When our doctor first suggested that we try intrauterine insemination (IUI), I was actually excited. My husband and I had been trying to conceive for a while without any luck. Our tests turned up relatively normal and we were told that we should be able to conceive, yet month after month, I failed to conceive. The diagnosis was frustratingly vague—unexplained infertility (with potential male factor)—so IUI offered a bit of hope. Here was something that could potentially help us have a child.
IUI is one of the first assisted reproductive technologies typically recommended by a doctor. It’s commonly used when the male partner is experiencing low sperm count or decreased sperm motility, but it can also help those suffering from unexplained infertility, endometriosis or cervical mucus issues and assist same-sex couples. I liked that the procedure is relatively non-invasive: It simply places healthy sperm as close to the Fallopian tubes as possible, giving them a bit of a head start in the race toward the egg.
Like all things to do with infertility, navigating the IUI process was overwhelming. I quickly became emotionally, physically and financially invested in something I didn’t know a whole lot about. I had a ton of questions: What happens? How does it feel? Will it work?
Here’s what I wish I’d known before doing my first IUI.
On Day 3 of my cycle, I did blood tests that checked my hormone levels, and my husband had his sperm analyzed to gauge the concentration, motility and morphology of his little guys. We had two options: a medicated IUI or a natural one. The former involves taking fertility drugs so that more than one follicle (typically two or three) matures and improves the odds of pregnancy; the latter doesn’t involve medication (so only one egg is released). Because it was my first fertility treatment and we didn’t want to do anything too invasive, we chose a natural IUI.
I began daily cycle monitoring at my clinic on Day 10. I had to arrive early—between 7 and 8:30 a.m.—for blood work and an internal ultrasound every day for a week. Though I knew the process would give my doctors insight into how my hormone levels and follicles were developing, I couldn’t help but feel like a pincushion. By Day 17, my nurse let me know that a mature follicle was ready to ovulate. (It was about time—I found this gruelling.)
My trigger shot was the first hormone injection I had ever received. I was given the pregnancy hormone hCG, which helps follicles mature and ensures that ovulation occurs within 36 hours. Doctors administer this hormone to help time insemination—they want sperm to be waiting for the mature egg (an egg survives for only 12 to 24 hours post-ovulation, while sperm can live in the Fallopian tubes for days). I don’t mind needles, but I was used to getting them in my arm, not my abdomen. While the trigger shot didn’t hurt, I know I flinched because it felt so weird (my hubby maintains that I took the injection like a boss).
On Day 18 around 7 a.m., we arrived at the clinic for IUI day. To say that we were nervous is a bit of an understatement—neither of us was sure what to expect. Would the procedure hurt? Would my husband be allowed in the room with me? There was also this great sense of anticipation—we desperately wanted the IUI to work.
I did my usual blood tests and internal ultrasound and my husband produced a semen sample. We were told to return to the clinic around noon—this gave the andrologist time to “wash” his swimmers. (Sperm washing is the procedure that separates the sperm from the semen and weeds out the low-quality “tadpoles.”) To ensure that there is enough sperm available to wash, men are typically asked to abstain from sex or masturbation for two to four days before an IUI. One hour before the procedure, I had to consume one litre of water, as a full bladder helps the doctor guide and angle the catheter into the uterus.
The wait between our early-morning appointment and the procedure was odd. At around 8 a.m., we found ourselves wandering around Toronto with nothing to do for four hours. For a while, we had no idea how to spend our time—it was clear that we both wanted the IUI to be over. We filled up our car with gas, bought groceries and treated ourselves to brunch (an awkward meal spent talking about everything but what we were thinking about). We laugh about the weirdness of it all now.
Once back in the ultrasound room, I sat on the exam table and placed my feet in the stirrups. We were shown a vial of my husband’s sperm and asked to acknowledge that the information on the label matched ours. I remember thinking “I sure as hell hope so!” but all I did was laugh out loud. It was such a funny—but important—request. I think I read the information 100 times before saying “Yes.” I was then asked to lie down and the doctor inserted a speculum into my vagina.
As the technician performed an external ultrasound, the doctor inserted the catheter into my vagina and my cervix. Using the ultrasound screen as her guide (which I watched closely throughout the procedure), she pushed the catheter through the cervical canal and pointed it toward the top of my uterus and right Fallopian tube (the side with the mature follicle). She injected my husband’s sperm through the catheter and into my uterus and advised me to stay seated for a few minutes. The process lasted only about 60 to 90 seconds.
While the IUI itself was uncomfortable and awkward, it didn’t hurt. The insertion of the catheter felt a lot like a tight, one-second pinch. “Most women compare it to a Pap test,” says Ari Baratz, a fertility specialist at the Create Fertility Centre in Toronto.
After the procedure, the toughest part was dealing with the dreaded “two-week wait.” That’s the terrible time before your period where all you can do is sit and dream about being pregnant. It’s agony—there’s no way to know if you’re actually pregnant that early on, but that’s all you can think about.
To minimize stress, Baratz recommends that women maintain realistic expectations about the chances for IUI success and try to focus on other things. “Don’t put everything on hold for that pregnancy test,” he says. “Do everything you can to live a normal life.”
I thought I was lucky to experience few to no side effects from the procedure, but according to Baratz, my experience is quite common. While some women have minor cramping, spotting or a feeling of fullness post-procedure, the vast majority don’t.
It was for us. We got pregnant but miscarried at around seven weeks. While we experienced loss, we were thrilled to learn that we could get pregnant.
On average, a woman under 35 will have a 10 to 20 percent chance of pregnancy with each IUI, while a woman over 40 will have a two to five percent chance. “The peak IUI effect is around three to four cycles,” says Baratz. “If you’re going to get pregnant [with], you’ll get pregnant within those attempts.”
He says that there’s sort of a cumulative success rate with fertility treatments. The more a couple tries something, the more likely it is that they’ll get pregnant. But just like trying naturally, there comes a point when certain treatments no longer work. If pregnancy doesn’t happen with IUI after a few cycles, a couple should consult their physician about another approach, like IVF.
A woman shouldn’t take a failed IUI as a sign that she won’t be able to conceive, though. “It’s always desirable to conceive in the least invasive way possible, and IUI offers that option,” says Baratz. “[But] there’s no one set path that anyone takes to build a family. The goal is to produce a healthy, live child.”
It’s something my hubby and I continue to focus on. Though we would have done another IUI after our first, we were lucky enough to “win” one of the funded cycles of IVF that the Ontario government now offers about a month after miscarriage. That’s our next “let’s bring home a baby!” step.