Should IUI Be Postponed for Active Upper Respiratory Infection?
No, there is no evidence-based requirement to postpone IUI for an active upper respiratory infection (URI), as infectious complications from IUI are extremely rare (1.83 per 1,000 procedures) and URI does not increase this risk.
Evidence on Infectious Risk with IUI
The actual infection rate following IUI is remarkably low, regardless of concurrent systemic infections:
- Infectious complications occur in only 1.83 per 1,000 women undergoing IUI, based on comprehensive literature review of 3,129 patients across 38 reported series 1
- The documented infections were primarily related to pre-existing pelvic pathology (such as adenomyomas) rather than the IUI procedure itself 1
- Most reported cases of infection following IUI failed to show firm bacteriologic evidence that the infection was actually caused by the IUI procedure 1
Why URI Does Not Contraindicate IUI
Current guidelines for IUI focus exclusively on screening for infectious agents that could be transmitted through semen or directly affect reproductive outcomes:
- Mandatory infectious screening is limited to agents in semen samples and those with reproductive transmission risk, based on local/regional/national standards 2
- The WHO guidelines emphasize facility-level infection control but do not list systemic viral infections like URI as contraindications 2
- No guideline evidence addresses URI as a factor affecting IUI timing or outcomes 3, 2
Infections That Actually Matter for IUI
The infections that warrant attention in IUI planning are fundamentally different from URI:
- HPV positivity in sperm may reduce pregnancy rates and increase miscarriage risk, potentially making IUI inappropriate as first-line treatment 3
- Endemic viral diseases (HIV, hepatitis) require prevention strategies in fertility care settings 3
- Genital tract infections like Ureaplasma urealyticum do not appear to significantly impact IUI outcomes 4
Practical Clinical Approach
Proceed with IUI as scheduled if the patient has URI, provided standard IUI criteria are met:
- Confirm at least one patent fallopian tube and appropriate sperm parameters (total motile sperm count >3-10 million) 2
- Ensure proper follicle development (1-2 follicles >15mm, ideally 16-18mm) before triggering 5
- Cancel only if >2 follicles >15mm or >5 follicles >10mm due to multiple pregnancy risk 5
Important Caveat
If the URI is actually influenza (not just common cold URI), treatment with antivirals is safe and recommended:
- Oseltamivir 75 mg orally twice daily for 5 days can be given without contraindication in the post-IUI period 6
- All approved influenza antivirals are safe even if pregnancy occurs after IUI 6
- No special monitoring is required related to the IUI procedure when treating influenza 6
The presence of URI symptoms does not warrant postponing a properly timed IUI cycle, as there is no evidence that systemic viral respiratory infections increase the already minimal infectious risk of the procedure or negatively impact fertility outcomes.