We did our first IUI recently. IUI stands for “intrauterine insemination,” which you can read more details about here (Source: American Pregnancy Association). IUI is used to help couples conceive if they have problems with their cervical mucus or sperm motility, for women that have to use donor sperm, or is attempted in “unexplained infertility” because it’s much less expensive than other methods.
DISCLAIMER: This post is medical in nature. I am not a doctor, only relaying information that I have been given by doctors and research. Your doctors may tell you different information, please listen to them and not me (they have medical degrees, I do not) for details regarding your own health. Due to the nature of fertility treatments, some people may find this post to be “graphic” or “sensitive” in nature, please do not read it if you do not want to be exposed to the nitty-gritty details of fertility treatments or if you are a minor. Proceed under your own judgment – I cannot be held liable for your decisions.
“Traditional” conception has many steps. Semen, a combination of seminal fluid and sperm, is deposited into the vaginal canal. From there, the sperm swim from the seminal fluid into the cervical mucus, then they swim into the uterus and all the way up into the Fallopian tubes. The sperm meet the egg in the Fallopian tubes where they fertilize it, then the fertilized egg travels down into the uterus and implants into the uterine lining. Once a fertilized egg implants, the woman is officially pregnant. (For the egg to get to the tubes is also a long process, that I talk about: here.)
IUI removes the first several steps for the sperm, hopefully making the journey easier and more successful. The male that is providing the semen (could be a donor or the partner) ejaculates into a sterile cup. The semen is then taken back to a lab and “washed.” Seminal fluid contains “glucose, calcium, acid soluble phosphorus, and […] chloride” along with other substances necessary to keep the sperm alive and facilitate their movement (Source: Huggins et al). As you can probably imagine, these products could cause problems if they are placed into the uterus. Because the seminal fluid cannot be placed into the uterus directly, a lab processes the semen and separates the sperm from the seminal fluid. During the wash process, some sperm are also eliminated, hopefully leaving behind only the healthiest sperm. The sperm are then mixed with a neutral fluid (one that will keep the sperm alive, but won’t cause irritation inside the uterus), and put into a test tube. This test tube needs to stay at body temperature until insemination. For the insemination process, the woman lies on her back much like she does for a pelvic exam (feet in stirrups, legs spread, naked from the waist down). The doctor inserts a speculum so that they can see the cervix. Then the doctor draws the sperm up into a piece of thin tubing with a syringe. The tube is then threaded through the opening in the cervix up into the uterus and the sperm is deposited. Around ovulation, the cervix is dilated, so it’s minimally painful, if the woman even feels anything at all. The woman then stays on her back (she’s allowed to bring her legs back together) for at least 10 minutes, though every office has a different length of time, to help keep as much of the sperm inside as possible. She then gets dressed and goes about her day. (Sometimes, the woman is prescribed medication before or after the insemination process to increase the chances of the IUI being successful. These medications can increase egg production, trigger ovulation, or hopefully increase the quality of the uterine lining. Every woman needs a different combination of these medications, or none at all. If a woman doesn’t need any medication, it’s an “unmedicated IUI.”)
Now, on to the details of our own story:
We had a consult at the fertility clinic that did my HSG and the semen analysis. The consult was less than desirable and left us frustrated, confused, and overwhelmed. Now, the doctor wasn’t telling us anything we didn’t already know about our health – that wasn’t the problem. The problem was that we spent all of 10 minutes with the doctor, where he talked primarily about IVF, and anytime I tried to ask questions I got a “well, I don’t want you to stress about it” with no answer. Dan didn’t know what most of the acronyms or tests were that the doctor was talking about, so he was even more lost, but thankfully I knew most of them. Then we were ushered in to talk to a nurse, and told she would explain more to us. All she did was tell us what tests we needed and how they would cost us roughly $600, because they said we had no insurance coverage. Problem is, we do have insurance coverage, we know we have coverage, but they kept saying we didn’t and claimed to have called the insurance company. The billing department left a horrible taste in our mouth, as trying to get them to adequately answer questions or submit claims to our insurance was harder than pulling the teeth on a conscious tiger that hadn’t been fed recently. Frustrated and upset is an understatement. I have never cried in a doctor’s office, nor have I ever been close, but in the time between seeing the doctor and seeing the nurse, I couldn’t hold back the tears. That’s how overwhelmed I was by the entire thing.
Thankfully, I was able to get an appointment with my normal OB/GYN shortly after the consult. When I first started trying to get pregnant, I had an OB/GYN which I liked for my annual exams. However, when the infertility process all started, I got frustrated. I now have a new OB/GYN – which is the one I’ll be talking about from now on. We met with my OB/GYN and talked about how frustrated we were at the fertility clinic, what the fertility doctor had said, and asked if she was able to do an IUI for me. She said she could, and that she didn’t think we had to wait for the next cycle, because an unmedicated IUI should be okay for me (since I ovulate on my own)! We talked to her on cycle day 10, and I ovulate (on average) on cycle day 14. She said that the day I get my peak ovulation test, I need to call them and tell their office; then they’ll help me set up the process for the following day.
