IUI folks, need some guidance

mypalbabs

My partner and I have done three at-home ICIs, two of which resulted in chemical pregnancies.

So we're taking the next step and are going to work with a reproductive endocrinologist.  We're concerned about the back-to-back chemical pregnancies, but also want to switch to IUI instead of at-home ICI. 

For those of you who have gone through IUI, what's the drill?  What can we expect?

Our appointment is June 11.

madisonpeas

The basic process for us was to do OPKs at home.  Once we got a positive OPK then we went in for an ultrasound to look at uterine lining and follicle count and size. Then the provider recommended when to return for our 2 IUIs for that cycle based on the ultrasound.  Of course the process may differ if you are on any meds that cycle.

 BTW we did ICIs at home and then IUIs in two clinics.

 Best of luck!

2moms2b

We just completed our first IUI.  Our procedure was similar to the above.  We started Clomid on day 3 - 7 then used opk's starting on CD 9.  The OPK's were simply to ensure we didn't ovulate early.  We had a follow up u/s on CD12 and due to follicle size and count were told to trigger the next night with our IUI scheduled 36 hours afterwards.  We only did one IUI instead of the two due to cost and it being or first cycle.  Our RE left it up to us whether we did one or two. We plan on doing one unless we get to IUI #4 then we will probably do two.

I didn't feel any discomfort during the procedure and we were in and out in about half an hour (I was told to lay with my hips elevated on a pillow for about 15 minutes afterwards). 

Best of Luck!

mypalbabs

For those who are using clomid, trigger shots, etc, how many cycles did you try before you started doing medicated cycles?

I assumed we'd try unmedicated cycles first, but I've never met with an RE, so I really have no clue.

Kershnic

We started with medicated because we knew from charting/menstrual history/family history that I wasn't ovulating regularly and had a high chance of having PCOS.

Many REs automatically start you on medicated cycles because the vast majority of their business is infertile heterosexual couples who in general would never bother with an unmedicated IUI.  They're not really known for re-considering the unique needs of presumably fertile but lacking in sperm lesbian couples.  Some REs also believe that jumping straight to clomid even in presumably fertile women will expedite getting pregnant and is a good idea considering the time/stress/expense of each cycle.

 My personal conclusion from the reading and thinking I've done is that if you have no concerns regarding you ovulating regularly that taking clomid only increases your chances of conceiving multiples and doesn't change your chances of conceiving at all.  Since multiples are medically risky I wouldn't go out of my way to seek them.  Not everyone will agree with this. 

ball.and.chain

mypalbabs:

For those who are using clomid, trigger shots, etc, how many cycles did you try before you started doing medicated cycles?

I assumed we'd try unmedicated cycles first, but I've never met with an RE, so I really have no clue.

mpb, I am on my 7th "natural cycle" IUI.  The first 4 were entirely unmedicated/unmonitored with a midwife practice -- we just used OPKs and called when it was positive -- and the last 3 were with an RE, trigger for all and progesterone for 2 cycles, but none of the "real" fertility drugs.  I think that most don't wait this long due to the expense/stress of this process.  We do plan to try Clomid on cycle 8 if this one doesn't work, although I haven't talked to my RE about it yet.  I think she will be on board.

I am extremely risk-averse, and I have no indication of infertility.  I do NOT want multiples -- partly due to the expense of infant daycare for two, partly due to the difficulty of raising them, and partly because the pregnancy and birth are riskier for mother and children.  I don't need that if I can avoid it.  My health insurance covers everything but sperm, and a few more cycles of sperm is still cheaper than twin infant daycare, so it seems financially prudent to hold off as well.  Since it supposedly can take healthy (hetero) couples up to a year to conceive, I believe (and my RE believes) that prior to 12 inseminations there is no reason to believe there is any problem.  However, we want to try Clomid next cycle because a) unlike hetero couples, I'm not just having free sex with free sperm in the comfort of home, so I am ready to move things along a bit (I am also 34 and would like a 2nd child eventually, so time is ticking), and b) I ovulate later than average, sometimes significantly later, and my RE thinks this could be a sign of "mild ovarian dysfunction."  Clomid would help this, if it is indeed an issue.  I am glad it exists and I will be thrilled if it -- or something else -- gets me pregnant, but I am also glad we held off for a while.

