Our Experience with Infertility Part IV - Trying again: IUI Attempt #4

As many of you know, Oscar and I have been blessed with a beautiful baby boy. Tyler Helaman Hunt was conceived at Seattle Reproductive Medicine through the miracle that is the invitro fertilzation process (IVF). We are incredibly fortunate to have good insurance that covered the vast majority of our costs, and now we're trying for a baby again. I've blogged about our experience with infertility before, but because we were so tied up emotionally in the results, I wasn't comfortable telling our story publicly until we'd actually gotten pregnant. However I'm a strong advocate of infertility awareness, and I believe most of the insensitive comments and assumptions I've heard were made out of ignorance, not rudeness. Most people want you to be able to have a baby, and they have good intentions to help you, but they don't understand enough about what you're going through to know how they can. Rather than complaining about it, I've decided to help educate through my own experience. This time around I'm going to let others be a part of the process. I imagine I'll be much less heartbroken if the results aren't what I'm hoping for now that I have my own sweet little boy to console me.

Here's a little update on where we our in our infertility and what our insurance has requested before they'll approve another IVF cycle. Our infertility is unexplained. We've been thoroughly tested - meaning I've had many vaginal ultrasounds showing that everything looks healthy and appears to be functioning properly. I've had a terribly painful test shooting ink through my fallopian tubes revealing there are no obstructions that would prevent an embryo from travelling to my uterus. I've also had blood tests to make sure no other aspects of my health are inhibiting my ability to conceive. Everything appears normal, and since I'm under 35, I have good quality eggs. The only area where I am below average is egg count. While most women my age have 15-20 eggs preparing for ovulation each month, I have 9 (possibly less now that I'm 2 years older). Though a woman prepares many eggs for ovulation, only 1 of them develops enough to be released (with the occasional exception of fraternal twins) while the body reabsorbs the rest. Since I still develop and ovulate one egg each cycle, my low egg count does not affect my ability to conceive. Strictly speaking, I'm not infertile. I'm plenty fertile, but I've never been able to get pregnant.

As for my husband, he's had sperm and blood tests to confirm that he also does not have fertility issues. His counts and stats are actually extremely high. In fact, if he weren't a carrier for Canavan disease he'd make an ideal sperm donor (fortunately I'm not a carrier so we don't have to worry about passing the disease on to our children). Plus when we did our IVF, my eggs fertilized easily without needing ICSI (a procedure used when the sperm can't penetrate the egg on its own). If everything looks good on his part, everything looks good on my part, and clearly we can conceive embryos together, why haven't we gotten pregnant?

This is my personal guess. After my doctor revealed our test results, she informed us that there's one thing the fertility clinic can't test for - what the body does with an egg once it's fertilized. We know that nothing in my tubes is obstructing embryos from traveling to my uterus, but we have no way of knowing if my body is actually sending them there. For all we know it could be reabsorbing them and discarding them. She didn't say "this is your issue" because we have no way of proving it, but based on the facts I have and on our 1st IVF attempt going so smoothly, I'm guessing this must be my problem. In IVF your eggs are removed, fertilized, and then implanted directly into your uterus. They never have to deal with traveling through your tubes. In IUI the sperm is implanted as high up as possible, but it still has to find the egg in your fallopian tubes, fertilize it, and then travel down to your uterus. We attempted to conceive for over 4 years on our own plus did 3 IUI's where everything looked optimal, but we never got pregnant. For years I wondered if maybe I'd been having early miscarriages, the kind that happen when an embryo stops developing in its early stages and the body simply reabsorbs it. But now that I've had a baby and know what my body feels like even when it's only a couple weeks pregnant, I'm sure I've never had a miscarriage. I imagine we've conceived dozens of embryos in our 8+ years of marriage, but my body doesn't know where to send them, and science hasn't yet figured out how to give it the right directions.

