IUI Process

This will be our last IUI so I figured I might document the process, as prior to the IUI I was a bit intimidated by it. 


April 19th, AF

Got my period. 
Going through infertility, every single month feels like another miscarriage.  Loss after loss after loss. I was expecting it, and have become numb to the grief. 


April 15th, Negative

I took a test this morning, as Dennis & I were going to the lab this morning for IVF bloodwork & I wanted to be sure that it is "necessary". My test was not surprising, Negative. However, as much as I doubt that it will work I still hold out a little bit of faith that it might work, and I might be surprised with a positive pregnancy test.
I feel betrayed by my body. This process is hard, it sucks. I was hopeful that this time it might work because it was our last round of IUI. I feel like IVF is our only option, but I'm concerned, what if that too doesnt work. It's a gamble financially and emotionally.
We will now wait until September to start IVF. I don't want to wait any longer but I know that we need a break. 

April 4th, Cycle day 13, 3rd & final IUI

7:30am Dennis appointment for his "sample"
He's a good sport!

Waiting for Den...

 Err

 Sock buddy sharing the love today! 

Me:

I go here to hang out between our appointments, 7:30am sample appointment, our IUI appointment is at 10:30am. After I drive Den downtown I go to Marda Loop, The Loop for breakfast. I love it.
Ive done this for the past 2 IUI's as well. 

10:30am Waiting for IUI, waited an hour this morning! 

IUI
We had 31 million sperm this morning which is excellent. Anything over 1 million is good! 
Now we wait for 2 weeks to see if it worked or not... 

Message from my hubby: 

haha

Cycle day 11, HCG

A typical protocol will involve taking clomiphene each day for cycle days 3-7. Ultrasounds are then used to monitor the egg as it matures. Once the egg is ready, a subcutaneous injection is given of a hormone called hCG (the ‘trigger shot’), which triggers ovulation of that egg approximately 38-40 hours after the injection.

10:56pm Note, I like to be in bed around 9pm, so I was tired! Dennis was at hockey so this time I was on my own. 
My previous HCG Shots havent gone well, at all. So this time I consulted with my sister, who is a nurse. She was a huge help in walking me through how to administer, and it went smoothly, and easily. 

Fill it up to 1ml. 

 Pretending to insert it. haha.

 Done!

Cycle day 10, April 1st update: Photo journal of my morning at the clinic, to prepare for IUI. 

This is where the magic happens!
I am grateful for the technology & options that we have! 

 This sucks, so Im no smiling. But I like it anyways. :) 

 The key chain tag is from my Aunty Bobby. On one side it says "I am" and the other side, "Courageous". It reminds me, to remind myself that I am brave & courageous. 

I go in to the 2nd floor, EFW Radiology for an internal ultrasound to measure the size of my follicles to determine when to do the IUI. Most people do not go in for follicular monitoring via ultrasound, however, pee sticks havent been working very well for me while being on clomid. The results for example were false positive for 6 consecutive days... so then I have no idea when Im actually ovulating. Hence the ultrasounds.

Wearing my special socks, xo sock buddy!

Ultrasound ... 

This is sick, so Ill make the picture small. This is the internal ultrasound wand (prior to insertion).

This time the lab tech gave me my lab report, which I think they arent supposed to do. I always have had to wait at least half an hour for them to fax it upstairs so Im glad that the tech gave it to me today. The tech today was the best that Ive had so far, she was great.
My report sucks, and Im feeling a little bit down.
My right side is stronger than the left, but so far there is only one mature egg. I received a prescription for HCG which I will take tomorrow night at 11pm (April 2nd) but for this round it seems that only one egg will be ready & available. One egg is measure 1.8, they like to see 1.8-2cm, so that's right on track.
Last time I had 8 eggs. I think my body is tired.
Also, for the last 2 IUI's I had 2 ultrasounds & the IUI was planned later. I expected to have a 2nd ultrasound this time as well, on Thursday and thought that we would be going in on Saturday for the IUI (which would have been more convenient). So I wonder if waiting an extra day & having a 2nd ultrasound - if the other eggs would catch up. I feel like Ive failed already this month. But- I only need one egg, so it could still work. And some of the other follicles may be mature & ready on Friday, who knows?! 