My RE considers it "natural cycle" even if you use a trigger shot, which she pretty much does as a matter of course (it makes timing easier).  Technically the trigger does increase the risk of multiples somewhat, but I think it's very little -- I haven't been able to find numbers and most women who use it are also on fertility drugs like Clomid, Femara, injectables etc so it's kind of hard to separate.  It's just synthetic HCG.

There are RE's who will medicate you right away and those who won't.  Mine would not.  Some are just used to dealing with women who have fertility problems, as kershnic said, and I'm sure there are some who are in it for the money that comes with higher-level treatments.  Make sure you're comfortable with the decisions that are being made, the reasons for them, and do NOT go with the medications unless you are comfortable with it.  You do not necessarily need to take them, and it is not automatic that because you're seeing an RE you have to medicate.

Our routine: when I get my period, I call my RE's nurse and she schedules my first ultrasound/bloodwork appointment of the cycle.  I typically ovulate around cd 19/20 so for me it's usually scheduled on cd 14/15.  They recommend you use OPKs starting a few days before just to make sure they don't miss anything, but you don't really have to.  These monitoring appointments are usually early in the morning because you have to go to several and it would conflict with work otherwise -- I go at 7:45 am and am out by 8:15.  The ultrasound is to check follicle size -- see if they're close to maturity if you're not medicated, and also to make sure there aren't too many mature follicles if you are -- and the blood work measures hormone levels to see how close you are to ovulation.  Normally you trigger 36 hours before the IUI but in my case, my LH surge has always been detected via blood work before I have been told to trigger.  My RE has had me trigger anyway at that point (usually about 12-24 hours before the IUI) because it can give your ovaries/ovulation a "boost."  Once my surge is detected, my IUI is scheduled for the following morning.

The IUI itself will probably not feel THAT different from the ICI, I would imagine.  I find the speculum itself more unpleasant than the insertion of the catheter.  Most of mine have been fine, though the last two have been kind of painful and I'm not sure why (again, pain from the speculum and not the catheter).  There is sometimes slight cramping when the catheter goes in and there can be some spotting.  It doesn't take long, you lie around for a while, done.

Also, if you haven't met with the RE yet, your first appointment will likely be just informational -- going over your partner's history, their procedures, explaining all the terms and meds and stuff.

Good luck!  My sister's friend (hetero) also got pregnant her first two times trying and miscarried on both -- but then she got pregnant and it stuck and her healthy boy is 3 months old.

ETA: Whoops, didn't mean to write a novel...

Kershnic

For the record, I pretty much always agree with everything ball.and.chain says.

Also, I would like to add that I did get a transvaginal ultrasound at my first RE appointment, which was a bit of a surprise for me, so I just want to throw it out there in case it helps anyone else.  I was expecting the informational meeting that ball.and.chain described.  And I got the impression that that is considered standard, but because I had questions about PCOS they wanted to vagi-wand me.  It's sort of normal to me now, but the idea of getting half naked and then having an ultrasound machine inserted into my vagina was a bit awkward for someone who had previously avoided pap smears like the plague.

ball.and.chain

Kershnic:

For the record, I pretty much always agree with everything ball.and.chain says.

Good thing, because I said a lot of it!

Also wanted to add that the ultrasound, while I can imagine it would be awkward when unexpected, is totally not a big deal, especially once you are used to it.  "Dildo-cam" is a fairly accurate nickname.  No speculum, it's not very big, and it's lubed.  Sometimes they have to push it around a little bit to find stuff, but I've never found it physically uncomfortable.

pixie76

I agree with a lot of what other poster's have already mentioned but I will tell you a bit about our RE experience.

