My dog strains at his harness, trying to pull me off the sidewalk toward some enticing scent in the neighbor’s yard. I tug at his leash to steer him back on course; we don’t have time for his usual painstaking investigation, not that we don’t appreciate it. For his part, Charley seems to have no idea what an important day this is for mom and dad. I walk on, wondering how long we should give it before heading back home. Is five minutes enough? Ten? I realize that after nine years together, I have no idea how long it takes my husband to masturbate. I’m thinking maybe we should take another loop around the block, but as we round the last corner, I see Jeff open the front door. He gives me a big smile and a triumphant thumb’s up. The deed is done.
After the near-debacle of his semen analysis, we’re doing everything by the book this time. I carefully tuck the little specimen cup into my bra so it’s flush against my skin. I know that this is just meant to keep the semen warm enough to prevent it coagulating, but it’s sort of sweet, having his sperm cushioned against my breast, absorbing each heartbeat.
Jeff gives me one of those hugs that make me feel weightless. “Try to have some fun,” he says. I kiss him, zip my jacket around the hard plastic bulge on my chest, and am on my way.
Play the Man, Not the Odds
Intrauterine insemination is a common, relatively low-tech treatment for infertility that involves transferring sperm directly into the uterus. Instead of making the perilous journey through the vagina and cervix, they’re dropped off at the door, so to speak. The idea is that getting the sperm as close as possible to the egg will increase the chances of fertilization. While it may conjure images of turkey basters (h/t Celeste Ng… read Little Fires Everywhere if you haven’t) the process is actually performed by pumping the sperm into the uterus with a syringe connected to a catheter which is inserted through the cervix.
For a long time, I didn’t consider IUI because I was convinced it wouldn’t work. The most cursory online research quickly reveals that the chances are slim anyway (somewhere between 15-40% success rates over three cycles), but they’re worse the nearer you are to 40. I’m 39. Everything I read suggested that women of “advanced maternal age” like me should just go straight to in-vitro fertilization (IVF), which has much better odds.
After talking it over with some of the incredible women in my life, however, I began to have a change of heart. Those success rates vary widely depending on other infertility factors, like PCOS, diminished egg reserve, tube or cervical scarring, male infertility, etc. My diagnosis is Unexplained Infertility, which means that my OBGYN has found no obvious problem preventing us from getting pregnant – and thus, no reason IUI won’t work for us. My friend and co-worker Rena, who happily had her own IUI success this past winter, pointed out that IUI is cheap, fairly easy, and entirely covered by our insurance, so what the hell did we have to lose? Nothing but all that time I spent hemming and hawing, time we will never get back. I resolved not to waste any more of it.
Except we did have to wait, because Jeff is deploying next fall and if I became pregnant anytime between January and March, I’d be due to have the baby while he’s in “the shit” (which is the most he’ll tell me about where he’s going). I can’t fathom doing this without him; I just don’t even want to think about it. So we waited out the winter, and finally, as the snow began to melt and the rivers rose and flooded their banks, we made plans to start our first IUI cycle.
Sex, Drugs, Ultrasounds
Most IUI’s begin long before you’re saddled up in the stirrups, on Cycle Day 1. That’s when you begin your protocol, which is the infertility term for the retinue of drugs you take throughout the cycle. If it’s your first round of IUI, you’ll probably start on Clomid. Meant to stimulate ovulation for women who don’t regularly ovulate on their own, this drug (taken orally for 5-7 days at the beginning of your cycle) is often the first line of defense because it’s cheap and easy to administer. The drawbacks are that it can decrease cervical mucus, which helps ease the way for sperm swimming to the uterus, and prevent the uterine lining from becoming thick enough for a fertilized egg to successfully implant. For these reasons, doctors will often switch to a type of drug called gonadotropins (Follistim, Gonal-F, Menopur) after three unsuccessful IUI’s. A bit more intense because they require daily, self-administered injections, these drugs have been shown to be effective for women who don’t respond to Clomid. They also cost around $1,000 per cycle, so it makes sense to start with Clomid.
Along with the drugs come the pelvic ultrasounds to monitor follicle development. Depending on the size and rate of growth, your doctor (or in my case, a wonderful Nurse Practitioner named Jaimi), can tell whether you’re on track to ovulate, and when. They can also see the growth of your uterine lining and address that with more drugs, if necessary. By day 12, my follicles were looking awesome but my lining was too thin, so she prescribed Estradiol, type of estrogen meant to help thicken it up. At my day 14 ultrasound, she was confident enough with the results to schedule my appointment for the IUI. Counting backwards 36 hours from that appointment, she also gave me instructions for when I’d give myself an injection of a drug called Ovidrel, known as a trigger shot, to stimulate my follicles to release the eggs.
I’d be lying if I said I wasn’t a bit freaked out about the prospect of giving myself an injection. I know it’s no big deal and that people do it every day, but I still required ample psyching up this first time. Luckily I had the old pro Rena to give me a few tips and the promise that we’d go get ice cream once I’d successfully injected myself. It was done in seconds; I hardly felt a thing. I savored my peppermint bon bon with the unique satisfaction of having graduated to a new rank of infertility warrior.
Side Effects May Include Headaches and Crippling Existential Dread
After reading that, you may be thinking to yourself “jeez, that’s a lot of drugs” and yeah, it was a bit of a juggling act making sure I was taking everything (in addition to my acupuncture herbs, prenatal vitamins and CoQ10 supplements) at the right times and in the right quantities. But the hardest part was the side effects.
