If you’ve been trying to conceive for over a year and want this level of detective work on your case, apply to work with me and my team here: drjanelevesque.com/application.

It takes about 5–7 minutes to complete. If we can help, we’ll invite you to a free Fertility Clarity Call with one of my team members. On that call, we’ll go through your story, see what’s been missed, and walk you through our simple 3‑step Clarify → Correct → Conceive process that’s helped over 70% of our clients finally bring home a healthy baby.

Episode Summary

If you’ve had a failed IUI, or your doctor is pushing IUI as the “next step” without much explanation, this episode is for you.

I break down why IUIs are a tool, not a plan, and why repeating them without asking “why didn’t this work?” can waste time, money, and emotional bandwidth. We’ll walk through clear green, yellow, and red lights for IUIs so you can see whether it’s actually the next right step in your fertility journey.

In this episode, you’ll learn:

• A failed IUI does not mean your body is broken; it means nobody asked why it failed
• IUI is a tool, not a plan
• Washing sperm does not bypass male fertility issues
• There are clear green, yellow, and red lights for when IUI is the right next step
• Most women going through IUI are not being tracked properly
• Never proceed with IUI without optimizing the basics first
• After a failed IUI, pause and understand why before doing another one

About Dr. Jane’s Practice

I’m a Naturopathic Doctor and Natural Fertility Expert. My team and I work 1:1 with couples who’ve been struggling with infertility for 1+ years to get to the root cause of their fertility issues so they can conceive and bring a healthy baby home, using advanced lab testing and personalized protocols.

Our mission is to make science-backed, natural fertility care the standard so more couples can build healthy, thriving families.

If you want this level of support on your own case, apply here: drjanelevesque.com/application

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Language: en

If you had a failed IUI or your doctor

is insisting that IUI is the next step

in your fertility journey, this episode

is for you. I'm Dr. Jane Leec and this

is the Natural Fertility with Dr. Jane

podcast where we help couples uncover

the real reasons behind their fertility

struggles. IUI tends to be the first

line of treatment after trying to

conceive naturally for 6 to 12 months,

depending on how old you are. And most

couples will sign up for an IUI in hopes

that they will never need to proceed to

an IU IVF. IUI is not a guarantee. And a

lot of couples are not successful. Once

you have a couple of rounds that have

failed, maybe it's two, three, five,

eight, you kind of start to question if

this is the right next step or even

worse, you start to think that your body

is broken and you just weren't meant to

have children. I want you to listen to

me really closely here. A failed IUI

doesn't mean that your body is broken.

It usually means that no one has gone

back to figure out why it failed before

signing you up in the first place

because IUI is a really great tool, but

it is not a plan. The real question is,

is this actually the next best step or

are you about to waste a bunch of time,

money, and hope on a cycle that was

never set up to work? So, here's what I

want to break down for you today. the

problem with a conventional approach,

what most people think and why it fails,

and then give you some parameters for

when IUI is the next right step versus

when you need to consider something else

entirely. I will use an example from a

case study in hopes that it helps you

make the right decision in your

fertility journey. Let's dive right in.

Here's the problem. You've done one to

three IUIs, maybe more, and they've all

been negative or you ended in a very

early loss. Uh maybe you haven't done

IUIs yet, but you've been told that's

the next step with very little

explanation. And then you're just kind

of feeling stuck right now. Do I just

keep trying naturally? Do I sign up for

more IUIs? Do I just jump straight to

IVF? Who wants to waste, you know, more

another month, another chunk of money

and go on another emotional roller

coaster? Let's face it, uh this journey

is very draining physically, mentally,

emotionally, financially. So, I want to

help you make as little mistakes as

possible to get to your family goals.

And here's what most people think and

how, you know, why it fails. We think

about IUIs is less intense than IVF. So,

I'll just keep doing it until it works.

And it's true. IUI is less intense, but

if it's not the thing that you nee¯d, why

would you do it at all? It is still

draining. Some of you have insurance

that needs you to do a certain number of

IUIs before you can get an IVF covered.

This one drives me really crazy because

although I totally respect the fact that

this journey is really expensive, I

think the fact that insurance companies

tell you you need to do three IUIs

before IVF is covered. If IUI is not

going to work, why are you going to put

yourself through that roller coaster

with a medication, with all the

tracking, with all the testing, with all

the procedures knowing that it's not

going to work just so the insurance can

have a checkbox? That drives me bananas.

