First off, let me assure you, turkey basters are not standard medical equipment…
Second, to get you up to speed, below is a fairly good description of the IUI process and why it’s done. And more information can be found at http://www.resolve.org/family-building-options/iui.html
Intrauterine insemination (IUI) is the placing of sperm into a woman’s uterus when she is ovulating. This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. IUI is often done in conjunction with ovulation-stimulating drugs. IUI can be performed using the husband’s sperm or donor sperm. Before IUI, the woman should be evaluated for any hormonal imbalance, infection or any structural problems.
Insemination is performed at the time of ovulation, usually within 24-36 hours after the LH surge is detected, or after the “trigger” injection of hCG is administered. Ovulation is predicted by a urine test kit or blood test and ultrasound.
In the case of husband inseminination, the male partner produces a specimen, at home or at the clinic or doctor’s office. The sperm is then prepared for IUI. Sperm from the male partner or third-party donor are “washed” or separated. Separation selects out motile sperm from the man’s ejaculate and concentrates them into a small volume. Sperm washing cleanses the sperm of potentially toxic chemicals which may cause adverse reactions in the uterus. The doctor uses a soft catheter that is passed through a speculum directly into the woman’s uterus to deposit the semen at the time of ovulation.
IUI may be used in conjunction with ovulatory medications, such as clomophine citrate, gonadotropins, or urofollitropins. If injectable ovulation stimulating drugs are used in an IUI cycle, careful monitoring is essential. Monitoring includes periodic blood tests and ultrasounds beginning around day 6 of the woman’s cycle. Results of these tests will indicate when eggs are mature, prompting the hCG shot.
IUI is also used with specially prepared donor sperm. The sperm bank sends the doctor’s office sperm that is already prepared for IUI.
IUI is a relatively quick procedure and is performed in the doctor’s office without any anesthesia. It should not be painful, although some women report mild discomfort.
Eric and I attempted two IUI cycles, in October and November of 2013. During one of my first visits with Dr. Van Voorhis, he suggested two to three cycles of IUI before we talk other options. We had originally planned to attempt a third IUI cycle in December, but the infertility lab at the University has altered hours around the holidays and thus it just didn’t work out for us, as timing is crucial. Before seeking medical intervention, Eric and I had been using the disposable ovulation test kits you can find at almost any pharmacy. Once we met with the REI department at the U it was recommended we buy a slightly more advanced monitor. I believe the more advanced monitor tests levels of two hormones instead of one, and gives more notice, as it displays low, high, and peak fertility rather than just low and peak. Same process otherwise though, a stick to pee on daily, nothing fancy there!
IUI can be done with no medications or some, and when I say some, I was lead to believe the combination and level of treatment can vary greatly depending on how aggressive the couple and the physician want to be as well as if the cause of the infertility is known or unknown. For me and Eric, all tests were normal and thus we didn’t necessarily have an ‘issue’ to fix, well, not one we know of. I was ovulating regularly, tubes were open, no uterine issues that we knew of, and Eric’s sperm were ‘beautiful’ as I’d been told. Dr. Van Voorhis suggested we try Femara, similar to the more well-known Clomid, but with fewer side effects and a lower risk of multiples. Below is a little bit more about the drug from http://www.ivf.com/clom.html
Both clomiphene citrate and letrozole are medications used to treat infertile women who have an ovulation problem. These medications work by helping your pituitary gland (located at the base of the brain) improve the stimulation of developing follicles (eggs) in the ovaries. Neither clomiphene citrate nor letrozole may help a woman become more fertile if she is already ovulating normally. For that reason, these medications are most often prescribed to those patients who have been found to have an abnormality with their cycle.
Clomiphene is often referred to as the “fertility pill”. Letrozole is very similar to clomiphene in the way it works. However, letrozole is quickly cleared from the body. It only works for the cycle in which it is taken and is less likely to adversely affect the uterine lining and cervical mucous. With clomiphene, one may experience effects 6-8 weeks after stopping the medication. Both medications are prescribed for five days each cycle, usually beginning on day three and continuing through day seven. The usual initial dose for clomiphene is 50 mg, one tablet daily. The number of tablets can be increased to as many as four daily, if a lesser dosage does not result in ovulation. Rarely are more than two tablets required. Clomiphene should be repeated each cycle until pregnancy occurs, or your doctor discontinues it. The usual dosage of letrozole is 2.5 mg., one tablet each day.
Of all women treated with clomiphene, or letrozole, 60% to 80% will ovulate normally. However, only half of those patients who ovulate will become pregnant. It is not known why only half of the women who apparently ovulate with clomiphene or letrozole therapy become pregnant. It is suspected that factors other than inadequate ovulation may be contributing to the fertility problem. Therefore, if you are not pregnant after three or four cycles, additional testing such as hysterosalpingogram or laparoscopy may be necessary. If you have polycystic ovary syndrome, a trial of metformin (Glucophage) therapy may be advised.
Some 10% to 20% of women taking clomiphene or letrozole will experience side effects. By far, most of these are minor and temporary in nature. They include such things as hot flashes, blurred vision, nausea, bloating sensation, and headache. Serious side effects are rarely seen with either medication. There are two side effects associated with clomiphene or letrozole therapy that warrant specific discussion. The first is the possibility of multiple pregnancy. The frequency of twins occurring in women who conceive while taking clomiphene or letrozole has been reported to be as high as 10%. Triplets may occur as frequently as 1 in 400 births, and quadruplets in 1 in 800 births. Neither clomiphene nor letrozole is the “fertility drug” you may have heard in the news bulletins often associated with large numbers of infants, such as quintuplets. Newer studies suggest that long-term use of either clomiphene or letrozole for more than 12 cycles may place you at an increased risk of developing ovarian cancer. Secondly, clomiphene and letrozole have also been associated with the occasional development of ovarian cysts. These cysts are not true growths of the ovary and within a few weeks will resolve without treatment. However, on an extremely rare occasion, these cysts have been known to cause internal bleeding or twist, requiring surgery and removal of the involved ovary. However, I must again emphasize that such a complication is extremely rare.
