Infertility Update: Explaining an IUI

 

In previous posts, I’ve mentioned our struggles with infertility.  In my last update, I let you all know that we had our first IUI scheduled for today.  For those of you unfamiliar with fertility terms, an IUI is commonly called artificial insemination or intrauterine insemination.  In today’s post, I’ll try to inform you about the process of an IUI, why we have chosen to proceed with an IUI and the differences between an IUI and IVF.

The process of an IUI combined with hormone therapy:

When going through fertility treatments, ovulation stimulating drugs are to be taken orally on cycle days 3-7 to prepare the body for ovulation. Clomid is the most common of these drugs, but doctors are increasingly having more luck with a new drug called Femara.  You can read more about Femara here.  The past two months I have been working with an RE (reproductive endocrinologist) who is a firm believer in Femara.  He believes that my chances of pregnacy are good with up to three rounds of Femara combined with an IUI.  I find that I have fewer side effects with Femara and prefer it to Clomid.  Femara works differently than Clomid by secreting the production of estrogen in the body during the time it is taken.  It also does not linger in the body once the user stops taking it.  As a result, the body works overtime to produce a surge of FSH(follicle stimulating hormone) once the medicine is no longer in the system; therefore, forcing the body to grow good follicles by mid-cycle.  I have ovulated like clockwork on cycle day 14 with this drug.  Femara is also known to produce super ovulation (more than one follicle), which can sometimes make for a more painful ovulation.  I can say that unlike any other month with or without drugs, I have had noticeable, slightly painful yet bearable, ovulation cramps with Femara, which I consider to be a good sign. 

After the ovulation stimulating drug does its job, a mid-cycle ultrasound is scheduled to see how well the drug performed.  The ultrasound is commonly performed on cycle day 12 or 14, but if one gets a positive OPK prior to those cycle days, an ultrasound is to be performed immediately.  I would say that most women who are actively trying to get pregnant, fertile or infertile, are familiar with OPKs (ovulation predictor kits), which can be purchased over the counter in any pharmacy.  While taking Femara, I have gotten a strong, positive OPK both times on cycle day 14, which is exactly what my RE likes to see. Today was my cycle day 14 ultrasound.  These ultrasounds are transvaginal, much like a first pregnancy ultrasound; only instead of looking for a fetus, doctors are looking at the uterus and the ovaries to determine how fertile a woman’s body is that month.  They measure things like the uterine lining, and of course they are looking for mature follicles on the ovaries. Mature follicles burst once they grow to a certain size, releasing an egg that is ready to be fertilized. This month, Femara helped my body produce three follicles, two on my right side and one on my left.  While I would have liked to have seen more follicles to increase my chances of pregnancy this month, I'll take what I can get. One follicle on my right side was considered a dud, only measuring 10 mm; however, we had a winner with the second one on my right side, measuring 22 mm!  That measurement told us that I had a very mature follicle ready to burst at any time, so I was really happy with that number!  There was an instant feeling of relief once they read that measurement to me, because if I didn’t have any mature follicles, we couldn’t proceed with the IUI today.  The follicle on my left wasn’t as big as the one on my right, but it was still considered mature, measuring 17.5mm.   If the follicles look good in the ultrasound, a woman typically is given an HCG trigger shot.  HCG is the pregnancy hormone, and when injected into the body at the time of ovulation, it forces the eggs to release, usually within 24 hours from the time the hormone is injected.  The only time I have ever had a positive pregnancy test is when I test the HCG out of my body. It usually takes my body less than a week to test out.  Even though I know I am not pregnant when I’m testing HCG out of my body, just seeing the positive on a test makes me a little happy….crazy, I know:/

This month, for the first time, we took our fertility to a new level by scheduling an IUI. An IUI is typically performed a day after the trigger shot.  In my case, we performed it the same day, because my husband will be out of town for a few days.  After my ultrasound results this morning, we got the green light to continue with the IUI.  To do this, my husband had to give a sperm sample.  Once collected, the sperm is washed to give us the best chances of pregnancy.  You can find out more about sperm washing here, and why it is so important to do when performing an IUI.  I was actually shocked when I saw the vile of washed sperm they were putting in my body.  It was only .5 ml!  So small, yet so potent….that’s how my doctor put it:) It looked like the size of the tip of my pinky finger; yet they say that it is common for some of it to come out after the procedure, because the uterine cavity can only hold so much!  The sperm washing takes 90 minutes, so we were told that we could leave the premises during that time to grab a cup of coffee or something.  90 minutes later, the actual IUI can begin.  The procedure is somewhat uncomfortable, but fairly quick and painless.  Basically, the vile of washed sperm is put into a catheter, and then inserted into the uterus. Once finished, the only instructions given are to lie down for 15 minutes and take it easy the rest of the day.  You can go here to have a youtube video explain it in an easy, textbook sort of way.