To do an unmedicated IUI with my doctor, I have to take a semen sample to a fertility clinic for processing, then I take that sample back to my doctor for insemination. We called all three of the nearby clinics (including the one we don’t like) to find out who had the best price on the semen wash (that’s what it’s called – I think it’s a silly name). We had already talked to our insurance and knew we had no coverage for the semen wash or the insemination, so we needed to find the best cash price. The clinic where we had our consult, which we don’t like, told me it would be $127.50 if we paid cash, so that was the best price.
I got my positive ovulation test, and called my doctor as soon as I could. Unfortunately, it turned out they were at the other office and they didn’t get my message. At 2:30pm (the clinic and my doctor both close at 4:30), I called again and started playing phone tag between the two offices to get everything setup. Thankfully, I did eventually get everything scheduled and setup by 4pm. As you can imagine, I was stressed out. However, I couldn’t get the clinic to tell me if their hour time they told me was for just the wash process or if they factored in sample providing time. But we had no way to get a sterile cup for the sample anyway, so I hoped it wouldn’t take an entire hour.
Dan woke up early and got to the clinic to provide the semen sample and start the wash process. I woke up a little later and went to meet him there, because he had to go to class (he’s in graduate school). I got there about 8am. My appointment at the doctor for the insemination was at 9:15am, so I needed to leave the clinic by 9 so that I could get to my appointment on time. When Dan went to pay, I overheard the lady was telling him it would be $150. The billing department had once again been useless. I had explained to billing that I needed them to do the wash, and that I would be taking it to my own doctor for the insemination. However, the billing lady had told me the price for patients doing it at their clinic. The “outside wash” was $150 and had no cash discount at all. I quickly changed from anxiously excited to anxiously grumpy.
We paid and Dan left to go to class. At 8:55am (over an hour since Dan had provided the sample), I went and asked how long it would be. They told me it would be another 15 minutes. Great. I called my doctor’s office (remember, my appointment was for 9:15am). I wasn’t having my doctor do the insemination because she hadn’t been available until the afternoon and that didn’t work for Dan’s schedule, so a different doctor in the practice was going to do it. Thankfully, they told me that the doctor I was scheduled with was running late as well, so it wasn’t a problem and they would see me whenever I got there. I’m glad they were understanding, since I could do nothing at all to speed up the lab. I was not given the sperm until 9:15am, I shoved the test tube and itchy bag into my bra (the sperm need to be kept at body temperature to survive), and then went to my doctor’s office as quickly as I could [safely] get there.
I arrive and they tell me the doctor is delivering a baby, so he’s going to be even later. I remind them I’m there for an IUI, which I’m almost positive is time sensitive, and they are like “oh, right, I’ll go find out.” I get called back, and it turns out that my doctor is going to do the insemination because it doesn’t take much time and is time sensitive. (So, maybe all the stress was for a reason? So that I could have the doctor I’m familiar with? Who knows?)
I keep the vial of sperm in my bra – that plastic bag was soooooo itchy – until my doctor asks for it. I get undressed from the waist down, lie down, place my feet in the stirrups, hand over the sperm, and then my doctor starts. She inserts the speculum, which should not cause pain (if it causes you pain, please mention it to your doctor, that is not normal), it just feels like a bit of pressure. Then she says “you may feel a little cramping with this next part” and I respond with “okay” while mentally preparing myself for the intense pain I had with the HSG. Suddenly, she asks if I felt it and I’m shocked when she says she’s already inserted the tubing (catheter) because I couldn’t feel anything at all! She then inserts the sperm, which also had no sensation involved, and helps me put my feet back onto the table. My doctor retains a small amount of the sperm to make sure they’ve survived (they had) and I am instructed to stay flat on my back for about 15-20 minutes.
I was expecting someone to come in to get me, but no one did, so after 25 minutes I decided to clean myself up and get dressed. Then I checked out, and left. Because I’d had such an emotional journey, I chose to rest and de-stress when I got home to hopefully give my body an even better chance.
My doctor did instruct us to try on our own again that night, just in case it would help any (she said “couldn’t hurt”), so we did. Then, the two week wait started.
After ovulation, it takes about two weeks before levels of hcg (the pregnancy hormone) are high enough to be detected in the urine on a home pregnancy test. The hormone is detectable around the same time your period would come if you didn’t conceive. You can sometimes test before the full two weeks has passed, but that can cause stress due to false negatives. I try not to test more than 4 days prior to my expected period, even if the specific tests I have say they can be used earlier than that.
Since it’s already quite long, there’s a part two to this post! Part two can be found: here.
Huggins, Charles, et al. “Chemical Composition of Human Semen and of the Secretions of the Prostate and Seminal Vesicles.” American Journal of Physiology, vol. 136, no. 3, 1 May 1942, pp. 467–473., physiology.org/doi/abs/10.1152/ajplegacy.1922.214.171.1247.
“Intrauterine Insemination (IUI): Uses, Risks and Success Rate.” American Pregnancy Association, 10 Sept. 2018, americanpregnancy.org/infertility/intrauterine-insemination.