Thursday, August 20, 2009

Our New TTC Protocol, Part One: Yes, Women ARE Complicated!

I’ve often heard men say that women are complicated. Men, you have no idea! So read on.

There are basically four levels of assisted reproductive therapy ("ART"): (1) a medicated cycle, (2) intra-uterine insemination (“IUI”), (3) in-vitro fertilization (“IVF”), and (4) intra-cytoplasmic sperm injection (“ICSI”). Because timing, and everything after intercourse, relies so much on the woman’s body, medicated cycles alone can help women who have unexplained infertility, irregular, or unpredictable cycles. The medication also has a higher occurrence of more then one egg being released, increasing the opportunity for a sperm to fertilize an egg.

The average woman’s menstrual cycle is 28 days long, and she will ovulate (“O”) usually on cycle day (“CD”) 14. Ovulation refers to the release of a mature egg from an ovary. Cycle day one is the first day of a woman’s full-flow menstruation. These are the dates that conception, and therefore assisted reproductive therapies, are based on.

My cycles are rather predictable, with O arriving on CD 14 like clockwork (unless I get sick earlier in my cycle). They are a little on the shorter end, at 24-25 days long, but this is not short enough to be diagnosed with a defect because of it. Since we have moderate male-factor infertility (“MFI”), the least-invasive step that could help for my husband and I is IUI. In proceeding with IUI, many fertility specialists like to have the woman on medications also to make her cycle extremely predictable, stable, increase the number of eggs released to increase the odds, and make her as fertile as possible. It made me feel like a bionic baby-making machine!

Anyhow, I liken IUI to the turkey-baster method. This seems to be a working metaphor, and it sticks in my friends’ and family members’ heads so I don’t have to repeat the descriptions over and over again! It also contrasts nicely with the next step, which is IVF, or what I refer to as the petrie dish method. A quick description of IVF and ICSI: For IVF, the sperm are donated and treated as in an IUI, and mature eggs are extracted from the woman’s body, then the two are put in a container together, and hopefully, sperm meets egg there. ICSI is IVF with the sperm being injected into the egg(s). We have been told that if IUI doesn’t work for us after about three times, ICSI would be the next step.

So, back to our current cycle, new protocol and IUI. It all starts with me taking Clomid on CDs 3-7. As it was explained to me, Clomid acts like a little general in your brain telling it to stop listening to certain hormones and to listen to the Clomid instead, which mainly tells it to mature extra follicles (in which eggs are maturing). Side effects that I had from it included hot flashes, bloating, headaches, and blind spots (like stars you see when you get a concussion or a migraine). I have heard from other gals that modd swings are also very common, and the doctor warned me that the Clomid could thin out the uterine lining and decrease cervical mucus (which is an important fluid present around O that helps the sperm swim through the cervix and into the uterus). Because of the last couple of side effects from Clomid, the next drug is Estrogen, or Estradiol, which I took on CDs 8-12. The bloating continued, but the other side effects subsided. Starting on CD 11, I had to use an ovulation predictor kit (“OPK”) first thing in the morning, and as soon as we had a positive, call the clinic and go in for an intra-vaginal ultrasound (“IVUS”) to see how big my mature follicles are and how thick my uterine lining is, and from that, predict how close I am to O. We also had to abstain starting on CD 9 until the insemination, so that my husband could build up a good store of soldiers before making his deposit! They start you on CD 9 in case you have to get the IUI on CD 12, so that you have three days of storage, but I didn’t O until CD 14 (as usual), so it was a long time, I tell ya! And mind you, those days are your most fertile, so for the last two years, that’s been baby-dancing time! What a switch…

Next post will continue at CD 13 when we went in for my IVUS to check out the follies. Make sure to check back!



  1. Wow. Science is pretty amazing. And this sounds like a full-time job. Keeping fingers crossed that this protocol will do the trick!

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