Intrauterine Insemination

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I want to cover the IUI (Intrauterine Insemination ) in this article as I’ve received many questions about this topic though my other article which was mainly addressing IVF( in-vitro fertilization), Summer’s journey from infertility to our baby and many couples considering assisted reproduction may not fully understand the difference between the 2

IUI is another technique used in assisted reproduction, and it is very different,and less costly than in-vitro fertilization. The reason why a doctor would recommend IUI would be, provided that the ovaries and uterus also function normally (again checked and assured by a gynecologist), are:

  • if the female fallopian tubes are functioning perfectly normal and are able to conduct the ovum (egg) through into the uterus for reproduction. The functionality of the fallopian tubes can be confirmed through laparoscopy or HSG ( Histerosalpingogram).
  • if male semen tests are within normal ranges (semen quantity produced, semen quality- morphology, motility and number of sperm cells)
  • if the infertility is due to unknown causes or idiopathic
  • if there is cervical mucus hostility (mucus appears thick, sticky and/or dry)caused by hormonal imbalances

IUI is the process through which male sperm concentrated solution is injected into the woman’s womb or uterine cavity around her ovulation time. With in-vitro fertilization the approach is more complex, requires egg (ova) pick-up done under anesthesia. I’ve covered the detailed IVF procedure in this article The journey from infertility to a baby

IUI can be done naturally, meaning the woman’s natural ovulation cycle is monitored through ultrasounds and the transfer of sperm is scheduled to happen around the natural ovulation. This procedure assumes regular to daily ultrasounds in order to capture the ovulation window and to schedule the semen transfer.

For increased chances of success fertility hormones are used to have more control over the entire process, use less ultrasound tests and to stimulate production of more than one ovule in this cycle. A protocol is developed together with your fertility doctor to ensure personalized treatment.

The journey from infertility to a baby

It took me a long time to get to the point where I was ready to share my own experience on infertility, IVF and all that it took to have my baby. I strongly believe and wish that my experience, shared through this forum, can answer many questions for you, as I’ve been in your shoes and understand how challenging it is to find answers in the myriad of online sources. I want to help other couples get their dream come true by sharing my detailed journey in a structured approach so you can read only the parts that are most relevant to you or the entire article to understand the entire picture. My experience and what I’m covering in this article is about tubal infertility and endometriosis, nevertheless it can serve as guidance for other infertility issues and how to solve them. 20150605_094923

Tubal infertility diagnosis

It all started with the wish of having a baby naturally and after some time, 6 months in my case (as I am not patient in general), but I guess my instincts were pointing me as well into the right direction, namely to do some specialized testing to find out if I can have a baby naturally. Gynecologists don’t worry you can’t have a baby naturally and don’t investigate deeper unless you’ve tried for at least 1 hour, so I’ve lied to my doctor and told her I’ve tried for more than 1 year. That statement triggered different tests among which a detailed ultrasound where she’d found I had a hydrosalpinx (a sack with fluid) on my left tube which would’ve been the 1st cause so far which prevented me to have a baby. She’d sent me to go for a laparoscopy (a procedure used to diagnose endometriosis and closed fallopian tubes) at the hospital in the Canton I live as my health insurance in Switzerland only covered for the canton hospital. In 2011 I’ve gone for surgery in November to be more precise. The doctors tried saving the tube using microsurgery but it wasn’t possible, therefore they decided to remove it together with the polips and tissue formed on the uterus due to endometriosis, and tried opening up my right tube which was also closed as they discovered. After the surgery the diagnosis was clear and the only way I was going to have children would be through invitro-fertilization. I’ve searched around for clinics and decide with my husband to try the clinic in Bregenz, Austria as it was the closest to our home and for the success rate.

First IVF attempt clinic Bregenz

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At our 1st consultation together with the doctor we went through the  information from my laparoscopy and diagnosis papers received from the hospital where I had the procedure,  covered medical history and if we had children or got pregnant previously.  We’ve were handed a list of laboratory tests to run for both my husband (spermiogram, HIV, Hepatitis , Syphilis, etc) and I( fertility hormones, HIV, Hepatitis, HIV, Syphilis, etc) before we could start the treatment or protocol as it’s called in the IVF world. The doctor also performed an ultrasound at the IVF clinic to get the full picture. From then on until the egg (ova) pick-up we’ve corresponded electronically and via phone with the clinic. We’ve sent all tests results and received the protocol with the prescriptions to start the treatment.

