Hold on to your hats, ladies. This is going to be a long one.
We finally took the plunge, after many many futile months of trying. I had just tired to the point that I'd rather be doing something, anything, than sitting around and charting my temperature or peeing on sticks or getting my period every month. ***During IUI, a prepared semen sample with adequate numbers of motile, normal sperms suspended in a nutrient medium is directly placed in the uterine cavity, thus bypassing the need for sperms to travel from the vagina to the uterus. This is done around the predicted time of ovulation.***
There are two types of IUIs, one is based on Clomid, a tiny pill about the size of a birth control pill, and another is based on injectibles. The efficacy is not terribly different, for Clomid it is 25%, and for injectibles about 30-32%. This treatment probably works by improving the timing of conception, bypassing potential cervical factors or increasing the number of eggs ovulated. ***It is very important to keep in mind that the chance of pregnancy is not affected by the frequency of your office visits, serial blood tests and ultrasounds or hCG administration. So you can feel like you are doing a lot but which results in very little.***
I left it to Dr N as to which course we should take, and he suggested that since it was the first time and our statistics were not that bad, we should take the Clomid first and then top up with the injectibles if required, which sounded like a reasonable plan. The Clomid was a breeze, no problems at all, two tiny pills every morning with juice. But then on Day 5, after the last two pills, they did a scan and Dr N. suggested three injectibles. No sweat. I had been expecting this.
Looking back now, I really wonder why I had been so scared of taking these injectibles, I guess it's just fear of injections and poking your skin. I found the hospitals oddly comforting (this would change totally later on), but what I was unprepared for was the emotional ride that it took to go back to the clinic each day. The first time, I held out my arm only to be horrified in realizing that these injectibles have to go through your stomach, ala Alien. I immediately decided to go back to the clinic for the injectibles each morning, so that they would be properly administered. This turned out to be a really bad idea, as being stuck in the morning jam, running through the crowded corridors, more waiting room time at the doctor's, all combined to make it a far more tedious experience than it had to be.
The first injection is an odd feeling but not bad, much like taking blood. The second injection was a breeze and the third one was heart-breaking, first because it hurt (I think my stomach was getting sore) and second because Dr N. did a further scan and prescribed three more injectibles. This time, it would be both the Gonal-F, which is to encourage the growth of the follicles and then a second injectible of Cetrotide to retard the growth of the dominant follicle, so that the different follicles would trigger at close to the same time. This basically made 6 additional injections, if you're counting, way more than I had expected expected to take.
I walked out of the clinic and wanted to cry. I don't remember if I did cry later on. I just went to have lunch first and sat at the cafe, feeling numb. By then, I was in a bad mood every day and had pock marks all over my tummy to show for it. I felt like a sick person. But I didn't have a choice, and I couldn't stop midway. The Gonal-F was in an epipen, with a very thin, fine needle, and it really didn't hurt or make much of an impact on the skin going in — even less than a pinprick or a bee sting, but the second injection was done with a thin but not as fine needle and that did hurt. I was resigned on the fourth shot, depressed again on the fifth and then really happy and relieved on the sixth day.
By the end of the cycle, I had developed three or four mature follicles, but only two of these seemed really mature, with the others perhaps too small or foggy to count on. I never really super ovulated, either because they controlled the dosages well or because I'm not one of those women who produces 6-9 follicles and eggs. The doctor prescribed an Ovidrel trigger, which is the HCG hormone that tells the ovary to release the follicles and then scheduled an IUI.
Now this presented a slight dilemma. I had been coming into the clinic for these injections. But the trigger shot had to be administered at 7.30pm and on a weekend when the clinic was no longer open. So I would have to get past my apprehension of jabbing myself, or find someone (not my husband, who was at work) to do it.
My mum was the most demonstrative about wanting grandchildren, carrying other people's infants and so on, but when we broached this process, she was not supportive. First, she said that we had not been trying very long, second that she was against trying IUI before we'd tried longer, because the injections can give you cancer, and third, she intuited that she didn't have confidence in the Indian doctor (as I would come to find out later on, she didn't have confidence in almost any doctor at all, perhaps the consequence of being married to one!). Stung by these strong and subjective views, pretty much after that, I stopped turning to her for much advice or support. I could ask my dad, who, as the retired doctor, was the natural choice. But I was naturally cautious about asking my dad for this kind of help, and I was also now additionally aware that we had not consulted, nor updated him before beginning the IUI process.