We too started with ICI's at home.  I have to admit, after about 6 of them, I felt like we were old pro's.  DW would use a speculum to actually look at my cervix.  She could tell I was always ready when my cervix would get what she called "spotty";)  We used OPK's, but felt that my CF as well as her "visual" assessment were better indicator's. When we went through our 2nd early loss, we made an appointment with an RE to talk about this and see what other options we had as we were ready to move to IUI's (I have to go back and check, but I believe we did 8 ICI's at home by this point) 

 On our first visit, he scheduled me to have some basic hormone testing done on both cycle day 3 and 7 which showed that I had a high prolactin level.  I took medication for that until my level went down to normal.  That took 3 months.  When we were ready to do our IUI, I went in on CD3 (which was very uncomfy for me because it wierded me out having a vaginal U/S with the "dildo cam" while bleeding, but I got over that real fast as the cycles moved on) for an U/S and when that looked good, I started my clomid meds that night.  They have to do a check before giving any meds to make sure the ovaries are clear of any cysts etc.  We went back for U/S on various cycle day's to check how I was responding as well as to determine when to trigger.  We did 4 cycles on clomid.  I have to say I hated clomid.  Holy mood swings Batman.  We then moved to injectables.  I was given Menopur.  The monitoring was the same as being on the clomid.  When I had yet another early loss, my RE scheduled a Repeat Pregnancy Loss (RPL) blood draw.  Wow.  That was 24 vials of blood they took.  It came back that I have one copy of MTHFR.  MTHFR is a type of blood clotting disorder.  We started off by adding 4mg extra of folic acid to my prenatal, a baby aspirin, and extra omega's.  I would take these my whole pregnancy.  We took a cycle off so I could build this up in my system.  That next cycle we got pregnant with JT, I had 3 good follicles.  We had talked about multiples and 3 follies was were we felt comfortable with proceeding.  At 4 we would have benched ourselves. We stayed at the RE's office until we were 11 weeks along.  I was a nervous wreck anticipating a loss at anytime.  If we did loose this pregnancy, we were going to move on to lovenox to help prevent clotting.  All went well and just shy of 37 weeks our little guy was here.

When we were ready to have another one, we followed the same protocol.  That cycle we had 1 super nice follicle and one that was barely 11mm.  We anticipated this taking a few cycles so we were surprised that we got pregnant on our 1st try.  Even more surprised with twins.  I guess that tiny follicle decided that it wanted to be here=)

Good luck to you on moving forward.  I would suggest asking your RE what his protocol is for using meds? How long on each dose? How long until you move on to another type if needed? etc.  At what point do they offer additional testing? Some do an HCG before starting meds, some don't.  Will they consider your 2 early losses if you have another? (some insurance companies need to have 3 early losses documented before they will pay for additional loss testing like the RPL blood draw)  

I had various procedures done, so if you have any other questions I would be happy to answer what I can.  If I typed our whole journey, it would be a novel!

 

mypalbabs

Wow!  Thanks, women, for all of this information.

The guy we're seeing has a good (and long) reputation - his specialties include repeat miscarriages and IVF resulting in singletons.  (Which is a comfort just in case we end up in IVF land some day - we really hope to be in the One and Done Club!)

Our insurance doesn't kick in until we complete 12 unsuccessful IUI cycles.  Crazy. I mean, I get that we're fortunate to have any kind of coverage, but 12 OOP IUI cycles could get really, really spendy.

Please, continue to tell your stories - I really appreciate it!

2moms2b

Our RE is the same way although with the use of medication.  We only do one IUI (we can do two if we choose) per his recommendation until we have had 4-6 unsuccessful IUI's.  Then he generally recommends further testing to ensure there is not something happening as well as two IUI's time at 12 and 36 hours. 

Although he deals with the LGBT community and we account for about 15% of his practice he recommends doing at least mildly medicated cycles (triggers) if for nothing else than timing.  When we discussed doing an unmedicated (thrown out window due to PCOS) he said he would do it. 

 We used OPK's starting at CD 8 (day after last clomid dose) to ensure we didn't ovulate before our CD 12 ultrasound.  Our Dr told us you can test at anytime as long as you test at the same time every day.  I am obsessive so I tested twice a day.  Once about 9:30 to 10:am (4 hours after waking) and another around 2pm.  I did follow the dr. recommendation and reduce liquid intake for 2 hours before the test.  We did not actually end up ovulating on our own due to follicle size and number so they triggered us. 

