If you're going through assisted reproduction to conceive, you probably will start with IUI, or intrauterine insemination. It's a very non-invasive procedure that can get you to your goal of conception.
IUI is the simplest procedure in a reproductive endocrinologist's arsenal--and the cheapest. It's just not very romantic.
IUI may be recommended if everything looks normal in your anatomy and hormones and your partner's sperm, but you're just not getting pregnant naturally. It is also useful if you have “hostile mucus” or if your partner has a low sperm count. IUI shortcuts the distance to the egg and delivers millions more sperm than could ever reach the egg naturally. And it is timed for your ovulation. If your partner has good sperm motility but a lower number of sperm, IUI can work well because it bypasses the most difficult part of the process for the sperm, which is getting through the cervix.
If you're doing a natural IUI, it means that you use ovulation predictor kits at home to find your LH surge. Then you call the doctor to tell them that your surge is happening, and they tell you to come in the next day for the insemination. The surge begins before ovulation, and most women ovulate 24-48 hours after the surge is detected. I used both the ovulation predictor sticks and an electronic monitor just to be sure I caught it. The hard part is that you have to be prepared to be flexible with your schedule, which can make it complicated for work schedules. When you go in, most doctors will do an ultrasound to confirm that you haven't already ovulated, take blood to test for LH and progesterone, and if it all looks good, you'll get the IUI.
Alternatively, the more expensive alternative is to go in for ultrasound monitoring of your follicle maturation before ovulation. When the follicle reaches a certain size, you inject a drug subcutaneously in your belly to trigger ovulation, and once again, the insemination is done 24-36 hours later. This is more expensive because you'll probably need at least 2 ultrasounds before you're ready for the trigger shot.
If you've had a few natural IUIs and still are not pregnant, your doctor will probably recommend that you try ovulation stimulation drugs. That is a huge topic all on its own, and in that scenario, the success rates go up, but so do the chances of a pregnancy with multiples. IUI with ovulation stimulation gets much more expensive because of the drugs as well as the monitoring required. When you go this route, you will either take an oral drug or inject a medication subcutaneously for a several days and then go in to the office to check on your follicle growth until the follicles are big enough to trigger ovulation.
The insemination is painless with someone with good technique. You lie on the table just like you do for a Pap test. The sperm is loaded into a very thin, long catheter, and the doctor or sometimes a nurse will thread the catheter through your cervix and dispense the sperm. They usually have you lie there for 10-20 minutes and then you go home. Interestingly, though, no study has ever shown that waiting to get up makes a difference in pregnancy rates. IUI can be uncomfortable if the timing isn't good because then the cervix isn't open, and the catheter has to be pushed through--that can feel crampy. Or sometimes the doctor or nurse pushes the catheter too far, and when the catheter hits the top of the uterus, you will feel cramping.
Then you wait for 2 weeks to test. That's the really hard part. I have met many women for whom IUI worked. Usually doctors will recommend 2-3 natural IUIs, then 3 IUIs with ovulation stimulation before trying IVF. Generally, after 6 IUIs, the odds are that it won't work for you. Be prepared for some disappointment, but also remain excited that each month could be YOUR month!