How Does it WORK, anyway?

There’s a lot of talk about cervixes here. Speculums, lube, ovaries. Lots of folks just don’t need to know that much about someone else’s body. I started having so many protective asterisks on each post that it seemed wiser to let you read in peace when you wanted to and move the “how did THAT happen?!” over here.

I’m the sort of person who wants to know exactly what will happen before I go into anything. Because this is impossible and I am stubborn, I spend more time than I should imagining possibilities and shaking down my friends (and the internet) for information. That said, doctors and procedures are different, modern medicine changes quickly, and my personal needs and experiences aren’t exhaustive or necessarily the norm.

Before I could get down to the business of getting pregnant, the doctor and I did a number of things to check for likely fertility challenges. Since I hadn’t ever tried to be pregnant, there was no outward sign of infertility though I am carrying around a set of lightly polycystic ovaries. Here’s what happened next:

First visit: Internal ultrasound and blood draw for blood type, thyroid levels, prolactin, and anti-mullerian levels (AMH).
What happened: The doctor noted my personal history and health, weight and blood pressure. Just like at a regular gynecology visit, I reclined on a table with stirrups (got to keep my shirt on, for the win!). He used a wand longish, narrowish, to take a look at my ovaries. It didn’t hurt and he lubed that thing up but good – wipe well, friends. I had just ovulated and could see several follicles hanging out, doing their job. He did note some signs of polycystic ovaries but nothing terribly concerning. The nurse took a vial of blood.
The blood tests came back in a week. Here’s what I had to say about it.

Second Visit: Another blood test on day 2, 3 or 4 of period to check estradiol and FSH levels.
What happened: The nurse took a vial of blood (no need to see the doctor so I was in and out of there in a flash). The first day of your period doesn’t include spotting so I wasn’t sure if I was on the second day or the third when I went in. Apparently, starting with a bang at 1pm and then stopping until the next morning counts as day 1, just so you know.
The blood tests came back in a week. Here’s what I had to say about it.

Third Visit: HSG (hysterosalpingogram). What does an HSG feel like? Well…have at it…
What happened: I like to think of the HSG as an opportunity to relax…half-naked with your knees akimbo. I got to keep my shirt and socks on (this is always important to me to know ahead of time, I’m not sure why) and lay on a table in an xray room. Xray rooms are usually dim and cool so socks are a good thing. I had pillows for my head and hips. I was met by the tech and a nurse from our clinic and they made light conversation ahead of time and said reassuring things in the moment. And by moment I mean the period of time where I reminded myself to take really deep breaths and not audibly whimper. The doctor uses a speculum to prop you open (not oodles of fun ever, really) and a swab of antiseptic to prevent infection. There’s a pinch there but whatever, pinches on your cervix are unnoticeable once the doctor starts threading a mac truck into your equipment. Sorry, this is referred to as “some cramping” but in reality it felt like a squeeze-twist. Like what you’d do to wring out a wet rag or to get the last juice from a lemon. Personal opinion of hurt is certainly a factor here. I’m quite good with sudden or sharp pain but I’m a disaster with slower or extended pain. This was certainly discomfort and not really pain but it was the sort of discomfort that makes you wish you had pain instead.
Results were instant. Here’s what I had to say about it.

Fourth Visit: Review results and set path forward.
What happened: Sat down with the doctor in his office (clothes on!) to discuss the results and get the go ahead to inseminate at the next ovulation. We’ll do an intrauterine insemination (IUI) the next time I ovulate and I’ll know that by using an ovulation predictor kit.

Interlude: How does an ovulation kit work?
We used the Clear Blue digital ovulation kit. After christening (ok, peeing on) the stick every 24 hours around the ovulation date, the kit will turn positive to indicate the surge that means the egg is about to let fly. The link has an excellent description. However, what the link can’t describe is the worry that comes with day after day of negative results. Not being a googler, typically, I only alarmed myself when I googled “period without ovulation” and found out that I could just skip the whole thing this month. W. T. F.