Clomid, Estradiol, and Ovidrel are all hormones, and as such can cause mood changes like irritability, anxiety, and depression. I never have been much afflicted by the former but this month I danced back and forth between the latter two with such wild abandon, I’m surprised no one grabbed me by the shoulders and put me under a cold shower.
I’ve been negotiating emotional triggers for years now and have gotten pretty good at recognizing when something’s about to upset me and redirecting myself. Taking all those hormones, however, made me feel like I’d completely lost those mechanisms. I’m certain I cried at least once every day. It was nothing too deep or prolonged, more like a cloud blocking the sun for a few minutes during an otherwise clear day. The feelings would just sneak up on me, and where before I could take a couple breaths and think of something else, now I was powerless against the sorrow that would not be ignored. One time it was the sight of a pregnant colleague at an after school meeting. I hadn’t seen her for a while, hadn’t realized how big her belly had gotten, and I felt my eyes begin to mist and I had to look away. Another time I was laying in savasana pose at the end of a yoga class and the teacher knelt down to press my shoulders against the mat, touch my face, and I lost it. It wasn’t so much that I felt sad all the time, just terribly unstable.
And then I had a conversation with my nurse practitioner about my irregular periods. I broke down during that one too, trying to explain the feeling I’ve had for a long time now, that something is wrong on that front but neither my GP nor my OBGYN has ever taken me seriously about it. Later that day she called and said she’d spoken to Dr. W (my OBGYN), and that he agreed with her that if this first round of IUI didn’t work, they would take a closer look at my uterus to check for polyps or fibroids.
The test is called a sonohysterogram and involves pumping your womb full of saline, rather like inflating a balloon, so they can get a clear picture of what’s going on in there. Perhaps it was the word ‘polyps’ that tripped my inner panic wire, but as she described the procedure, one thought invaded my mind and blew up like a womb balloon:
Cancer. That’s what they’re going to find. Cancerous polyps stacked high and deep. Well, it would explain some things, wouldn’t it? For about three days I felt like I was being constantly stalked by this awful fear of what they’d find, that I’d need an emergency hysterectomy and then the curtain would suddenly drop, the lights would go out and this show would close for good. I’d be going about my day as usual and suddenly be ambushed by images of myself, frail and weak, lying in a hospital bed and saying goodbye my loved ones. All I could do was murmur to myself, “I don’t want to die…” and wait for the moment to pass.
Some Women Feel Nothing At All
Getting inseminated is a surprisingly casual affair. After I checked in, the receptionist directed me to put the sperm in a cabinet that looked like a mini-fridge where it would keep warm until someone came along to wash it. This is the part of the process I find most fascinating. “Washing” the sperm involves adding a solution containing antibiotics and protein supplements to the sample and spinning it in a centrifuge until the sperm are separated from the semen. It enhances chances of conception by getting rid of the dead, slow, or otherwise suboptimal sperm, leaving behind the fastest and healthiest among them.
The sperm washing took about 20 minutes, time enough for me to read two chapters of Cranford. When it was done, Jaimi led me to an exam room and directed me to assume the standard position. Jeff’s concentrated sperm was now loaded up in a plastic syringe (and tinted pink, oddly) with a long, thin catheter attached to its tip.
“You might feel a little cramping,” she advised me as she locked the speculum into place. “Some women feel nothing at all.”
Then she threaded the catheter through my cervix and SWEETHOLYFUCK *tearing the vinyl covering off the exam table* Jesus, Mary, Paul McCartney, who the fuck are these women???
“Um… a little cramping,” I grunted through gritted teeth. I tried some deep yoga breathing, and that seemed to help a little.
“You’re doing great,” she said in an effort to soothe me, but she was concentrating on getting all that sperm into my uterus so it didn’t feel like her heart was really in it. Fair enough. Soon after, she gently withdrew the catheter and removed the speculum. Much better. The entire process was done in five minutes.
Before she left she raised the bottom part of the exam table a few inches, sort of like a lounger in reverse, and told me to lay there with my hips elevated for fifteen minutes. After that, I would be free to go. A warm smile, hands pressed together as though in prayer – I felt like she really cared, and it was nice. I closed my eyes and thought about lying in bed with Jeff. Sometimes I wake up in the middle of the night and realize that our bodies are pressed so close together they’ve formed a seal. It always hurts a bit to peel myself away.
There were times during the past month when I got a little melancholy thinking about unromantic it all was. When most couples want to have a baby, they get to go about it in the traditional way, and that child will always be living proof of their love and intimacy. In our case, Jeff wanked in a cup and I suffered a few minutes of excruciating discomfort – what a sweet story to tell our kids someday. But I got over that soon enough. Silly to think that it’d be any different just because we needed a little help.
Now we are well into the interminable Two Week Wait, a period when many women adopt a mindset referred to as PUPO – pregnant until proven otherwise. For me, PUPO is less about wishful thinking (though it is definitely that) and more about lifestyle choices. I’ve cut way back on caffeine and haven’t had a drink in weeks. I’m eating fresh pineapple every day, including the core, which contains an enzyme that’s supposed to help with implantation. I’m trying to do everything I can to reduce stress, which everyone seems to agree is fertility kryptonite, by meditating, going to yoga, getting enough sleep, and spending time with my friends. Perhaps it’s just getting those hormones out of my system, but I feel happier than I have in a long time, even if it’s a delusional sort of optimism. I don’t care.
I know full well that at the end of these two weeks, I may be in for a disappointment. But hell – I’m used to that. For now I’m going to enjoy being pregnant, even if it’s just in my heart.