The surge is detected 24 to 48 hours prior to ovulation.  Our doctor told us he schedules at 36 hours past trigger/surge due to the fact that frozen samples only survive 12 to 24 hours after thaw.  This allows you to catch your ovulation if it does take the full 48 hours.

 Best of luck to both of you and let us know how it goes. 

betsykerry1

we never saw a RE. My OB did my IUI. we didn't do triggers/clomid/whatevertheheckelse you can do. I charted for a couple months and when I got a positive OPK, i called my OB, made an appointment for the next day and had my IUI. It was seriously less painful than a pap, and took about two seconds. Have you talked to your regular OB about whether seeing a RE is really necessary? you might be surprised about what your OB is willing to handle in their office. all I can think of, is that your chemical pregnancies MIGHT have been due to "missing the boat" in terms of timing... good luck!

hlke

Hopefully I'm not hijacking here, but I have a few questions for ladies who did natural IUIs.  Did you do any testing before you started?  We're going to continue doing at home ICIs (probably at least until we've done six), but we were wondering if we should at least do CD3 bloodwork early on in the process.  C is 34, about to turn 35, and I know she'd be disappointed if we did six cycles (which will be 8 or 9 months) and then found out there was an easily diagnosable problem.  Her charts look really good, so there's no real reason to suspect a problem.  We'll be OOP for the bloodwork, which is the only reason to hesitate.

Just to add my 2c, we've chosen a very low intervention route for C's comfort.  Dildo cam, speculums and catheters are really not her cup of tea, so we're postponing that as long as we can.  I think we'd hold off on meds for the same reason. 

mypalbabs

betsykerry1:

we never saw a RE. My OB did my IUI. we didn't do triggers/clomid/whatevertheheckelse you can do. I charted for a couple months and when I got a positive OPK, i called my OB, made an appointment for the next day and had my IUI. It was seriously less painful than a pap, and took about two seconds. Have you talked to your regular OB about whether seeing a RE is really necessary? you might be surprised about what your OB is willing to handle in their office. all I can think of, is that your chemical pregnancies MIGHT have been due to "missing the boat" in terms of timing... good luck!

I don't think chemical pregnancies are caused by bad timing.

Our midwife taught us the ICI method so we could do it at home.  We had two successful conceptions in our three at-home cycles.

We're seeing an RE now because we're concerned about back-to-back miscarriages.  Statistically, that's unusual and we want to be sure there's not an issue, for example, with her uterine lining preventing implantation.

ball.and.chain

hlke:

Hopefully I'm not hijacking here, but I have a few questions for ladies who did natural IUIs.  Did you do any testing before you started?  We're going to continue doing at home ICIs (probably at least until we've done six), but we were wondering if we should at least do CD3 bloodwork early on in the process.  C is 34, about to turn 35, and I know she'd be disappointed if we did six cycles (which will be 8 or 9 months) and then found out there was an easily diagnosable problem.  Her charts look really good, so there's no real reason to suspect a problem.  We'll be OOP for the bloodwork, which is the only reason to hesitate.

Just to add my 2c, we've chosen a very low intervention route for C's comfort.  Dildo cam, speculums and catheters are really not her cup of tea, so we're postponing that as long as we can.  I think we'd hold off on meds for the same reason. 

The bold part was a concern of mine.  I'm 34 and we do want to have a second child at some point.  The only things we had tested at the beginning were the things the midwives required -- STDs, CMV, that kind of stuff.  Nothing hormonal.  I REALLY wanted to be low-intervention, but after 3 midwife cycles the anxiety got to me -- not because we hadn't gotten pregnant after 3 cycles, which I knew was normal, but because of all the things that COULD be wrong.  I couldn't stand the idea of getting to cycle 6 or higher and finding out there was something wrong all along that we hadn't known about it.  We asked the midwives for cd3 b/w, and they thought it was slightly off; we met with the RE just to talk about testing and then we got more b/w and the HSG.  The result was a) she thought my b/w was fine and b) my HSG showed a POSSIBLY blocked tube but she thought it probably wasn't blocked.  We did one more cycle with the midwives and then officially switched to the RE.  I have to say knowing the RE is monitoring my cycles has reduced my anxiety quite a bit.