And you know, the clinic usually your

fertility clinic will just say

everything looks fine and we just need

to keep trying. There's really clinics

out there that believe the more reps you

do um the higher your chances are and

they don't tend to change anything. I

also think that is negligence and just

poor care. I think you have an idea of

why this fails. But I think the biggest

concern for me as a naturopathic doctor

and a natural fertility expert when

you're signing up for an IUI is no one

gave you an explanation of why you're

not able to get pregnant in the first

place. And then no one is pausing

between cycles and actually and asking

why didn't this work and then the basics

are usually not optimized or even

tested. So, your odds are low before you

even start. Whether that's looking at

inflammation or your immune system

function, blood sugar, sperm quality,

uterine environment, nutrient levels,

all of those things need to be optimized

in order to optimize the chance of

successful pregnancy. Whether that's

naturally IUI, IVF, it doesn't matter. I

often think that we just focus so hard

on getting pregnant. We forget that it's

not just about getting pregnant. It's

about having a healthy pregnancy and a

healthy baby. And you are the place

where the baby will grow. So if your

nutrients are low, they will continue to

stay low through the pregnancy and

through postpartum and your baby will

get less nutrients because the baby's

going to pull everything out of you. But

the depleted mother is not a happy

mother. And this is when we see the

postpartum depression. This is when we

see the postpartum anxiety and a lot of

traumatic experience during labor and

even pregnancy that we can address those

and we can see those things coming a

mile away and that women are just not

properly uh tested beforehand or through

pregnancy and then there's very little

support postpartum as well. So here's my

new lens for you. What's a green light

versus a yellow right or a red light

when it comes to uh going forward with

an IUI? Because the real decision isn't

do another IUI or not. Is this actually

the next right step in my fertility

journey or do we as a couple have some

things we need to optimize or do we

actually just need a completely

different plan entirely? And we can see

that through lab testing and a proper

assessment. Okay. So just because your

insurance covers it, I really encourage

you not to just jump into the IUI

because you have this ex, you know,

expensible income or something that you

can write off to the insurance. It

doesn't make sense logically. And I

often see those couples get themselves

into trouble because they're doing so

many rounds because it's covered, but

the body is getting further and further

away from the pregnancy. So here's the

green light for proceeding with an IUI.

Your tubes are open. I know it's going

to sound crazy, but there's so many

women out there that have blocked tubes

and they were never properly assessed

and we just go straight for the IUI. So,

your preworkup should look at an HSG

where we're essentially looking to see

that your tubes are open. The sperm

numbers need to be good. The sperm

concentration needs to be at least over

20 million per mill. Ideally, want to

see it over 50 million per mill.

Morphology needs to be over 4%. Matility

ideally over 70%. And there's no

infections. There's no clumping. There's

vitality. I can't tell you how many

couples have really terrible sperm. The

partner has 1% morphology, really low

concentration, really low volume, and

they're still being told that IUI is the

next right step where it is clearly not

going to work. Uh, as a woman, you do

need to be ovulated, but maybe that

ovulation is not super strong and your

lining looks good. So good is anywhere

between 8 to 12 mm when we're testing

day 8 to 12 of the menstrual cycle. If

you are over 12 mm I'm concerned. If

you're under 8 millm I'm also concerned

and those are things that we need to

look at you basic labs. So that's your

thyroid, your vitamin D, your iron, your

blood sugar, your inflammation. They

need to be optimized. I consider those

basic labs. Those are things that I run

on my women when they are pregnant. And

I don't run a lot of testing on my

pregnant women because they already have

so many appointments, but I'm always

looking at their thyroid. I'm always

looking at their vitamin D and their

iron and, you know, their inflammation

markers and their blood sugars, liver

enzymes, all those things because it's

so important for the health of the

mother and therefore the health of the

baby. We want those things optimized

before we're going into a procedure like

an IUI. Um, ideally my green light for

proceeding with an IUI is that you have

already optimized your diet, your

lifestyle, and your environment. I think

everybody needs to do this. The couples

that I tend to walk through an IUI

cycle, we've done some really good work

and it's been, you know, 6 months to a

year and those all the sperm parameters

are good and maybe there's still a

couple of tweaks. Her ovulation is

pretty good, but that egg and that

follicle is not developing quite as big

as we wanted to. But it's it's literally

I look at the IUI as like a gentle nudge

in that right direction as opposed to

we're overriding the system. Here's the

yellow light in terms of you know we

want to pause and maybe optimize before

we do an IUI or we sign up for another

round of an IUI. So if your sperm

partner sperm parameters the it's

borderline and maybe there's like he

hasn't done that many sperm analysis but

lifestyle factors are still an issue. So

whether that's he's still using

nicotine, he's still drinking alcohol,

he's not sleeping great, he has excess

weight, he has blood sugar

dysregulation, if those things haven't

been addressed, they are going to show

up in the quality of the sperm. Now your

fertility clinic might say, well, we

just do a wash and everything is good.

