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.
