IUI – Cycle # 1

I started my IUI cycle towards the end of January 2009. The cycle medication normally starts with b/w and u/s on day 3. I was towards the end of my menstrual cycle and was hoping that my AF would start soon (so that I could start my IUI cycle)… though nothing seemed to happen till day 35! So I went in for u/s and b/w to see if I could be induced. Surprisingly, I had not developed any lining on my uterus (to shed during a period), so even if I had been induced, it would not work. The b/w it seems turned out such that… my hormones were at a level that one would have during day 3 of a new cycle. So my RE decided to start my medication.

I administered Follistim (http://www.follistim.com) every night (75 IU for 4 days, 100 IU for 4 days and 150 IU for 2 days) at home starting on day 3 of the cycle. I was scared big time to poke myself in the belly the first night, but honestly it wasn’t bad at all. Though I did realize that I had different sensation every night (from no pain to sharp pain to tingling sensation)! I guess things changed as my body hormone level went up/down. Follistim made me bloated, tired, my boobs were sore, nipples were extremely sore, I was a lot more thirsty, had an increased appetite. My follicles went from too small (less than 10 mm) to 15 mm + as soon as I up’ed my dose to 150. With PCOS (excessive follicles in the ovaries), the doctors do not want to stimulate you to quick, because it could cause a severe hyperstimulation (OHSS: http://en.wikipedia.org/wiki/OHSS). I was monitored (b/w and vaginal u/s) on day 3, 7, 9, 11 and 13. On the 13th day of the cycle (3 follicles > 18mm @ right ovary and 1 follicle > 15 mm @ left ovary), I administered myself the prefilled syringe of Ovidrel (http://www.drugs.com/mtm/ovidrel-injectable.html)! We were supposed to go to the RE on day 14 for the 1st insemination and day 15 for the 2nd insemination (My RE does 2 insemination to increase the chances of catching the ovulation post induction).

Insemination went well! Husbands sperms were collected (both days – good count) and were washed (Sperm Washing: http://en.wikipedia.org/wiki/Sperm_washing). The insemination procedure did not take very long (approx 10 mins) and there was no pain or cramping or bleeding involved. I rested both the days after IUI. The Ovidrel did make me bloated and soar. My ovaries cramped, my feet hurt bad, caused headaches and I was very thirsty… it was manageable and it all subsided within 3-4 days. I went in for progesterone check 4 days past first insemination. Progesterone level was 6.4 units, the doctor recommended taking an Ovidrel shot to up the levels (10 or above is required for implantation to occur). I had similar symptoms to my first Ovidrel shot, though the intensity of all the pain was higher! My ovaries were cramping badly and I couldn’t move much, had some chest pain and had difficulty urinating! I was afraid it was OHSS! I ended up calling the emergency line at the RE’s office and spoke to a nurse. According to her, as long as I had not stopped passing fluids (urinating), I should be okay. She scheduled an u/s and b/w appointment for the following morning. The u/s revealed a few cysts in the right ovary (not very big). Cysts normally subside by the end of the cycle. Sometimes they can persist through pregnancy. If they don’t subside a cycle might have to be skipped (if not pregnant)! My RE mentioned that bloating and pain normally increases towards the end of the day (because of physical activity throughout the day). He also mentioned that since the Progesterone levels were above 3 units (during the progesterone check 4 days past insemination), ovulation had occurred and these cysts were not just left over eggs.

My OHSS symptoms subsided in the next week or so. I was perfectly fine initially during the 2 weeks waiting (2ww). With all the medication I had had thus far, it was hard to tell if all the changes/symptoms were pregnancy symptoms or medication. My August 2008 experience had taught me not to read too much into these symptoms. Though it did not stop me from looking up information online… it just made me a little cautious and less anxious! However as the 2ww almost came to an end, I couldn’t stop myself from trying an EPT! I used the Walgreens brand (I had spent enough $$ last yr to realize that the brand name didn’t make much of a difference) 2 days prior to going to the RE’s office for b/w! It was slightly positive, though it could have been the Ovidrel (HCG)! I tested again the day before (b/w) and the line was much lighter than the previous day! I was kind of mentally prepared for a BFN at the RE’s!

Never ever has this treatment not surprised me (till date)! My b/w results were indeterminate. My HCG level (pregnancy hormone) was 3’ish. If one is not pregnant, the levels are below 2 units. Progesterone levels were 6’ish (not suggesting pregnancy). I was asked to come again 2 days later for another round of b/w. Even though I had anticipated this (after my EPT), I was frustrated and angry! Why me!?! I cried a lot that day, didn’t want to speak with anyone. Though I calmed down after speaking with my husband at night and I was pretty normal from the next day. The second round of b/w was definitely a very BFN for sure! My AF started the following day. I cramped like never before… I could hardly move during the first half of the first day!