ETA: Now that we're on cycle 8 (!), I am really glad we're not still with the midwives, wondering if anything is wrong!

Kershnic

betsykerry1:

we never saw a RE. My OB did my IUI. we didn't do triggers/clomid/whatevertheheckelse you can do. I charted for a couple months and when I got a positive OPK, i called my OB, made an appointment for the next day and had my IUI. It was seriously less painful than a pap, and took about two seconds. Have you talked to your regular OB about whether seeing a RE is really necessary? you might be surprised about what your OB is willing to handle in their office. all I can think of, is that your chemical pregnancies MIGHT have been due to "missing the boat" in terms of timing... good luck!

1. OBs open to doing IUI is a somewhat regional thing as far as I can tell from the infertility internetz.  In bigger cities it seems to be less common, and on the east coast it's less common.  I'm sure this correlates with the availability of REs.  Midwives are also a good option for many who don't have any fertility issues. 

2. Chemical pregnancies have NOTHING to do with timing.  If anything they're actually an indication that your timing was good, because by definition sperm met egg which is always the goal.   But obviously something else was wrong.  There's a lot of reason to believe that early miscarriage rates are actually really high (like 20% of pregnancies or more) but most people never know they have one because they're not testing at 9dpo.  Of course having two in a row is slightly more concerning, but I thought I'd throw that out there for people who are unfamiliar. 

hlke

ball.and.chain:

The bold part was a concern of mine.  I'm 34 and we do want to have a second child at some point.  The only things we had tested at the beginning were the things the midwives required -- STDs, CMV, that kind of stuff.  Nothing hormonal.  I REALLY wanted to be low-intervention, but after 3 midwife cycles the anxiety got to me -- not because we hadn't gotten pregnant after 3 cycles, which I knew was normal, but because of all the things that COULD be wrong.  I couldn't stand the idea of getting to cycle 6 or higher and finding out there was something wrong all along that we hadn't known about it.  We asked the midwives for cd3 b/w, and they thought it was slightly off; we met with the RE just to talk about testing and then we got more b/w and the HSG.  The result was a) she thought my b/w was fine and b) my HSG showed a POSSIBLY blocked tube but she thought it probably wasn't blocked.  We did one more cycle with the midwives and then officially switched to the RE.  I have to say knowing the RE is monitoring my cycles has reduced my anxiety quite a bit.

ETA: Now that we're on cycle 8 (!), I am really glad we're not still with the midwives, wondering if anything is wrong!

Yeah, our alternative insemination program will do the CD3 BW for us, and if anything is off, they'll refer out.  We're going to do it in July, right before our third cycle.  I hope that is is reassuring, but if something is off, I'd want to know now.  Even though KD cycles are relatively inexpensive, the time involved is substantial for everyone involved.

ball.and.chain

hlke:

Yeah, our alternative insemination program will do the CD3 BW for us, and if anything is off, they'll refer out.  We're going to do it in July, right before our third cycle.  I hope that is is reassuring, but if something is off, I'd want to know now.  Even though KD cycles are relatively inexpensive, the time involved is substantial for everyone involved.

Not to mention the stress!  It's definitely good to know what's going on.

maryoosa

Pretty Much everything here already.

 

My tract went like this: 

 

Visit with RE -consult--baseline initial bloodwork and transvaginal ultrasound. He wanted me to see a perinatologist and a nutritionist because of my blood pressure and my fatness. I told him to f'off about the nutritionist ('cause really, I'm fat, it's not like I don't know how to eat well, I know how and I do and I exercise alll the time) but I saw the PN who was like "you're fine go for it". 

Then, I switched RE's  (the first one didn't send labs out to Quest, which is the only place that my bw gets covered) so I went to a new endo with the old paperwork and bloodwork and test results. Then, he wanted to do an HSG (clear) and  Day 21 bw (bad news--low ovulation).

We had a meeting , and I started clomid. Inseminated once on clomid, didn't respond twice. The insemination failed. Then, we had another  meeting, and started injectibles (they suck) and did another failed insemination. We have the go ahead to try again and now we're on a break to try and get my hormones back to a place that they like. We'll try again on my august cycle. 

 marisa