Clomiphene or letrozole stimulated cycles are not unlike normal cycles in that there is only a 20-25% chance of conception occurring each cycle during the first three to four treatment cycles, even if the medication is working properly. (Results may be lower with unexplained infertility.) This means that at least four to six cycles of treatment are necessary before one has given either medication an adequate trial. Recent studies indicate that if a pregnancy occurs as a result of the clomiphene/letrozole treatment, there is no clinically significant increased risk of miscarriage or congenital birth defects when compared to other infertile couples who conceived without clomiphene/letrozole treatment. However, women with polycystic ovary syndrome may be at higher risk for miscarriage during a pregnancy conceived using either of these medications.
Both of our IUI cycles were extremely similar. I was given the prescription for Femara, 5mg taken each evening for 5 days, meaning I’d begin taking it on day 3 of my period/cycle and continue until day 7. The advanced ovulation monitor we were using by that point had a little mind of its own and thus would tell me when to start testing my pee each month and then alter that cycle day as appropriate. Both cycles it requested to begin testing on day 6 and continue until day 15, at which point my ovulation was complete, as I normally ovulate between day 12 and 14. Even though the list of side effects was long for Femara, I really only experienced a few which were mild… I would take the pills, two, 2.5mg tablets, before bed each evening and normally find myself EXTREMELY hot roughly 30 minutes later. Far from unbearable, and if I was already asleep, I wouldn’t even notice! The only other side effect was my increased heart rate during my morning workouts at Kosama. If anything, this was embarrassing since we each wear heart rate monitors which are displayed for all to see. Mine would be in the red zone already during the warm-ups!
The morning after our monitor displayed a peak reading (tests were done in the evening) we were to call the infertility lab and let them know we’d be in for insemination. The lab opened at 7:30AM and they expected all insemination patients for the day to arrive as close to 7:30AM as possible, which made for fun times in the waiting room! The infertility lab is separate from the REI clinic where the actual inseminations are done; the infertility lab is where semen collection and processing is done.
Eric was working on both insemination days, and both happened to be weekends. Being he’s normally at work by 5AM for rounds, I met him at the infertility lab around 7:30AM. I believe partners are allowed in the collection rooms, but honestly, I’d rather not have that imagine of my baby’s beginnings in my head. I opted to remain in the waiting room both cycles. Once Eric’s part in this process was complete (they have it so easy!) he returned to work. I was given a pager so I could return to the lab once the sperm had been washed and prepared. You know the pagers you get at restaurants? Yeah, nothing like waiting for your sperm to be ready! Can this process get any more awkward??
So off I wondered in the hospital with my table pager… The time to wash and prepare the semen sample takes about three hours, so with quite a bit of time to waste I’d find my way to Java House. What? I don’t have to give up caffeine until after the pregnancy is confirmed, right??
Back at the lab to collect Eric’s sample. And you thought the table pager was awkward! My ID was checked, yes, let’s make sure I’m getting Eric’s swimmers and not the creepy guy’s I saw in the waiting room! I sign to acknowledge I’ve picked up the sample, and I’m handed a test tube. Yes, they hand me a test tube and direct me down a floor to the REI clinic. Nothing like walking through the hospital carrying millions of sperm! Yes, millions, as they give you a detailed report of more things about the sample than you ever really wanted to know… The lab tech laughed and said some men like their reports posted on the fridge at home. Um, no, not on our fridge… No no no.
Checked in at the REI clinic and immediately called back to a standard exam room. My hospital bracelet is checked and matched against the sticker on the test tube, which the nurse thankfully finally takes from me. I’m asked to undress from the waist down and cover with a lovely sheet left on the exam table. The insemination itself is really quick. The nurse uses a speculum to visualize the cervix and then washes the cervix with extremely cold cotton balls and some special solution. A very thin catheter is then fed through the cervix and into the uterus where the contents of the test tube are deposited. Mild cramping during the procedure but fairly painless immediately after. The head of the bed is lowered after the procedure to allow gravity to help direct the sperm (I thought nature told them what to do?) before I was left alone to relax. The nurse returned 15 minutes later and said I was free to go with no activity restrictions. I was asked to return in 14 days for a pregnancy test at which point another round of Femara would be prescribed if the cycle was unsuccessful.
Ultimately both of our IUI cycles were unsuccessful. Disappointing… In December, when we’d hoped to do the third IUI cycle, I had taken the medication in preparation, so we tried on our own that month, timing as appropriate with the help of our ovulation monitor, but unsuccessful that cycle as well. There are no signs that point to an ovulation issue for me, and plenty of proof I am ovulating monthly, such as the peak readings on the monitor as well as good follicle counts on ultrasounds. I assume the medications were added into the IUI as a ‘just in case’ measure. IUI also works around any cervical mucus issues, but there have been no signs that’s an issue for us, although there is no true test for such, or so I’m told. Personally I think our issue is implantation, more specifically lack of sufficient uterine lining, but I’m solely basing this on my own observations during ultrasounds. No physician has confirmed any such issues to me. I did question this at our IVF consultation and was assumed that if implantation is the issue, IVF should overcome that problem, as I’ll be given plenty of progesterone, in two different forms, pills and injections, to make sure the lining is able to support a pregnancy upon embryo transfer. Only time will tell…