Like previous months, I will finish my cycle by taking 200mg of progesterone daily, beginning 72 hours after ovulation and finishing at the time pregnancy is achieved or a new cycle begins.  My body does not make enough progesterone on its own, another unfortunate factor in in my infertility. The progesterone supplements give my body a better chance of achieving implantation and sustaining a pregnancy.  Progesterone supplements can be taken orally or vaginally, it just depends on the doctor.  My OBGYN always prescribed them orally, but my RE prefers his patients to take them vaginally.

Why we chose an IUI:

We chose an IUI, because the past four months of hormone therapy alone have failed.  It is important to say that an IUI can be done without hormone therapy, but when combined with hormone therapy the chances of pregnancy are higher.  Considering that the reason for our infertility is that my body is unable to ovulate like it is supposed to do, hormone therapy is a must for us no matter what.

The differences between IUI and IVF:

There is a big difference between IUI and IVF.  IVF, commonly called in vitro fertilization, is much more complex than an IUI. In IVF, the eggs are extracted and combined with the sperm in a dish, and then put back into the woman's uterus; whereas during an IUI, the sperm is simply injected into the woman's uterine cavity, bypassing the cervix.  Rather than having me ramble about a procedure that I have not gone through, you can read more about IVF here or watch a youtube video here.

Aside from the actual procedures being different, IVF has higher statistics resulting in pregnancy.  I believe that the latest statistics state that a woman has a 50% chance of getting pregnant with IVF; whereas a woman of my age only has a 20% chance of getting pregnant with an IUI combined with hormone therapy.  My chances are obviously much higher with an IUI than without one, but not nearly as high as going through IVF.

One big difference between an IUI and IVF is the cost.  My RE told us that one round of IVF cost $10,000.  Anyone struggling with infertility knows that it can take several rounds of IVF or IUI to get pregnant, and in some cases women may never get pregnant.  An IUI cost $500 for the procedure/sperm wash, $300 for the ultrasound and $200 for the HCG trigger shot. We walked out of the office today paying around $1,000 for the day, which is obviously much less than IVF. Because fertility is often not covered by insurance companies, we don’t get a break on the cost.  My husband has a good job working for a finance company downtown, and like nearly everyone else struggling with infertility, we don’t have any coverage for fertility treatments. I’m gonna get on my soap box for one minute here…bear with me:  my husband and I are fortunate that we are in a position financially to be able to afford all of the treatments that we have done up to this point, but I get really frustrated when I hear about the government using my tax dollars to pay for other people’s abortions at institutions like Plan Parenthood…..or when I hear about companies being fined, because they believe that it is morally wrong for them to pay for their employees to use the morning after pill, which could possibly terminate early pregnancy. Yep, for someone like myself who is paying A LOT of money to try to conceive a child, I get really irritated when insurance companies don’t help pay for people to get pregnant, but the government has no problem terminating pregnancies for free! I’m obviously pro-life….read my blog much and that wouldn’t be too hard to figure out, but whether one is pro-life or pro-choice, I just think there is a glitch in the system….that’s all….stepping off of my soap box now.

Lastly, a couple is given more control over the outcome when they choose IVF.  Whenever you hear about women who have 6-8 babies at a time, it is usually from an IUI.  In an IUI, you have no control over the amount of follicles that could potentially become fertilized by the sperm.  Some women produce six follicles thanks to ovulation stimulating drugs. While only one of those may release an egg and be fertilized, there is a chance that all six will be fertilized.  In my case, I only produced three follicles this cycle, one was bad, one was decent, and only one was considered a really good follicle.  It’s safe to say I’m not going to have six babies if I get pregnant this round;) In fact, with only one really good follicle, I'll be lucky to get pregnant at all this month.  When a couple chooses IVF, they can choose how many and which follicles to extract from the body, giving them more control over the situation.

I hope today’s post helped some of you understand more about what my body is going through from a medical standpoint.  I now begin the dreaded two week wait before finding out if today’s procedure was successful.  There is still a very good chance that we will not end up pregnant this month.  I am preparing my mind for that very real possibility; however, there’s nothing wrong with hoping, and I’m certainly hoping that we have a successful month.