Tyler was born on May 21st, 2013. We would have been happy to have another baby as soon as possible, but I wanted to nurse him, and most women don't ovulate while nursing exclusively. My menstrual cycle returned in November once Tyler stopped needing to nurse at night. We've attempted to conceive on our own since then, still with no success. I'd had hope that we would get pregnant since many women are able to conceive on their own after a successful IVF, but alas, that has not been our case. I asked my doctor about it. She said most women she knows who've conceived post IVF did so very quickly due to the fertility rush that often occurs after having a baby. This to me is another sign that physical fertility is not our issue. It doesn't matter how fertile I am if my embryos aren't able to get to my uterus. She had recommended we try on our own for 6 months after my cycles returned and then attempt another IVF. Unfortunately my insurance has other requirements. As far as they're concerned, my fertility status starts over after I've had a baby. I have to attempt to conceive without IVF for a full year before they'll approve a 2nd IVF (we get 3 lifetime attempts). The soonest we could get approval is November, and since a cycle of birth control is required prior to IVF, I won't be able to do the IVF itself until at least December. Last time my insurance required 3 IUI attempts, while this time they will cover IUI's but I'm not required to have them.

I mentioned in Part I that I could have done more to "multiply and replenish the earth" besides simply not using contraceptives. We had this fertility coverage for years before I even knew it was available to me. I sabotaged myself by lamenting my infertility rather than admitting to it and going to someone that could help me, and my spiritual, physical, and mental progression were all greatly increased once we started putting all our efforts into having a baby. Although I'm not required to do the IUI's this time around, I'm going to do them because I don't want to make that same mistake again. I also want to show the Lord that I'm willing to do whatever I can in order to obey His commandments. I don't believe we will conceive with IUI because it can't fix what appears to be my issue, but maybe I'm wrong. Doing the IUI is the right decision for me whether it works or not. If it works, fantastic! And if it doesn't, I've shown the Lord (and my insurance) that we've truly done everything we can to conceive.

Today I had an ultrasound to make sure my egg was developed enough to attempt an IUI. 10% of women do not respond to ovulation kits, and I'm one of them. I've never had a positive result from multiple kits, though I do ovulate regularly. For this reason I have to go in for an ultrasound to see that I have an egg ready to go, and then I'm given a shot to force ovulation. In all 3 attempts before I used Letrozole to make sure I developed a large enough egg. I did respond to this ovarian stimulation and actually produced 2 good eggs each cycle. This time we chose to do a natural attempt and not use the Letrozole since I'm still nursing and any drugs you take can pass into breastmilk. Ty is down to nursing once every 2 days, and I'm hoping to have him weaned by the end of the month. He could stop anytime (he only asks for it when he's bored), but I'm weaning gradually to give my body more time to adjust since I'm prone to engorgement and clots. If we're done by the end of the month and still haven't conceived, we'll try the IUI again with the Letrozole.

Mommy, I need a sibling now!!!

However, it appears I don't even need the Letrozole. It's day 13, and my egg was definitely ready to go. My lining looked great and the egg was plenty large. She said the magic number was 20. Mine was over 24. I have to say it was nice to see that my body had worked. It did exactly what it should do without anything needed to help it along. She said I'd likely ovulate on my own today, but just to make sure so we can time it with Oscar's sample tomorrow morning, they gave me a shot of Novarel. The IUI has its best chance of success between 24 and 38 hours after the shot's been administered. Oscar has to be to work at 10am tomorrow, so he's going in at 9, and I come down at 11 (isn't it weird that to conceive a baby you don't even have to go into the clinic together?). Myla and Kienna are going to keep an eye on Ty in the waiting room during the actual procedure. We'll see how it goes. The next post will either be "Hoorah We're Pregnant" or the one I think more likely, "IUI Attempt #5."



Update: 8/28/2014 - As expected, IUI #4 did not result in pregnancy. We'll be attempting IUI #5 with Letrozole this coming cycle