Also, one of the biggest lies, you do

not bypass male fertility issues by

washing the sperm. You do not change

anything within the DNA or the nutrient

levels. You're simply washing away the

debris and any infection that's sitting

right on top of the sperm, which we can

address by addressing internal aspects.

So, yes, you're making the sperm a

little bit more mobile and you're

essentially isolating the fastest sperm,

but in reality, that's what nature does

anyways. When the body is healthy,

nature will want the strongest sperm to

get to the egg and the egg literally

sends signals to the sperm to get there

and the sperm has to, you know,

obviously respond to those signals and

there's a big microbial component to it.

Point being is we do not bypass male

fertility factor with just washing the

sperm. That's not a thing. If sperm is

born and those lifestyle factors are

there, yellow light for me and I want to

continue to optimize. If you have

symptoms that are still very strong, so

whether that's the energy is not good,

the periods are still heavy, you have

gut issues, you're bloated, you're

tired, you're acne, all that stuff, I

think that tells me that we need to

continue to optimize. If you feel

emotionally fried and rushed, I think

that's really important. A lot of women

will numb themselves to go through the

experience. And again, it's literally

the opposite that I want for a woman,

especially when once you are pregnant

and learning and to listen to that

intuition and to bring this baby into

this world, we can be numbing ourselves.

We actually have to learn how to listen.

And the last IUI cycle, uh, if the last

IUI cycle that you did, the response

wasn't great. Basically, you didn't get

very many follicles that grew properly.

The lining was too thin. The LH peak

wasn't there. The estrogen wasn't quite

there. Maybe you even we were like,

"Nobody even tracked anything when I did

the IUI cycle." Um, that's a big yellow

flag for me and honestly a red flag that

we need another clinic. Uh, and we need

to do some work before we go in for it.

Like I said, just because IUI is not

IVF, it's still a big emotional toll.

It's still lots of appointments. It's

still lots of testing. Um, we want to

make sure that you're tracked properly.

It's a red light for me. So, we do not

proceed with an IUI or we basically

because we need to do some more

optimization or maybe IUI is just never

really going to work for you and we need

to get you ready for an IVF. So, if

tubes are blocked, that's an obvious

one. Um I think if sperm numbers are

really low, so morphology 2% or lower,

your sperm concentration is after 15

under 15 million per mill, the sperm

volume is really low, sperm vitality is

low, you know, I mean I had a couple

where he was told his sperm is fine and

he literally had no viable sperm. So

like all of his sperm was dead and it

was still moving because uh it's like a

chicken with the head cut off. When you

cut the chick off the chicken, it still

runs around for a little bit before it

quote unquote when we have no live sperm

and it's moving. It's just there's some

mitochondrial energy that's still

present there, but there isn't. The DNA

is quite quite damaged. We IUI is not

going to bypass and honestly neither is

IVF. We need to do some work with a

partner. And I think if you've done more

than two IUIs and uh they were wellrun,

I would just say and there was no

pregnancy, I would definitely be looking

at something else. So here's kind of the

questions that I want you to ask and

when not to proceed. I think this is

really, really important. You had a fail

IUI. Here are things that I want you to

review. Did you actually have at least

one goodsized follicle? How you know

that is by being tracked properly? And

I'm going to go through what that looks

like in a second. Most women are not

tracked properly. They're tracked maybe

once or twice throughout the IUI cycle

and then you're kind of just basing it

on estrogen or LH. I think it's really

important to look at the follicles. You

want at least one over 20 millm uh when

it's close to ovulation. So if you've

had two or three total respond, that's a

great outcome. And then you should be

tracked minimum two times but ideally

three within that cycle. So most women

will start led day 2 to 5 and then day 8

10 to 12 and then 12 to 14. We want to

do an ultrasound and then some clinics

will also do blood work at that same

time and they'll look at your kind of

progesterone, your LH and your estrogen

numbers. I think that every woman is

different and so we need to track your

cycle. I've had women who ovulate on day

16 and I have women who ovulate on day

10. So, if you're the kind of woman that

ovulates on day 10, we still are going

to probably look at an ultrasound on day

seven, see how many follicles are

recruited, and then I would look at

again on day nine, and see how many

follicles are recruited and growing. And

then sometimes we go again on day 11.

