Complications of IUI are very rare. Most complications are caused by the use of ovulation stimulating drugs prior to receiving IUI. Pelvic Infection The use of a catheter or an official neck hook during IUI can cause mild uterine cramping, which is common, self-healing, and often recovers within a few hours of the end of IUI. If the discomfort persists, it often suggests a possible active pelvic infection? The probability of occurrence is less than 2/1000. early diagnosis and treatment is key in these few patients and reduces the risk of IUI-induced pelvic inflammatory disease, especially in patients with secondary reduced fertility. Vasovagal response Manipulation of the cervix can cause a vasovagal response, including vasodilation, slowing of the heart rate, and consequent hypotension. Clinical manifestations include sweating in supine patients; fainting when sitting or standing. The supine position does not. Symptoms may persist when the patient lies supine and crosses his or her legs. Patients with more severe reactions may require intramuscular atropine to relieve symptoms (0.5 mg). Allergic reactions Allergic reactions, including anaphylactic reactions, may be due to the presence of potential allergens in the washing solution used in semen preparation for IUI. Allergy to the bovine serum albumin or antibiotics (penicillin and streptomycin) in them has been suggested in the literature. Of these, kenmosol allergic reactions are the most common, presenting as a mild rash in mild cases. In severe cases, laryngeal edema, bronchospasm, and hypotension are life-threatening. In patients with a history of IUI allergy, it is recommended that serum albumin-free, antibiotic-free washing solutions be used when handling semen. Antisperm Antibodies When IUI was initially performed, a major concern was whether the IUI injection process could lead to the development of antisperm antibodies in the female reproductive system. Fortunately, 40 years of clinical practice has demonstrated that exposure of the female internal reproductive tract to washed sperm suspension during IUI does not stimulate the production of clinically significant antisperm antibodies in the reproductive system. Pregnancy-related complications 1. Multiple pregnancies IUI does not increase the risk of multiple pregnancies. However, the use of ovulation stimulants for the recruitment of multiple follicles increases the risk of multiple pregnancies. Ovulation induction with clomiphene can be associated with a 5% to 10% twinning rate, with more than two fetuses rare. Gonadotropin injections are associated with a 14% to 39% multiple pregnancy rate. Careful monitoring of preovulatory follicle number and estrogen peaks can help reduce the risk of multiple pregnancies. In conclusion. When a woman is younger than 30 years of age. The risk of multiple pregnancy is high when the number of preovulatory follicles is more than 6 and the peak serum estrogen is higher than 1000 pg/ml. 2. spontaneous abortion and ectopic pregnancy The rate of spontaneous abortion in lUI cardiac patients is higher than that of the normal population. It is about 20% to 25%. The rate of spontaneous abortion may not be a direct result of IUI, but is most likely due to the patient’s underlying infertility problems. Similarly, ectopic pregnancies are mostly due to predisposing factors such as tubal disease rather than IUI manipulation.