After we got the PCOS diagnosis,  our doctor decided that it might be helpful to try a round of IUI.  IUI, or intrauterine insemination, is the process of placing the sperm inside the uterus in order to help with implantation.  It’s considerably less expensive than IVF, but not as successful.  It tends to be successful for many couples with PCOS or other unexplained infertility issues and our doctor thought that we would be good candidates.

We embarked on our first attempt at IUI shortly before our first wedding anniversary.  The process for IUI is quite regimented.  It actually starts about 6 weeks before the insemination.  I was put on one cycle of birth control to regulate my ovulation schedule.  Once I got my period, I called to schedule what’s called a baseline ultrasound.  Performed within the first 3 days of menstruation, the baseline ultrasound is typically performed on people with known issues such as yours truly.  They perform the ultrasound to make sure that the uterus has mellowed out enough to start the IUI cycle.  More specifically, they’re checking for cysts.  If there are cysts present, they are looking to make sure that the cysts are too small to affect the cycle.

Once my uterus was deemed calm enough to start the cycle, I was put on Letrozole, a drug that inhibits the production of estrogen.  Seems crazy, right?  You would think that extra estrogen would be a good thing as a woman trying to get pregnant!  In fact, Letrozole suppresses ovulation which then tricks the brain and pituitary gland in to creating more FSH, or follicle stimulating hormone.  The increase in FSH helps to develop follicles on the ovary that will mature to produce an egg.  Letrozole is taken for 5 days to help the follicles mature.  At that point, another ultrasound is performed to track follicle growth.  Once the follicles reach about 12-13 millimeters, ovulation will be induced via one shot of HCG (human chorionic gonadotropin).  HCG stimulates the ovaries to release an egg (or multiple in the case of multiple follicles.  The insemination takes place roughly 36 hours later.

The insemination is a tag team effort between husband and wife.  The husband goes in for his appointment first.  There, he will be escorted to a room with a chair and a couch, a TV and VCR and a variety of assorted “reading materials”.  Once he’s made his deposit (and yes, that’s what they call it), he’s done.  The sperm is then examined for volume, count, structure and motility.  The sperm is “washed”, meaning that the sperm is separated from the seminal fluid.  At that point, any abnormal or immotile sperm are removed from the sample.  My doctor aims for 2 million motile sperm per IUI.  They will do the procedure if there are less, however, 2 million or more is optimal.

Once my uterus was deemed calm enough to start the cycle, I was put on Letrozole, a drug that inhibits the production of estrogen.  Seems crazy, right?  You would think that extra estrogen would be a good thing as a woman trying to get pregnant!  In fact, Letrozole suppresses ovulation which then tricks the brain and pituitary gland in to creating more FSH, or follicle stimulating hormone.  The increase in FSH helps to develop follicles on the ovary that will mature to produce an egg.  Letrozole is taken for 5 days to help the follicles mature.  At that point, another ultrasound is performed to track follicle growth.  Once the follicles reach about 12-13 millimeters, ovulation will be induced via one shot of HCG (human chorionic gonadotropin).  HCG stimulates the ovaries to release an egg (or multiple in the case of multiple follicles.  The insemination takes place roughly 36 hours later.

The insemination is a tag team effort between husband and wife.  The husband goes in for his appointment first.  There, he will be escorted to a room with a chair and a couch, a TV and VCR and a variety of assorted “reading materials”.  Once he’s made his deposit (and yes, that’s what they call it), he’s done.  The sperm is then examined for volume, count, structure and motility.  The sperm is “washed”, meaning that the sperm is separated from the seminal fluid.  At that point, any abnormal or immotile sperm are removed from the sample.  My doctor aims for 2 million motile sperm per IUI.  They will do the procedure if there are less, however, 2 million or more is optimal.

Guys don’t get to have all the fun, though!  Their female counterpart gets to experience a fun, papsmear-esque prodedure.  I’m talking, naked from the waist down, feet in stirrups, butt hanging off the end of the exam table fun.  A catheter with the sperm sample is inserted in to the uterus and that’s that.  The procedure itself takes less than 5 minutes and then you’re on your way.  Sounds pretty easy, but the worst part of the process is just beginning:  The two week waiting game.

There’s really nothing you can do to make the process more successful.  I mean, it would probably be frowned upon if you did a keg stand immediately following the procedure, but there aren’t any steps you can take to make sure it works.  You just have to be patient.  Well, I suck at being patient.  Yes, patience is a virtue and blah, blah, blah.  I don’t have it.  Never have.  And I probably won’t develop it until I’m forced to for the sake of my children.

So the two week waiting game begins, and I do my best to maintain my composure.