So, even a woman that ovulates early,

let's say on day 10, typically when we

introduce the medication and the

follicle grows a little bit longer, she

tends to ovulate a little bit later. And

then I've definitely had women uh

especially my PCOS women that don't

ovulate until like day 16 or 17. I

remember one couple they went in and the

first time they're like, "Okay, we're

getting a good response on day eight.

There's two follicles this size um you

know 14 and 16 mm or it was like 14 and

12." She goes again on day 12 and

they're like, "Okay, well it hasn't

grown that much. It's like 14 and 16 mm

and one at 8. So I don't think this is

going to be a good cycle." and they're

getting ready to do like a trigger shot

and I'm like, "No, no, no." And so at

day 14, she goes and she has two

follicles that are at like 23 mm, 22 and

a 19. So we were even thinking like, "My

god, she might get pregnant with twins

because and obviously that's one of the

side effects of doing uh these

procedures, but she went from being told

that, oh, this is not a good cycle. it's

unlikely going to work to like, oh my

god, this is amazing and we should do a

trigger shot immediately. We actually

ended up not doing a trigger shot

because if unless you have you're really

trying to time something and like you're

using a sperm donor or trying to track

something with a clinic, I find most

women will ovulate on their own when

that follicle gets. So, I try to really

do it as natural as possible. And then

sure enough, you know, she ovulated on

her own on day 15 and then we started

her progesterone and you know, she had a

beautiful pregnancy and a beautiful baby

girl. Now, but you need to be tracked

properly and ideally within two to three

ultrasounds so we can actually see. So,

we're not just looking at the follicle.

We're also looking at the uterine

lining. And the lining that's, you know,

2 mm, 4 millime, 6 or over 12, that's a

big red flag. So, after failed IUI, you

need to make sure that that is reviewed.

And um you know, I'll tell you about the

case where it's like, God, this IUI was

never going to work. I can't believe

that they just let you continue to do

more cycles. I I just get medical

negligence at this point. Um you know,

if the sperm numbers, especially after

wash, are not good. Was uh was ovulation

confirmed? Was the progesterone and

lutial phase strong enough? These are

the kinds of questions we want to be

asking after a failed IUI. And then

before doing the next IUI, here are the

questions that I want you to ask your

doctor. Like what do you think went

wrong in this last cycle? Is there

anything we need to change in this next

coming cycle? Is there medication dose?

Is there timing? Is it tracking? Is it,

you know, stress levels? Is there

anything in my blood work or my

partner's sperm analysis, my symptoms

that still needs to be cleaned up before

another IUI? Now, if you ask your

conventional system that last question,

they're literally not going to have an

answer to it. But it is something that I

ask my patients and I don't like

literally ask them because I know them

so well. One of my couples who needed to

go for a second IUI, we kind of rushed

the first one and they just decided they

wanted to go and by the time they were

able to get the medication, she was on

day four. And technically, you're okay

to start let on day four, but I think

for her starting on day two would have

been a lot more potent. And so she had a

pretty good response and then they had

some stress, but you know, it was

rushed. Um they had some couple stress

as well that happened and her LHP peak

was really great. Estrogen was a bit on

the low side. She is you know in her

40s. Essentially when we make a plan

that IUI didn't work and then when we

make a plan moving forward I go here's

what I would do differently. I would

start on day 2 to 5. I would make sure

the ultrasound's done on this. You need

to make sure you know we sorted through

some of their partner stress that was

going on. And it's like, I need you to

just make sure you take it easy and we

continue to track the cycle properly so

we can see how your system is

responding. Here's when not to proceed.

Like, I want to make sure you do not

proceed with an IUI. Your FSH is over

12, your AMH is below 0.5, your baseline

progesterone is below 1.5, so on day two

and three, your LH is over 10 on day 10.

your estrogen is um over 80 or I would

say under 30 on that day 2 to three

baseline testing if your TSH is over 2.5

obviously I said when the both tubes are

blocked on an HSG if you have fibroid

polip or something that has been

unadressed then it's definitely in the

way if you have an active SDI or

positive lucasite estrays on your

analysis so if you have a UTI or your

partner like you can test those things

in the semen as well. And I've had semen

analysis show up with infections and

they're still proceeding. If the feritin

is below 30, vitamin D is below 40. If

your liver enzymes are elevated above

40, ALT and A or GGT is considered

elevated. I honestly want it in the

teens. I think over like close to 40 is

quite high. Uh so those are all the

reasons that you do not want to proceed.

