Making the Leap from IUI to IVF

Somewhere in the middle of the 2WW for my 3rd IUI, Joe and I were in the car together when I tearfully turned to him and said, “I’ve decided something. If this current IUI doesn’t work, I don’t think I’m ready for IVF. I’m young, we have a lot of time to have children, and I don’t think I’m ready to subject my body to the invasiveness of an IVF treatment cycle at this point.” I was having a bad day. But I did somewhat mean it.

A few days later, I got my period. Failed IUI, #3. I wasn’t so surprised… but that didn’t mean it didn’t hurt in every way. It was harder than ever not to know what was “wrong,” after so many tries. Still unexplained, this infertility. Was it timing? Was it an undiscovered medical condition? What. Was. The. Problem?!

Back in the 2nd IUI cycle, we had a catch-up meeting with Dr. Fogle to talk through next options past IUI and so I had a general understanding of the physical and financial commitments of IVF, as well as the 6-week time commitment required. I can’t remember the moment I changed my mind and decided to move forward, but our reasons for jumping into IVF were pretty practical:

  1. We weren’t getting any younger, at 32 and 31. Egg reserve and health only diminish with time.
  2. Perhaps the IVF process would help us understand why our bodies hadn’t been working to produce a baby over the last year and a half.
  3. We had already met our insurance deductible for the year, and it was to our benefit to continue with IVF treatment in the same calendar year.
  4. We had also been saving money for a new car, and had money in the bank to write the upfront checks that IVF treatment required (insurance only covered about 70% of costs in our case).
  5. We were ready to see this adventure through…and ready to be parents! We’d come this far… so, we asked ourselves, why not? We didn’t want to live with the regret that we didn’t do all we could.

So, in mid-September, I started back on birth control pills for the first time in almost two years… the beginning of our next adventure.

IUIUIUI: Turkey Baster Time

IUI stands for intra-uterine insemination. I had literally never heard of this word before my ob-gyn brought it up, somewhere in the Clomid months. I didn’t know there was a step (multiple steps) in between “can’t get pregnant” and IVF. But! I was glad to hear of this seemingly low-key treatment option. So we agreed to start with IUI right away under the watchful eye of Dr. Fogle and the wonderful nurses at ACRM.

How IUI works: well, the specific protocol probably differs person to person, but at my clinic, here’s how it generally worked on each of my 3 cycles.

Cycle Day 1: On the first full flow day of my period, I was to call the office and let them know that it had started. They would then schedule my Day 3 ultrasound and bloodwork to start the treatment cycle.

Cycle Day 3: Ultrasound and bloodwork. The vaginal ultrasound (via dildo-cam, as others have called it) is really not a big deal. It didn’t hurt me personally. The doc goes in and checks out the uterus and ovaries to make sure that everything looks good to start. Bloodwork checks estrogen and progesterone levels to make sure all levels also look good.

Cycle Day 5-9: Clomid, my old friend.

Cycle Day 11-ish: This is the mid-cycle check up, pre-trigger and ovulation. Same deal as Cycle Day 3, ultrasound and bloodwork. The doc checks to make sure that everything in the uterus and ovaries still looks good, and that the follicles are growing as desired. Depending on how the follicles are doing, the doc prescribes the medication to trigger ovulation.

Cycle Day 13: Trigger time! It’s an HCG shot given by a nurse in the office. Funny – I remember thinking, there’s no way they expect ME to mix this up myself?! I clearly did not know the IVF drill yet.

Cycle Day 14: IUI day! Joe’s appointment to produce a ~*sample*~ happens early in the morning. The lab washes the semen, distills the most qualified sperm, and then gets it ready for the short catheter trip directly into my uterus. Then I’d come in and the doc would insert the swimmers up the chute, hoping that more sperm in the uterus = a better chance of fertilization. I’d lay still on the bed for 5 minutes, then I would be able to continue my day as usual.

SEE? JUST LIKE SEX!

No. But hey, SCIENCE! What a time to be alive.

 

Our New Best Friend, the RE

I remember being so nervous for that first phone call to ACRM, our fertility clinic. Driving in the car on the way to work, I stuttered over my explanation of my reason for calling (trying to get pregnant… nothing happening… help) and was pleasantly surprised when they scheduled my first consult for later in the week with Dr. Robin Fogle, a reproductive endocrinologist (RE) at the practice. Before the appointment, the office had us download and fill out a bunch of entry paperwork, including our individual and combined medical history and insurance documentation. I also had to call my regular doc to send in paperwork on previous tests, including the HSG (dye test) results and semen analysis (I told you we were going to get into the details!).

Insurance sidebar: We were lucky enough to have insurance cover a significant portion of our infertility treatment (there’s a lifetime cap amount). I hope to do a post someday breaking down the costs we entailed throughout this process, including with IUI, IVF, and meds. I’ll need Joe for that one – he really took care of all the financial details so that I could focus on staying calm throughout our treatments. I was extremely thankful.

Back to the story. We got to the office (Perimeter location, for Atlanta-based readers). I had some more forms to fill out while waiting, then our names were called. Dr. Fogle herself greeted us at the door. She was nice as could be, and led us to her spacious office with a beautiful view of the surrounding scenery. We talked through medical history, she asked a few questions along the way, then we got down to the business of infertility. Dr. Fogle described the physical and chemical details of a regular cycle, and then pointed out the areas where we could run into issues: Egg quality. Ovulation. Physical blockage. Male Factors. And so on. She reminded us again that all tests had come back just fine… so at the moment, our infertility was unexplained. Or as she put it, “You’re unexplained.” Then, we moved on to treatment possibilities: Clomid. IUI. IVF. Chances of success by age group. (Since we’re in the youngest bracket, time is on our side.) All the while, she sketched the information she was telling us on a plain piece of paper, to illustrate the points. As a lifelong doodler myself, I mentally gave her bonus points for the visuals.

At the end of the conversation, we discussed immediate next steps: more Clomid, or direct to IUI. We decided to go home and think it through, rather than make a decision on the spot. It just so happened that we were there on a convenient cycle day for some bloodwork, so after saying our goodbyes and thanks to Dr. Fogle, I was shuffled off to The Blood Room (as I call it in my head), for a quick draw.

I liked Dr. Fogle right away. She was warm, friendly, completely sympathetic, but also straightforward with the details of our treatment options and chances. She made me feel comfortable. Her doodles felt like a map to somewhere hopeful. I didn’t feel like crying. I felt like everything was going to be ok.

We went home, and pretty quickly decided to jump into the IUI process. Dun-dun-dun!!!