The IVF protocol started with Down regulation hormones, followed weeks later by stimulation hormones which help mature the ova (eggs) which accumulated during the Down regulation. multivitamins which both my husband and I took form the day of the 1st consultation. The vitamins were specially made by the clinic and were provided to us then. After some days into the stimulation I went for the 1st ultrasound at the hospital where I had the laparoscopy, and sent the results to the IVF clinic for further guidance. A few days later as advised by the IVF doctor I had one more ultrasound, than the hCG injection that evening and 30 hours later I was ready to go for the ovule pick-up procedure.

The ova pick-up or follicle aspiration is a procedure through which the ova(eggs) are extracted from the follicles which formed during Down regulation and stimulation in the ovaries. The procedure is performed under full anesthesia (fully asleep) and pain medication plus antibiotics and medication preventing ovary over-stimulation are provided at the clinic. I didn’t have pain after the procedure but I was bloated for a week I recall, and I’ve tried controlling the bloating through what I ate. Because of the Down regulation there are many more follicles and ova formed than usual. I had 12 ova(eggs) picked-up and after the fertilization done in-vitro at the clinic 9 embryos resulted. The doctor or embryologist usually calls you 5 days after the fertilization to tell you how many 5 days vs 3 days embryos you had and of which quality.

We’ve scheduled the 1st transfer as a fresh cycle 5 days after the pick-up as we had blastocysts (5 days embryos, after fertilization they take 5 days to develop, are more mature than 3 days embryos and research shows higher success rates with blastocyst transfers) transferred. Note that from the protocol start and after transfer the medication hasn’t stopped, it just evolved  to help mimic the body’s reaction from follicle and ovum formation, through ovulation, fertilization, and implantation.

The embryo transfer is not painful at all, and beforehand together with the doctor and abiding by the country’s legislation (Austria allows 2 blastocysts or 3 -3 days embryos per one transfer) you decide how many to transfer. I had 2 blastocysts transferred in the fresh cycle( it’s called fresh cycle because the transfer happens in the same cycle as the pick-up, 3 or 5 days after, and remaining embryos get cryopreserved for future transfers). Two week after the transfer I’ve done the pregnancy tests at home which was negative and very disappointing. It is hard to digest that after all the effort which went into this whole process the result was different than what we wished for.

Months later we’ve scheduled a 2nd embryo transfer without medication or natural, even when my doctor didn’t agree to it. Given the 1st experience I had with the injected hormones (very painful injections) and reading online about research showing that natural vs medicated transfers have equal chances of success, I decided for a natural transfer. It was again not successful.

1 year after the pick-up we’ve scheduled a 3rd embryo transfer with the a different protocol tailored only for the transfer, and easier on the medication. It was not successful and all embryos were transferred at this point.

Brake, giving up hope

It was of course with mixed feelings and sadness that I had to accept this failed attempts and I will not have a baby, so I decided not try again. I started focusing on other things in my life and got two beautiful Persian cats 20140802_190232

which alleviated my pain and gave me a lot of love. I’ve changed jobs, I’ve traveled to places I had in mind for a long time but never came around to do, connected more with my family who leave far from me (8 hours door to door including a  2 hour flight), and had a beautiful wedding as when we started the IVF journey my husband and I weren’t married, we were living together. I’ve completely switched focus form the baby topic. Changing focus helped me cope with the situation and accept that life has more to offer if children are not an option.

Through my new job I met a lady who moved from my country of origin here to pursue her new job at our company. We’ve connected very quickly and shared stories about our families, and of course why I didn’t have children, and how she’d wanted a second child but wasn’t able to conceive naturally due to a complete different condition than mine.

She was the one coaching me about never giving up on my dreams, and if i really wanted to have a child I should try again, moreover as she put it -2 years passed after my first attempt and surely medicine and technology advanced much more during this time. I should give it another try she’d insisted. I started my quest on searching for news in this field but couldn’t find much, and I was decided if I tried again that I would change clinics. It’s the advise I’ve seen many women give in the infertility forums. I found Dr. Feichtinger‘s clinic in Vienna, the 1st clinic to have the 1st baby through IVF in 1982 in Austria and 6th in the world, has high success rates and based on reviews they apply a personalized approach to the treatment which was very important for me after having had 3 failed embryo transfers. I am adding the name of my 2nd clinic from a pure altruistic reason, namely because they were the ones helping me have my baby and I hope they can help anyone reading this article and contacting them for help with assisted reproduction. And let me add that distance doesn’t matter. To get to the clinic I flew 1 hour for the 1st consultation and drove 8 hours for the pick-up day as I couldn’t find a ticket at such short notice, and flew again for the transfer. This goes to show how much trust I had in them and the determination I had to get my baby.