So, if you're like doing a mental

checklist right now and you're like, I

have like three of these things on the

list. This is why the IUI didn't work

and this is why we just want to do much

better workup beforehand. So, I'm going

to give you a quick example. Uh, because

this couple did eight IUIs, she actually

had premature ovarian insufficiency that

wasn't properly diagnosed. Her lining

was at like 2 to 4 millime during the

different cycles. Her FSH was over 12

and sometimes over 20. She had very poor

follical response to the medication and

then her estrogen was low, progesterone

was low. So this is a very typical

premature ovarian insufficiency case. I

think she was scared to get that

diagnosis and so she didn't really like

they kind of suggested it but she didn't

want to investigate it further because

you know who wants to get that

diagnosis. I think it's really important

that the woman feels safe enough that we

can actually address all of the issues

that are going on and help her reverse

it because there's women there are women

who are getting pregnant with premature

ovarian insufficiency naturally or

through IVF or through IUI. You just

need to address her individually. He had

1% morphologies. So like that cycle was

never going to work. And when we met,

she did eight cycles of IUIs. Like they

literally were just like, "Yep, you can

just keep going." going and she kind of

numbed herself and was like, "Okay,

let's just keep going." You know, when

we met now, we had to help her process

all of those eight cycles. We had to

detox from all of those drugs and then

pro process the emotional toll of those

cycles because like I said, many women

just numb themselves going through the

experience. They're putting their trust

into the doctor and the doctor spends

like 10 minutes with them and then they

just follow a procedure. So, if you feel

like you're a number, you're just a

number. It's because you are. And I

think it's brutal and that's what I want

to change in the fertility space and in

healthcare in general. We have been

working with this couple for a year. We

have improved a lot in terms of her

lighting and her cycle, her energy, her

mood, um his sperm parameters. And we're

kind of finishing up a little bit uh of

a protocol before we retest. And I

typically like to retest everything. So

we'll do the baseline again from day two

and three and then day 19. um look at

her intro count, look at her uterine

cavity, look at the day to three

hormones, look at the day 19 to 23

hormones, and then see what the next

best step is. And this is a couple that

might need IVF. Uh like I said, we're

just kind of letting the body do its

thing and supporting the methylation,

the mitochondria, etc., etc. And we test

and we see what the next right step is.

But I think the big lesson here is just

it wasn't about doing more IUIs. It was

just actually understanding why she

wasn't get pregnant in the first place

and that she had undiagnosed premature

insufficiency, premature ovarian

insufficiency, which for many women it's

a scary diagnosis like I said, but it

typically IUI is not going to be the

next right step for this woman because

her FSH is high, her LH is high, uterine

lining is in there. So, we need to

recruit a couple of different things

before uh we're convinced that it's

going to work. Here's what I want you to

walk away with is that IUI is not a

magic step. It is definitely a tool that

can work, but the basics have to be in

place and someone actually has to be

properly following you through the cycle

and then reviewing your data in between

cycles. We do not just want to go on

feels like, oh, I feel ready. I feel

like this is going to whether that's you

or your doctor, the data is what needs

to drive our decision because our mind

plays a lot of tricks on us. So we'll

say I feel ready. This is the best I

have ever felt. This is does the data

actually show that and back that up.

After failed IUI, you want to make sure

you review what didn't work. Um not just

the outcome of obviously, oh my god,

there's no pregnancy. I feel uh broken

and it sucks. Let me try again. We want

to understand why your body didn't

respond and where along the chain it

didn't respond. Sometimes the next step

is to just pause and optimize versus

getting into a rushed cycle. And then

sometimes IUI is, you know, not the

right tool at all and moving on sooner

protects your time, money, and of course

your heart. If you had a fail IUI and

you're not sure whether to try again,

pause or move on, you don't have to

guess. This is exactly what my team does

in the Maximize fertility program. So,

if you want us to look at your history,

your IUI, IVF cycles, your labs, and

give you an honest opinion on whether an

IUI is really your best next step, go

ahead and fill out an application down

below, and then my team will review it.

If we can help, we'll show you what that

next step is. Otherwise, I hope you

found this episode helpful. Thank you so

much for tuning in and I'll see you next