Looking back on our decision to start with IUIs after our unexplained infertility diagnosis, I think I am split 50/50 on whether I would do it over again. But before we go there, let me tell you about IUIs, a.k.a intrauterine insemination, a.k.a. artificial insemination.
Many fertility doctors recommend starting with IUI as the first shot at overcoming infertility since it is less invasive and less expensive than IVF. From my understanding it is typically recommended for men with poor sperm quality and for women with unexplained, endometriosis-related or cervical factor infertility. So we agreed, especially since they were partially covered by our insurance, to plan on trying 3 IUIs in 2018 before we moved to IVF.
Here’s the process of how an IUI works. On cycle day 1 (the first day of your period), you alert the fertility clinic and they provide you with a schedule. This schedule includes when monitoring appointments will start and, for us, when we would start taking the fertility medicine that goes along with IUI (more on that AWFUL drug later). The fertility medicine is used to encourage your body to "super-ovulate" in hopes of increasing the number of ovulated eggs that cycle (which hopefully will increase the chance of fertilization).
As you are taking the fertility medicine, the clinic is monitoring you via vaginal ultrasounds and blood work. Because the IUI needs to be done as close to ovulation as possible, once the clinic deems you and your ovaries (the eggs!) are ready you will administer the “trigger shot” (hCG or Ovidrel) to tell your body it’s time to ovulate (this is a shot at a very specific time of day in your stomach). The IUI is typically done 24-36 hours after this trigger. If I remember right, my first 2 IUIs I had 2 monitoring appointments and my third IUI I had 3 before I was given the green light to administer the trigger shot.
The morning of the IUI, J produced “the goods” at home and drove it to the fertility clinic. They will then wash the sperm, which separates the good stuff from the ejaculate. Then later that morning we show up for the IUI procedure. The IUI starts off like a pap smear. They insert a speculum into the vagina to help visualize the cervix. A catheter containing the concentrated sperm is inserted through the cervix into the uterus (ideally next to the Fallopian tube openings as that is where fertilization takes place) and the sperm is released. That’s it - all done in just a matter of minutes! They had me lay on the bed for about 20 minutes and then I was free to go and begin the dreaded two-week wait (more on that in a future blog post).
At the end of the day, I always explained the IUI procedure as having sex once but the sperm are given a head start by being placed directly in my uterus. In natural intercourse, only a fraction of the sperm make it past the woman’s cervical mucus into the uterus so that’s where IUI helps. But, at the end of the day, an IUI still requires a sperm to reach and fertilize the egg on its own. And in our case, they never did.
So here are my pros/cons for the IUIs:
PROS:
$$$ - having an affordable option versus how expensive IVF is was great
It was a good introduction to the fertility treatment world and what it was going to be like. Yes, I only took the fertility medicine for 5 days and had to give myself one shot but it was good practice for IVF.
I learned I truly have to be my own advocate when it comes to my fertility treatment. During our 3rd round, they decided during the 2nd monitoring appointment I wasn't quite ready and to come back a couple days later. By this point I have started to learn what pre-ovulation symptoms felt like and the day after my 2nd appointment I was feeling them. I called the clinic and made them see me as I was scared we were going to miss our window if we waited a couple more days). Turns out....I was right and I administered the trigger shot that night. Standing up for yourself and what you need in this journey is so important!
CONS:
Success rates are low. An IUI is slightly more likely to help you get pregnant than trying to conceive naturally. Odds are an IUI won’t work in one cycle and in order to increase the odds, you have to plan on doing multiple cycles. So for me, doing something that wasn’t probably going to be work (in my mind) made it hard for me to stay positive during those months when I just wanted to start IVF.
Clomid kicked my butt (putting it mildly)! My first 2 IUIs were partnered with clomid (clomiphene citrate) and the side effects were debilitating. Besides the typical side effects I was warned about (migraines, fatigue, etc.), I was one of the lucky ones who got the rare side effect of insomnia. I didn’t sleep for the 5 days I was on clomid so partner that with feeling awful from the other side effects, and I was not a happy camper. To note: we switched to Letrozole for our third IUI and I only had to deal with the normal side effects and (thank goodness!) no insomnia.
My Letrozole IUI cycle required a blood pregnancy test (by law) to determine if I was pregnant or not. It’s bad enough that I was doing what I shouldn’t have been doing and peeing on all the pregnancy tests I could sneak into our grocery cart without J seeing, but for some reason, having to do a blood test when I already knew I wasn’t pregnant hit me hard. Guess it was the “medical confirmation” that I had another failed attempt and waiting for that phone call later in the afternoon from the nurse that put me in a funk.
Looking back, I know we probably did the right thing by trying 3 IUIs before we jumped into IVF, but I can’t help be feel that they were wasted months. A part of me wishes we had started IVF sooner so that the real odds could be in our favor (but also know that IVF isn’t a guarantee either). As simple as the IUI procedure is, I still found it to be stressful. Even though it wasn’t as much as IVF, we were still putting money towards something with low odds. We were beginning to put our trust in medicine and our fertility clinic to help us conceive a baby. So we tried, we failed, and now we move on to our first round of IVF.
**This is not meant to be medical advice. Be sure to consult your doctor with any medical concerns. This is the account of my personal journey through infertility**
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