Momma & Oscar love!

This is the fertility clinic. I go up to the clinic (4th floor) to review the results of the ultrasound with a nurse. I also purchased my HCG, and the nurse went through administer the HCG. 

HCG (Trigger shot) instructions

Step one, call in period. On the first full day of my cycle I call in to the fertility clinic to book my IUI. I called in my period yesterday. 

• They just phoned me back to book in ultrasounds (to check the size of the follicles and determine when to do the IUI & give trigger shot).
• Step two, get clomid meds, 100 mg. Check.
  Take 2 pills once per day, from days 3-7 of my cycle.
  Today, March 25th is my day 3, so Ill take the pills for the next 4 days.
  There are a lot of crazy side effects with clomid, mainly people indicate that it turns them into a psycho bitch. I found that to be the case the first month that I was on clomid however, since I dont notice any major side effects.
  
  Update- clomid day 3, I have been experiencing night sweats for the past 2 nights. Waking up in a cold sweat. Not very nice!
  
  Also, major headache 2 days ago (on my first day of clomid)
• 
  

• Step 3- Ultrasounds, my ultrasounds this month are booked for April 1st  8:30am & April 3rd 9am. After ultrasounds are completed I go upstairs to the fertility clinic, wait for the results to be sent from the ultrasound tech lab, meet with a nurse to review the information to determine when the IUI will be.
• Step 4- HCG Trigger shot. This is the worst part of this experience for me. I have to take the shot at 11pm, I go to bed at 9pm, so Dennis needs to wake me up to give myself a needle. Last time it was a complete mess. I couldnt get the needle in and ended up with blood on my hands, pajamas and the table. Not fun!
• Step 5- IUI.
  Dennis goes to the clinic at 7:30am, for a sample on the day of the IUI. His sperm get's "washed" and only the good one's are preserved for the insemination.
  I go in at 10:30am for the procedure. Dennis has come with me for the past IUI's which has been supportive. 

Why are we stopping after 3 IUIS:

Intrauterine insemination (or IUI) is an in-office procedure that attempts to increase the likelihood of pregnancy by bringing the sperm closer to the egg in order for fertilization to occur.  It has to be done at the right time in order to be effective, and as a result intrauterine inseminations should be timed to spontaneous (i.e. LH surge) or induced ovulation using human chorionic gonadotropin (i.e. HCG).   Intrauterine inseminations should be performed the day after detection of the LH surge,  or within 34-40 hours after ovulation is triggered by HCG.  This is because the oocyte (i.e. egg)  has a limited window after its release to be successfully fertilized.

Intrauterine insemination is commonly used to treat mild male factor infertility, endometriosis,  unexplained infertility, ovulatory dysfunction,  and cervical factor  infertility.  It is also a viable treatment option for women under age thirty-eight and for couples who have failed multiple ovulation or superovulation induction cycles (usually 3-4 treatment cycles) before moving on to in vitro fertilization (IVF).  Although treatment with intrauterine inseminations is often seen as a step before IVF, pregnancy rates achieved with IUIs have not significantly increased over time (as they have with IVF) and as a result the number of intrauterine inseminations being performed is starting to decline.

In order to increase pregnancy rates with intrauterine inseminations, some have even advocated doing two inseminations instead of one at 12 and 36 hours after a HCG- induced ovulation.  However, studies have not shown a significant increase in pregnancy rates by doing two inseminations.  As a result, I encourage patients to only do a single insemination during their treatment cycle because a second insemination is more associated with increased costs than the expected outcome.

When should one look into other treatment options when intrauterine inseminations have failed?  This is more dependent on female age, other infertility diagnoses, duration of infertility, and quality of the insemination specimen.   I generally recommend in vitro fertilization if the female partner is over age 38  or has a history of diminished ovarian reserve because success rates with IVF is significantly higher than those achieved with intrauterine inseminations.  I also recommend IVF after three or four failed intrauterine insemination cycles, because pregnancy rates begin to decline after the fourth IUI attempt.