Second IVF attempt, clinic in Vienna

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As mentioned above we’ve scheduled our 1st consultation at the clinic in Vienna and went to see the doctor chosen by us. You can choose which doctor you want to see and have assigned. We’ve sent all documentation we had from the other clinic, and diagnosis from the laparoscopy in advance. The doctor had already gone through our file and new the history  at the consultation time, which gave us even more confidence that we were in the right place and guided the discussion more onto the solution than the problem. This time the identified infertility problem after having the failed transfers was the implantation failure. Were were provided with 4 options we had to pursue to narrow down the reason why embryos wouldn’t implant and went for further testing.

The tests required before the protocol were the same as with the 1st clinic:  for my husband (spermiogram, HIV, Hepatitis , Siphilis, etc) and for me( fertility hormones, HIV, Hepatits, HIV, Siphilis, etc). These are standard and I don’t provide more details because you get the info from the clinic, plus the clinic may offer to do the tests for you while you are there. Besides these test we were advised to do: Genetic karyotip testing for both my husband and I to check for any genetic predispositions, preimplantation genes on me to check if any of the implantation genes are missing, immunology testing on me with focus on implantation, there are immune complexes (NaturalKiller cells) which if present in the blood can prevent implantation.

The protocol was designed for my diagnosis and it was  a lighter version than what I had previously in my 1st IVF attempt. Coming back to my friend’s advice science does advance rapidly. I’ve followed strictly what I had on the protocol remotely, including the ultrasounds and communicated tightly with my doctor, then the pick day came.

We checked-in at the clinic that morning, and they’ve explained the procedure to me, they told me that I’ll be going into the surgery room and come out of it on my feet, which I did.   It was  a lighter anesthesia they’ve used minimal to serve the purpose of being asleep only during the pick-up. They’ve sent me home again with antibiotics and pain killers, and watch for ovary over-stimulation and bloating. We received a call from the clinic to tell us about the embryos and their status. we had 5 blastocysts which we could send for genetic testing the other 4 embryos didn’t make it beyond day 2 or 3 which meant they weren’t strong enough and we were strongly advised not to us them.

We’ve decided to have embryo genetic testing, pre-implantation genetic screening after Throphectoderm Biopsy to be more precise. That meant that 2 cells were taken from each embryo and sent to the genetic lab at the university for chromosomal analysis. This procedure also ensures that transferred embryos don’t have Down syndrome or any Trisomy. The results came back 3 weeks later which didn’t allow for a fresh cycle transfer, so we’ve opted for a cryopreserved cycle.

The 1st month after pick-up I didn’t ovulate so no transfer was possible. The 2nd month all went well and we’ve scheduled the transfer  of 2 blastocysts. Again we had a protocol to follow: Intralipid 1st day of the period and at the transfer date, plus prednisolone to prevent the immune system from attacking the embryos,  multivitamins, progesterone ovules to ensure support for the early pregnancy, granocyte to help with implantation as I missed the implantation genes, and lovenox for improved blood circulation.

Two weeks after the transfer the blood test for pregnancy showed positive and we were happy but still waiting cautiously for the next test at 7 weeks after transfer the heartbeat of our baby.  I’ve kept in touch with the clinic further and adjusted the protocol as I had some spotting and light bleeding, I tried progesterone injections but it didn’t help and then I’ve given up lovenox which did the trick. At 7 weeks I’ve heard my baby’s heart bit the 1st time, and I knew from that point on that my life will change. I’ve continued with my protocol till week 12 after which all medication stopped and I continued with my gynecologist through the pregnancy.

In 2017 in March we’ve welcomed our baby boy, 11 months old now.

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To summarize:

  1. Identify the cause of the delay in having a baby naturally
  2. Try natural ways to help you conceive naturally if anatomically possible, such as nutritional supplements, healthy eating habits, healthy work life balance, positive mindset, acupuncture, and avoid any intake of  alcohol, smoking or other influences preventing your body from functioning in a healthy way and as designed.
  3. Very important: if you need doctor’s help to conceive, like IVF or other assisted reproduction techniques,  take the lead of your journey and stay on top of things from beginning to the end. Communicate with your doctor and ensure all your questions are answered whenever they come up clinic. Understand from the start what is the problem and what is the solution medically and monitor step by step how to get there. You can make your dream of having a  baby happen and the doctor is part of the solution.