When hearing "fertility treatment", many automatically think of the very expensive, very invasive IVF treatment. Well, we did. And we were reluctant to follow this route, even after 4 years of trying. But when a friend told us about artifical insemination, a light went up.
As I've since discovered, while IVF is no doubt a wonderful option for many couples, it certainly isn't the first line of treatment. Intrauterine insemination (or the old "articifical insemination") is a relatively inexpensive and less invasive option with a good success rate, depending on the underlying problem.
The IUI process
First, we made an appointment with a fertility specialist at a fertility clinic. The first consultation (with my husband in tow) was a lengthy one, with lots of questions asked. I'd suggest you come prepared with the dates of your last few cycles, and charts if you've been keeping any.
I was examined by the specialist, including a vaginal ultrasound to see, among other things, whether my fallopian tubes were clear, and my husband was asked for a semen monster for analysis. Specialists are looking at the sperm count (a minimum of 3 million is needed), motility (movement) and morphology (shape). He checked out okay.
My anovulatory cycles were an obvious problem and I was given Fertomid (Clomid) to stimulate follicle growth in the ovaries. It's a small white tablet that I had to take once a day from day 4 to 8 of my cycle. You could be started off on half a tablet (25mg) or the full tablet (50mg).
Depending on the underlying problem, you too may be prescribed fertility medication, including Fertomid and/or Menopur injections, Femara tablets, Fostimon injections, Gonal F injections, Lucrin (PT pack), Progynova tablets, and a quarter Disprin a day.
I was asked to return for an ultrasound scan on day 12 of my cycle to monitor the growth of the follicles. The ideal size is 16 to 18mm and mine was ready.
Blood tests: LH
Next up was a series of blood tests to determine my LH (Luteinising hormone) levels, which I had to get done early morning for the next few days at my nearest pathologist. What the specialists were looking for is a spike in LH levels, which will indicate that I was about to ovulate.
Should your hormone levels not spike, like mine didn't, the clinic sister calls to arrange for you to have an Ovidrel or Choragon injection on a specific day and time. This injection stimulates ovulation and I could administer it myself, but I chose to go into the clinic and have it done.
An appointment for the IUI was made for 2 days later – it could also be performed the next day, depending on your hormone levels and personal history.
On the day of the IUI, my husband had to pass a semen monster into a sterile cup. The sperm then get "washed" and only the best retained for the treatment.
Around 2 hours after the semen was handed in, the IUI was performed. It's a simple procedure whereby the sperm is placed directly into your uterus. It is a bit like a pap smear: the doctor inserts a clamp to open your cervics just wide enough for a thin tube to be inserted, through which the the sperm is deposited straight to your womb. It did hurt a tiny bit but it was all over within minutes.
I was then asked to lie down for around 15 minutes, before I could get up, get dressed and get straight back to the office.
My first blood test to test for pregnancy will be on day 12 after the insemination, and if there is a positive, again on day 16.
The whole treatment costs around R4,500. Here's a break-down of what it cost us:
- First consultation: R750
- Fertomid: R110 (other medication could be up to R1,100)
- 2 Ultrasound sonars @ R550 each: R1,100
- 4 Blood tests for LH @ R140 each: R560
- Ovidrel: R360
- Preperation of sperm: R750
- Intrauterine insemination procedure: R350
- Wallace catheter: R250
- 2 Blood tests for pregnancy @ R140 each: R280
This may differ as everyone's treatment may comprise more, or less, tests and medication.
A couple having intercourse at the correct time of the month have a 10% chance of conceiving. A couple undergoing IUI with medication has a 20 to 25% chance. A couple is normally counselled to try 4 months, and to give it a rest for another 2 months if those weren't successful, before starting again.
In our specific case, IUI was successful on the second attempt.
For whom can IUI help?
IUI treatment helps women to regulate their cycles and ovulate, and then the best of the husband's sperm is inserted at the exact time of ovulation.
This means IUI can assist reproduction in cases such as when the woman's cycles are irregular or she's not ovulating (like me), and when the husband's sperm count is low, or the motility or morphology isn't ideal.
It isn't a risky procedure at all. The medication may have side effects such as moodiness (they are hormones, after all), and as with all fertility treatment the medication could stimulate more than one follicle to reach maturity, which could result in 2 eggs being released and the possibility of twins – if you consider that a risk!