Fifth Visit: Ovulation kit turns positive, pick up the vial of sperm at the lab, and go to clinic for an IUI.
What happened: We got the smiley face in the morning and an appointment for the afternoon. Ovulation waits for no one. Our lab thaws the specimen in a room down the hall from the clinic and, after verifying my photo id and all the pertinent information, sends us back to the waiting room clutching our vial. It’s a tiny thing, not much bigger around than a pencil. The nurse verified the donor number and specimen with me again and then there we were in “undress from the waist down” land. Using a speculum, the doctor made way for a tiny catheter that moves the sperm past the cervix and into the uterus. No gatekeeper here! Although I laid still for about 15 minutes, there were no other precautions about hips up, no exercise, walk with your knees together, don’t cough, etc. After all, the drain is plugged, as it were. All that remains is for the egg and sperm to live long enough to hook up and make peace. You’d think the odds would be higher. They aren’t.
Here’s what I had to say about it.

Sixth Visit: Progesterone test to determine whether or not ovulation occurred.
What happened: With ovulation and insemination 7 days behind us, I headed in to get blood drawn for the progesterone test. The nurse hardly needed any blood at all and explained that for unmedicated cycles, they like to see above a 3 (obviously, I was not savvy enough to ask 3 what) and medicated cycles above a 15. Given those numbers I was delighted when a result of 12.17 came back later that afternoon. This is the last stop before finding out whether this try took and even though the chances are still slim, it’s nice to know that my body wasn’t working against me in any way. In fact, go on awesome body, go on!
Here’s what little I had to say about it.

Visits seven and eight/nine: IUI with two samples and two IUIs back to back.
What happened: My fertility clinic says the jury’s out on the effectiveness of twice as much sperm or IUIs back to back. If we were willing, the doctor said, it couldn’t hurt. The first month, I ovulated late in the day on a Sunday so, instead of back to back IUIs, we used two samples at once. The next month, we did back to back IUIs. As you can see, neither approach guarantees success.
Here’s what I had to say about it: try two and try three.

Tenth Visit: Dude. That was three tries. What now?
What happened: We met with a doctor on the third day of my cycle to talk about using medication to improve our chances. While I had read that 97% of people are pregnant in four IUIs, the doctor assured me that those statistics are more normal for 25 year olds and that folks of my advanced…er…sophistication, should expect something along the lines of seven or eight IUIs. He recommended Clomid which, since I am ovulating regularly, would just increase our chances at the whole sperm-meet-egg thing. We were on the fence but the chance of multiples for my age is low. I took Clomid on days 3-9 of my cycle.
Here’s what I had to say about it.

Eleventh Visit: IUI
What happened: Ovulation came ridiculously (to me) late, leaving me to find an emergency child-keeper and meeting my wife at the clinic in the rain on a Sunday morning. She took a cab from the airport in order to be there. We were accidentally forgotten in the waiting room for 30 minutes while I held the sperm in my hot hands, sure they were expiring by the millions every minute.
Here’s what I had to say about it.

Twelfth Visit: Progesterone check.
What happened: Quick blood draw and quick turnaround. With a progesterone level of 73, we all feel confident that I ovulated successfully, not that we were worried about it before. Everything works except the one thing that doesn’t. Still no baby.

Thirteenth Visit: Internal ultrasound.
What happened: No baby + clomid means an ultrasound with the wand to check for cysts. Hurt for a split second but, man, I’d take that over the speculum any day. Plus! You get to look at pictures of your ovaries on the screen! The doctor saw evidence that two eggs were released as hoped and I’m happily cyst-free. Permission to try again with clomid granted.

Fourteenth Visit: IUI
What happened: You know, five IUIs in and I’m wondering, is it possible to crank the speculum open any wider? I just feel like I’d like to aim for a double decker bus instead of just a semi.
Here’s what I had to say about it.

Fifteenth Visit: Progesterone Check
What Happened: Quick blood draw and quick results. Progesterone level is lower than last time, 55, but was reported as “excellent”. The nurse reemphasized that with a medicated cycle, anything over 15 is good.
Here’s what I had to say about it.

At the beginning, I don’t know if  I would have thought 15 was a few or a lot. Probably the latter. Regardless, that fifteenth visit was the last visit. The time, energy, and money we spent trying to get pregnant again resulted in nothing. Learning experiences, maybe. I’m not sad (anymore), but I don’t think happy is the right word (for now). Regardless, we are done.
Here’s what I had to say about it.