4 things that surprised me most about intrauterine insemination

When I walked into the fertility clinic for my first intrauterine insemination (IUI), it was my first foray into infertility treatments and procedures. I desperately wanted to get pregnant, and I was a mixed bag of emotions. One day I was excited and optimistic that the IUI would work, and the next day I’d be so stressed out, I couldn’t even eat.

I asked countless questions at our consultation, researched the procedure online and got sucked into message boards that discussed the outcomes for hours. The procedure seemed simple enough: Doctors would inject healthy sperm into my uterus, close to my fallopian tubes, in the hopes that one of them would fertilize an egg. I thought I knew what I was getting into. But, despite all my prep work, I was surprised by some of the things that happened during and after my IUI. Here are four things I wish I’d known.

1. Success rates are low  IUI is one of the first lines of defence against infertility, especially for men with poor sperm quality and for women with unexplained, endometriosis-related or cervical factor infertility. So it was surprising to learn that its success rate is ridiculously low. In fact, the procedure is only slightly more likely to help you get pregnant than trying to conceive naturally.

“Under the best circumstances, success rates are in the 15 to 20 percent range per cycle,” says Ari Baratz, a fertility specialist at CReATe Fertility Centre in Toronto. “The odds are that IUI won’t work in just one cycle.” (In terms of conceiving naturally, age plays a role: Ninety-one percent of women are able to get pregnant at age 30, 77 percent by age 35, and 53 percent by age 40.)

What’s more, if you want to improve your odds of getting pregnant with the procedure, there are only two ways to do so: take fertility drugs, such as Clomid and Letrozole, or have more IUIs. The former increases the chance of conception because there are more eggs (usually two or three) for sperm to fertilize (during a non-medicated cycle, there will only be one mature egg). The latter deals with the law of averages.

“To really get the power of IUI, a person has to have multiple cycles, which means multiple months of having the procedure,” he says. “The more attempts you make—like flipping a coin—the more eggs you’re sampling and the more sperm you’re accessing.”

2. It’s non-invasive and fast As procedures go, IUI is incredibly simple. “IUI has a big name,” says Baratz. “It sounds loaded, but it’s quite non-invasive.” He likens the procedure to a Pap smear: No drugs are used to sedate the patient, and no incisions are made.

A fertility doctor will insert a catheter or needle full of semen into the uterus. The sperm are injected into an area that’s close to the mature egg. The procedure only takes a few minutes (mine was done in less than 60 seconds), and there’s zero recovery time at the facility. The side effects are minimal (minor spotting and cramping can happen), and Baratz says that most women are told to resume normal activities as soon as they leave the clinic.

I was so surprised at the speed and ease of the procedure that I actually asked my doctor “Was that it?” when she removed the catheter. Since my IUI happened on a Saturday, my husband and I spent the rest of the day relaxing. We had brunch and went for a long walk.

3. Old wives’ tales are just tales Before having my IUI, I Googled every variation of “how to increase IUI success rates.” I always came across the same tips: Lie with your legs above your head to keep the sperm in the vagina, take it easy and avoid urinating for at least an hour after the procedure. The advice sounded a little far-fetched, but I followed it anyway (why not, right?).

But all that extra effort was probably for nothing, says Baratz, because there’s little anyone can do to control the outcome of IUI. “The insemination places the sperm right in the uterus,” he notes. “By the time the procedure is over, the really fast sperm have already started to move toward the egg.” That means that  the egg will or won’t fertilize almost immediately.

What’s more, gravity doesn’t play a role in hindering the movement of sperm, adds Baratz. All of those tips about doing inverted yoga poses are old wives’ tales.

4. It’s emotionally draining For such a simple procedure, IUI is incredibly stressful. While the actual insemination is short, says Baratz, it comes after weeks of monitoring, washing sperm (which takes an hour) and having multiple consultations with your medical team. “You spend so much time in the clinic and then you’re on your own,” he says.

What happens when you’re on your own is the dreaded two-week wait: that period between possible fertilization and when tests can pick up pregnancy hormones in the urine and blood. It was a wait that almost drove me mad. I would Google pregnancy symptoms hourly (knowing full well it was too early to experience them), and I tried to distract myself with all sorts of activities. I went to a brunch where I learned to needlepoint, baked just about everything, went on long walks and obsessively listened to podcasts. I also worked and socialized a lot.

My IUI timed well with the busy holiday season, so I spent most of my free time writing articles and seeing family and friends. I recommend that you try to keep busy so that the dreaded wait time will pass (a little bit) quicker.

Read more: What egg retrieval is really like 5 things that surprised me most about in vitro fertilization