turn to fertility treatments to improve their chances. The two most common options are timed intercourse and intrauterine insemination (IUI). Both methods aim to synchronize ovulation with the arrival of sperm in the uterus, but they have different characteristics, advantages, and limitations. Here’s how they work and how they differ, so you can decide with your doctor which suits your situation best.
What is timed intercourse and how does it help you?
Timed intercourse is a simple assisted reproduction method. It involves identifying your fertile window and having intercourse 24 to 36 hours after ovulation. It’s recommended when there are no serious fertility issues or when the cause is unexplained. Avoid self-medication and always follow your specialist’s instructions.
How timed intercourse works step by step
This method is divided into three phases:
- Cycle monitoring: Using ultrasounds and hormone tests (FSH, LH in mIU/mL) to detect the day of ovulation.
- Ovarian stimulation (optional): If your doctor recommends it, you may take clomiphene citrate or letrozole to regulate cycles.
- Timed intercourse: You have intercourse at the optimal time, increasing your chances of pregnancy.
Advantages
- Minimally invasive with easy follow-up.
- Lower cost than IUI or IVF.
- Improved precision by concentrating efforts in your fertile window.
Disadvantages
- Depends on semen quality; a normal semen analysis is required.
- Not ideal for severe male infertility or low ovarian reserve.
What is IUI and how does it help you?
Intrauterine insemination (IUI) involves processing and placing sperm directly into the uterus at ovulation. This bypasses obstacles like the cervix. It’s a low-complexity method and is especially helpful for cervical factor infertility or moderate semen quality. Before starting, consult a reproductive specialist.
How IUI works step by step
- Ovarian stimulation: Hormonal medication to mature multiple eggs.
- Sperm preparation: In the lab, the most motile sperm are selected.
- Insemination: A thin catheter is used to introduce sperm into the uterus at ovulation.
Advantages
- Closer proximity of sperm to the egg.
- Improved sperm motility after sample washing.
- Recommended for mild infertility and cervical mucus issues.
Disadvantages
- Requires medication and frequent monitoring.
- May need multiple attempts.
- Risk of multiple pregnancies if multiple follicles are stimulated.
- Not suitable if tubes are blocked or in cases of severe infertility.
Key differences between timed intercourse and IUI
- Medical intervention: Timed intercourse is more natural; IUI involves a lab and catheter.
- Success rates: IUI usually yields better results in mild infertility.
- Cost: Timed intercourse is more economical.
- Emotional and physical: IUI involves injections and mild discomfort, while timed intercourse can cause stress due to scheduling.
- Suitability: Timed intercourse for regular cycles; IUI for mild male factor or thick cervical mucus.
Which option is best for you?
- If there’s no clear cause and your cycles are irregular, start with timed intercourse.
- If semen quality or cervical mucus is an obstacle, IUI may yield better results.
The decision should be made with your doctor, considering your age, test results, and medical history.
What if they don’t work?
If after several cycles neither timed intercourse nor IUI succeeds, you may move on to more advanced treatments like in vitro fertilization (IVF) with ICSI, where a single sperm is injected into the egg to maximize fertilization.
When to recommend IVF?
- Low ovarian reserve or blocked tubes.
- Very poor sperm quality.
- Failure of timed intercourse or IUI.
- Need for preimplantation genetic testing.
Frequently Asked Questions
1. How long should I try timed intercourse before moving to IUI?
Typically 6–12 cycles are recommended if your only issue is ovulation. If there’s a male factor or low reserve from the start, your doctor may suggest IUI or IVF sooner to avoid frustration.
2. Does IUI hurt and what is recovery like?
Most women feel only a mild cramp when the catheter is inserted. No anesthesia is needed, and you can return to your routine almost immediately. A brief rest of 10–15 minutes helps, but then you can continue your day without issue.
3. Does it increase the risk of multiples?
With timed intercourse alone, the chance of twins is low (1–3%). It can increase if stimulation drugs are used. In IUI with stimulation, it reaches 10–20%. Your clinic will monitor the number of follicles to minimize this risk.
4. What habits improve success?
Maintain a BMI between 18.5 and 24.9, eat a diet rich in folate and antioxidants, exercise moderately, quit smoking, limit caffeine (<200 mg/day), and avoid alcohol. Techniques like yoga or mindfulness reduce stress and improve hormonal balance. Both partners should undergo preconception exams and follow specialist recommendations.
Sources consulted
- Practice Committee of the American Society for Reproductive Medicine. (2020). Definitions of infertility and recurrent pregnancy loss. Fertility and Sterility, 113(3), 533–534.
- MedlinePlus. (2023). Intrauterine insemination. https://medlineplus.gov/ency/article/007304.htm
- National Institute for Health and Care Excellence (NICE). (2013). Fertility: assessment and treatment. https://www.nice.org.uk/guidance/cg156
- Van Voorhis, B. J. (2007). Clinical practice. Intrauterine insemination. New England Journal of Medicine, 356(6), 676–683.
We understand how important this journey is for you. Stay hopeful, share your concerns with your partner, and don’t hesitate to seek support from a reproductive specialist. Every case is unique, and an expert will guide you to the most suitable treatment.