Left with no real choice, I decided to ask my dad for his assistance. I was very blessed that beyond asking a few direct questions, he accepted my explanation and solemnly said only, that we should follow the instructions carefully, so as not to waste the effort and expense. He did a great and careful job with the injectible administration!
The IUI was done on a weekday and the procedure was laughably simple, except neither of us were laughing by then. The husband goes in a cup, you have to get it to the fertility centre within the hour, where it is spun clean. ***Three hours later, I came back to collect it from a lab-coat dressed woman who wished me good luck. I carried the two little valves through the hospital back to our clinic, which might be the most bizarre experience that I've had to date in this whole process.***
Looking at the statistical semen analysis, I could now quite clearly see why we needed the help of an IUI. The first semen analysis that my husband gave was botched, so this was the first time that I was really looking at dependable statistics. The motility was merely 4% rapid (48% sluggish) and after washing out the immobile dregs, it was 10% rapid. The morphology was a lowly 2%, in the sub-fertile range (normal being 4% and very fertile being >14%). There was nothing that the IUI could do for the morphology, in fact the lab lady told me that 2% is still alright for an IUI, if it were 1%, you couldn't do an IUI at all. Great.
The IUI process was done in a bed similar to a delivery ward, or the regular gynae chair. ***The sample is inserted via a catheter while a speculum is inserted into the vagina so that the cervix, which is the mouth of the uterus, is visualized. It's not uncomfortable at all, but I found that for a few hours or the rest of the day afterwards, I experienced a regular, dull ache around the vagina and pelvic region, a bit like remnant period aching (but no cramps).***
The nurses had me get up from the seat quite quickly and I was able to walk around before going back home. It was all over in less than 5 minutes, although you pay a healthy sum for the IUI, and I was asked to start progesterone sticks, called Crionine (you squeeze them to release the vaginal progesterone cream) after two days.
This proved to be the most tedious part of the process — Crionine gives me sharp cramps, headaches, exhaustion and weird dreams. I've heard it called the evil hormone. Progesterone is supposed to calm the womb but I was cramping so badly that I pulled out the specification sheet of the medication and read it through. The vivid dreams aren't monsters-chasing nightmares, but like charged versions of your subconscious. One night, it was touring a house renovation with a contractor, creating a budget. The next night, it was that my husband loaned his car to a female friend with a large pearl ring and me running after the car as she drove off, with the film narrowing onto a focus on the ring, like the ending of an old black-and-white movie. The next night, it was some other slightly sinister adventure, or a throwback to my old college loves. When I stopped taking the progesterone, all of it stopped. The side effects themselves, it turned out, were themselves exhausting.
But the worst side-effect of all is that Crionine gives you hope. For me, I suspect it prolongs and makes my period late and then when it comes, right at the very possible last end of the cycle, it feels like it was mocking your days of hope. I'm also not sure if Crionine can be blamed for mood swings, but when I am triggered, I have a spontaneous urge to break down and cry. And when I do, it's like an intense sobbing and then I'm done. It feels like you're thirteen again.
People who already have kids, or are lucky enough to have twins keep telling you that it's so tiring, but it's more tiring to not have kids and spend those good hours in or travelling to and from the doctor's waiting room, injecting yourself daily, taking Progesterone and other hormones that mimic the symptoms and exhaustion of pregnancy, and then, to get an eventual negative result.
I can't separate what is the Progesterone from the deepening sense of emptiness or loneliness, sometimes a desperation of waiting and below it, a fear that we'll keep on going like this and maybe it's not meant to be. A fear that I've unheeded for too long, that it might be beyond reach and that it's always going to feel like this. I wish someone could just tell me that it's not always going to feel like this, but I guess the truth is, nobody does know. There are days when I know, just know, positively, that it'll turn out good. And I try to hang on to them because other days, I really need that positivity to live in the present.
