IUI? No YOU UI.
Like the title of this post? No? Just me…? Haha
So, how is infertility treated? Turns out, its more than just in-vitro fertilization (aka IVF)! I wanted to share a post about intrauterine insemination (IUI) first because it was our entry into fertility treatments. I didn’t even know this was an option before I started panic-Googling (yes, it’s a thing, and you know you’ve done it) when we were hitting 9, 10, 11 months of trying.
Before getting to IUI, a lot of people will try medicated cycles (e.g., with Clomid), timed intercourse, or other minimally invasive fertility treatments. I don’t know much about those because after talking with our doctor, we wanted to get moving on something a little more likely to correct for potential issues that baseline tests hadn’t revealed - so we started with IUI cycles.
Disclaimer: This post is kinda long. However, weirdly enough it’s serving to help me reflect on just how involved even the gateway fertility treatments are. Sometimes I think “you’re overreacting - get a hold of yourself, its not that bad… some people have it way worse” and then I write a post like this, and it reminds me to give myself (and my husband) a high five for all the effort this takes… and how totally opposite it is from the “normal” way of making a baby.
Let’s get into it:
Fertility clinics sometimes refer to IUI as a “low-tech” fertility treatment. It’s a procedure where a doctor inserts a concentrated sample of sperm into your uterus at juuuuust the right time. The goal is to get the sperm as physically close to the egg as possible after ovulation. If you’re like me, that’s where the questions begin: “what is a concentrated sample of sperm and how do they get that?” “how do they know when to put it in?” “will it hurt?”
Monitoring appointments…
The doctor determines the best timing for the IUI by assessing the results from monitoring appointments. These appointments are about 30 minutes long, depending on how many other patients there are in the waiting room. They consist of bloodwork and a transvaginal ultrasound (ultrasound from here on out). They are testing your hormone levels with the bloodwork, and looking at the thickness of your uterine lining and development of follicles on your ovaries via the ultrasound. I’d get a call later in the day from my nurse letting me know whether I needed an appointment the next day, or whether they wanted me to trigger ovulation with a shot, or… at the end… whether or not I was pregnant.
…a planner’s nightmare
The most difficult thing for me to come to terms with was the unpredictability of the appointments. I’d just like to give a shout out here to my coworkers who covered for me, moved meetings, and in general were awesome during these cycles. As a capital P Planner the inherent last minute nature of fertility treatment cycles was (and still is) hard for me. If you’re working during all of this and can’t just skip out randomly with <12 hours notice several times in a row every month, it gets a bit tricky. I actually had to open up to my colleagues before a lot of other people because they were the first to notice or be impacted by my random unplanned absences or work from home days after years of almost no unplanned schedule changes. Luckily I count many of my colleagues as friends :) so it was easier to share.
What I found helpful was telling my boss up front that I was going to have several medical appointments in the next few months, but that I didn’t know exactly when they would be. It made it much easier to then call out sick or come in late at the last minute when appointments were scheduled.
The timeline
My appointments began around day 7, 8 or 9 of my cycle and continued daily (sometimes skipping a day in between) through day 12, 13, or 14. I’m really lucky that my fertility clinic has an office close to my house, because they only offered monitoring appointments in the early morning - 7AM-830AM. It’s fairly early to be at the doctor’s office, but very helpful when you’re trying to get to work afterwards. I had a crazy long commute at the time (1.5 hours each way, 2 if you added the trip from the clinic) so I would try to work from home on days I had appointments.
Here was roughly my timeline. It’s different for everyone, and for me it was different even across the three IUI cycles we did.
Cycle Day 1 - Call nurse to start cycle
Cycle Day 3 - Bloodwork and ultrasound to check if your hormones are good and make sure you don’t have any ovarian cysts
Cycle Day 3- Begin Clomid
Cycle Day 8 - Finish clomid
Cycle Days 9-14 - Daily or sometimes every other day bloodwork and ultrasound appointments
Depending on my hormone levels I either had to administer a “trigger” shot of HCG (the pregnancy hormone, ironically) 36 or so hours before your insemination.
One cycle I had to supplement with inserts of estrogen twice a day during this time to thicken the lining of my uterus
Cycle day 12-14 - Insemination
Cycle days 14-28 - Twice daily progesterone inserts and the infamous two week wait
Cycle day 28 - Blood pregnancy test
The “big day”
Our clinic allows the male partner, if you’re using a “fresh” sample, to procure said sample at home, as long as you can procure it within a few hours (maybe 2? I can’t remember) of the insemination appointment and drop it off at the clinic. You can do IUIs with donor sperm as well!
About two hours after my husband had dropped his sample off, I would come to the office for the insemination. In that time they will have “washed” the sample, which removes the semen and leaves just a concentrated sample of sperm. Our clinic would tell us the number of sperm per sample, which was neat. The procedure itself is really simple and fast - they confirm (about 1,000 times) whether you are you and your husband is himself, and this sperm in this vial is his. For this, I am grateful.
Now for my non medical description of what happens: The doctor sucks the “washed” sperm into a flexible catheter tube, inserts speculum “up there” and then inserts the catheter through your cervix into your uterus and injects the sperm. Anddd voila! Then you lay flat on the table for 5-10 minutes to allow the sperm to get swimming.
And then, you wait…
For anyone who has tried to conceive for a little while the two weeks between ovulation and when you could in theory have a positive pregnancy test seem to drag on FOREVER. There are tons of resources out there with tips and tricks for helping the time pass. My favorite was from Robyn Birkin’s Fertility Warriors podcast. She suggests this: instead of agonizing over whether or not every symptom you are feeling during this time indicates or doesn’t indicate pregnancy, pretend that they ALL do. Let yourself get excited. Her theory is that you’re going to be down no matter what if the pregnancy test is negative, so why not spend the two weeks hopeful. This has really helped me get through those weeks. I still definitely get down, and overthink my symptoms, but when I remind myself to try hoping for the best, it always improves my mood! :)
Why did we do 3 IUIs?
We stopped after 3 IUIs to move on to IVF for a few reasons:
Our insurance does not cover the cost of fertility treatments or medications.
One cycle of IVF plus meds can cost upwards of $9,000-$15,000, depending on your clinic and drug regimen. Some clinics offer multi-cycle discounts or even “money back guarantees” for $16,000-20,000 and up…before the cost of meds. There are less expensive clinics out there for sure - this is just the range we found when looking around.
IUI for us was about $2,000 per cycle. We decided we’d rather be spending what was quickly amounting to a lot of money on a treatment with a significantly higher rate of success than continuing with IUIs.
Typically if insurance does cover fertility treatments, they require 3-4 IUIs before they will pay for IVF.
Hey - if this is a model that works for the insurance companies - who are in the business of not losing money - it’s a good enough reason for us.
No positive pregnancy test
I’ve heard/read a lot of stories of couples who were successful on an IUI cycle and then miscarried. Since I had not had a single positive pregnancy test through it all, we decided it was time to bring on even more intense treatments.
