Popular website, Parents.com, featured SGF patient’s journey of getting pregnant with IUI treatment.
SGF patients Sarah and Jay Hudson looked forward to starting a family. But after several unsuccessful months of trying to conceive, Sarah was diagnosed with polycystic ovary syndrome (PCOS), a common ovulatory disorder that affects many women of reproductive age.
Anxious to make their dreams of having children a reality, the couple consulted with SGF’s own Joseph Doyle, M.D., in the Rockville, MD office. Dr. Doyle conducted a complete infertility work up to check if other factors, in addition to PCOS, may be impacting their infertility. What many people don’t realize is that male factor infertility accounts for nearly 40 to 50 percent of all infertility cases, which is why SGF tests both the male and female during an infertility work-up. Once a diagnosis is determined, the physician can devise an individualized treatment plan unique to your situation.
“He started me on Clomid and timed intercourse because he wanted to try the least invasive protocol, but one that he still thought could be successful,” says Sarah, 31.
Clomid is a commonly prescribed fertility medication that helps stimulate ovulation. The couple tried this method for 3 months without success. SGF believes in a stepped approach to treatment starting with the least invasive treatments first and then only moving on to more advanced treatment options if necessary.
The next step for the Hudsons was intrauterine insemination (IUI). Intrauterine insemination is the process whereby your physician will place a concentrated specimen of sperm in your uterus. IUI is commonly used for patients who have been diagnosed with unexplained infertility, mild male factor infertility, a cervical factor, or irregular or absent ovulation.
“The treatment is stacked right on top of the patient’s regular cycle,” Dr. Doyle says. “They should be able to have one try each month.”
To help your physician time the IUI with when you will be ovulating, you’ll visit your local office every few days for monitoring appointments. At these appointments, bloodwork and ultrasound will help to monitor your estrogen levels, uterine lining, and egg (follicle) growth. The goal of these appointments is to make adjustments to your protocol and to determine the best timing for ovulation and the subsequent intrauterine insemination.
Clomid is also used in conjunction with IUI. Sometimes, in addition to Clomid, an injection of Ovidrel is recommended prior to the IUI to trigger the release of your egg to increase the ability to correctly time the insemination.
“We [use medication to] try to push the ovaries to produce more like two to three eggs. Our first thought there is that if the first egg doesn’t fertilize, maybe the second or third one will,” Dr. Doyle says. “Part of this is just a numbers game. We’re increasing the number of eggs and getting more sperm close to those eggs.”
“It felt like light cramping. It took maybe 5 minutes, plus the 10 minutes you lay down afterward. Like any doctor’s appointment, it’s the waiting in the waiting room that took longer,” Sarah says.
Dr. Doyle, who rarely does unmedicated IUIs, says that of the 15 percent of women who get pregnant via medicated IUI, 92 percent experience single gestation while about 8 percent become pregnant with multiples.
Our physicians generally perform IUIs 1.5 days after the trigger injection, which sets ovulation in motion. The exact timing of insemination is not critical to the exact time of ovulation. Both the sperm and the egg remain viable in the female genital tract for many hours, so the physician may time the insemination within a window of several hours around the time of ovulation. Following the IUI, you will take daily supplemental progesterone—usually in the form of a capsule inserted into your vagina twice a day—to support the endometrial lining of the uterus and implantation of the embryo.
Sarah says the post-IUI wait is the hardest part. “I definitely tried to keep my mind off of it and continue with business as usual because the more I got my hopes up, the sadder it was when it didn’t work.”
IUI helps patients to achieve pregnancy rates closer to the natural per cycle chance of pregnancy for women in their age group who do not have infertility. If IUI is unsuccessful after a few cycles, it’s generally recommended to move on to more advanced treatment such as IVF.
It took Sarah and Jay Hudson three cycles of IUI to become pregnant. Now that she is expecting her baby’s arrival in June, Sarah says she is happy she started with a low-invasive treatment like IUI.
“I felt like Dr. Doyle made sure my treatment plan was right for me,” Sarah says. “I’m also happy because before starting treatment I had an intense fear of needles so moving right to IVF would have been really hard on me personally.”
While IUI is successful for many couples, IVF is sometimes the better alternative for fertility treatment depending on the age and diagnosis of the patient.
Sarah admits that she was fully prepared to try IVF if the IUI hadn’t worked. “IVF is, of course, more costly, but we could have cut some of the extra things out of the budget to afford treatment,” she says. “At the end of the day, we wanted to be parents and we were going to do whatever was necessary to make that dream a reality.”