Should an Intrauterine Insemination (IUI) procedure be postponed in a female patient of reproductive age with a history of infertility or subfertility, who is currently coughing up yellow sputum, indicating a respiratory infection?

Should IUI Be Postponed for Yellow Sputum?

No, IUI should not be postponed for a patient coughing up yellow sputum, as upper respiratory infections are not contraindications to IUI and no guideline evidence supports delaying the procedure for this reason. 1

Guideline Evidence on Infectious Contraindications

The World Health Organization and other major reproductive medicine societies focus infection screening on sexually transmitted infections and bloodborne pathogens that could be transmitted through semen or affect reproductive outcomes—not upper respiratory infections. 1

• Relevant infections for IUI timing include: HPV in sperm (which may reduce pregnancy rates), HIV, hepatitis, chlamydia, and gonorrhea—all requiring screening based on local standards. 1
• Upper respiratory infections are not mentioned in any major guideline (WHO, ASRM, ESHRE) as factors affecting IUI timing or outcomes. 1

Actual Infection Risk from IUI Procedure Itself

The infectious complication rate from the IUI procedure itself is extremely low, providing context for why systemic respiratory infections are not considered relevant:

• The overall infection rate following IUI is 1.83 per 1,000 women (0.183%), based on pooled data from multiple series. 2
• These rare infections are typically ascending pelvic infections (like the single case of E. coli septicemia reported), not related to systemic viral or bacterial illnesses. 2
• Prophylactic antibiotics do not reduce this already-minimal risk and are not recommended. 2

Clinical Decision Algorithm

Proceed with IUI as scheduled if:

• The patient has yellow sputum from a presumed upper respiratory infection (viral or bacterial)
• She is otherwise medically stable and able to attend the appointment
• Standard IUI eligibility criteria are met (patent tube, adequate sperm parameters, appropriate timing) 1

The only infection-related reasons to delay IUI are:

• Active untreated sexually transmitted infection in either partner 1
• Acute pelvic inflammatory disease 3
• Severe systemic illness requiring hospitalization (regardless of cause)

Important Caveats

• If the patient has influenza confirmed or suspected and becomes pregnant from the IUI, she should receive neuraminidase inhibitors (oseltamivir 75 mg twice daily for 5 days) as pregnant women are at higher risk for complications—but this does not preclude performing the IUI. 4
• Yellow sputum alone does not indicate severity of illness; the decision should be based on the patient's overall clinical status, not sputum color. 4
• Facility-level infection control standards should always be maintained, but these relate to preventing procedure-related infections, not protecting against patient's concurrent respiratory illness. 1