Friday, April 1, 2016

Successful and Safe IUI At Home?? Yes, it's Possible!

By popular request I am finally getting around to writing this blog post! I meant to write it much sooner but when I finally had time to write at night when Audrey was asleep I was usually exhausted and nauseous on the couch. (Thanks, first trimester!) But I'm feeling good tonight and first trimester is almost over! FYI, this post is longer than I originally intended and includes some back story, so feel free to skim or skip ahead to the interesting parts!

Also, please take note that this blog post is intended to journal our experiences with infertility and at home IUI's and is in no way giving medical advice. I hope this is helpful for others who find themselves in similar situations, but please do your own research and don't rely solely on my experiences!

Most people are probably unfamiliar with the term IUI or why we choose this option, so I'll explain from the beginning: Once upon a time there was a young hetero couple who wanted to have a baby. They had lots of unprotected sex at the time of ovulation each month but no baby was conceived.

After a long year of repetitive sex and temperature taking, they went into a fertility specialist called a Reproductive Endocrinologist (RE). He said everything looked good with the incubator-partner but the swimmer-shooting partner had a problem with his swimmers. After another awkward visit with a bad porn magazine in the office of a urologist, the couple was given the options of: IVF (very invasive for the incubator-partner and crazy expensive), adoption (very, very expensive and no chance of incubating or pushing the baby out of her vagina - very important for this couple), or donor sperm (much less expensive and invasive, incubating included, but baby will not be biologically related to the swimmer-shooting partner).

After much thought, prayer, and therapy the couple decided to go with donor sperm. They contacted the RE who said the procedure would cost X amount, more than the couple had anticipated. So the incubator-partner went online to research (note, this becomes a major addiction habit of hers in the future) and found that some couples inseminate with donor sperm at home! She found a cryobank that ships to any residence (most require you to use a medical provider) and together they picked a donor.

First cycle was an ICI (intra-cervical insemination. Basically it's just like regular, hetero sex: the semen is placed into the vagina near the cervix) and was unsuccessful. Second cycle their donor of choice did not have any more ICI vials available (rookie mistake: only buying enough vials for one cycle) but he did have IUI vials. IUI stands for intra-uterine insemination where the semen is washed so only sperm remains. The sperm is placed directly into the uterus with a catheter and syringe.

So after more obsessive thorough research online the couple decided to do an at-home, DIY IUI. And.... it worked! Pregnant! 9 months later a baby girl came out of the incubator-partner's vagina in a large tub of water at their house (because after an IUI at home, a birth at home couldn't be that much more complicated!) Cue angels singing Hallelujah! - But seriously, A) homebirth was the best decision I ever made, ever in my life and B) it was the most empowering, amazing, and beautiful experience! If you're curious to read my first birth story, I'm going to be posting that next.

Fast forward about 3 years and we decide we're ready for another baby! (Yes, I realize I'm switching from the third to the first person and I'm ok with that). So I do lots of things to prepare my body and we try IUI's at home for 6 months with no success. See here to read more details.

While taking a break from TTC (trying to conceive) for a few months, I went to see a highly recommended naturopath who did muscle testing and determined that I had mild hyperthyroidism which was throwing off all my hormones. She was not surprised I wasn't able to conceive. I did some supplements and dietary changes for a month to address this issue. (I know I know, this is another "weird" alternative voodoo thing, but she was able to tell a lot about me just from the muscle testing, such as my blood type and that I had a mold problem in my house. Combined with my friend's experiences and my getting pregnant after following the personalized regimen for a month, I am a believer! Here is the link to her website with more info.)

So a few weeks after weaning Audrey and implementing the changes suggested by the naturopath we decide kind of on a whim to try a month earlier than originally planned. Partly because my husband starts an intense internship for his master's program in December and he wanted to have some time with the baby before being really busy for 6 months.

First of all, it's very important that you know your typical cycle very, very well. I had been charting my temperature, checking my cervix, and doing OPKs for almost a year at this point, and in total I have charted over 24 cycles in my life. That's a lot, but I recommend charting and checking all your fertility signs for at least 3 months. Read Taking Charge of Your Fertility or use the app for more information on that. Once you've charted a few cycles and can look back and see when you typically ovulate and get used to the signs of impending ovulation, figuring out the timing of IUI's is a lot easier!

Knowing your cycle and your body is really important for doing an IUI at home because washed sperm doesn't live as long as semen in an ICI vial (or semen from hetero sex). So timing is everything! I was ovulating very soon after I got a positive OPK - about 12 hours (I took these 3 times a day, not just once as the box says. Your LH surge can happen anytime of the day and you have a much smaller window of viability with washed sperm versus fresh semen from hetero sex). I also had ovulation pain. So that made timing pretty easy for us to figure out, although with my daughter I didn't have any ovulation pain. The timing issue is why we do two vials every cycle. This way we can extend the amount of time my uterus/fallopian tubes have live sperm in it. We do two vials about 12 hours apart, but depending on your body's individual  patterns you may want the timing more spread out.

All right, here comes the best part of this post: the pictures! No, not pictures of us doing the IUI or anyone's body parts but pictures of the dewar the vials are shipped in and the process of preparing to do the IUI.

Helping Mommy with the dewar! (No, she was not present during the actual IUI!)

Opening the box, you can see the paperwork on top

The dewar! There's liquid nitrogen inside which keeps the sperm very frozen until you open and thaw the vials. The dewar is guaranteed to keep frozen for a week from when you receive it.

NW Cryobank takes their dewars very seriously! This letter says if you lose or damage it you owe them $800 to replace. 

Paperwork verifying the donor number and all the testing they do on the semen.

Written and illustrated instructions on how to remove and thaw the vials. Don't remove the dewar from the box!

Opening the dewar and removing a vial on insemination day! Yes, gloves are essential because you're working with liquid nitrogen. You can see two canisters in the middle of the tube which are holding the vials. They are set firmly in there and you have to kind of pry them off.

First the vial sits by itself for 3-4 minutes until all the frost is gone.

Next I hold the vial in my hand for 10-15 minutes until it has come to body temperature. 

Here are the supplies you need for an IUI: speculum, catheter, syringe, and missing is a flashlight or headlamp. We sterilize the speculum after each use but you can also buy one-time-use plastic ones. The catheter and syringe are one-time-use. I like the catheter and syringes from here

(Before you do this, you need to make sure you have scrubbed and scrubbed your hands very clean! Or use sterile gloves. Sanitation is super important when doing IUIs because you are bypassing your body's natural filter, the cervix). Here I am aspirating the sperm out of the vial and into the catheter and syringe. Although I'm using the catheter attached to the syringe I recommend you aspirate with only the syringe and then place the catheter on. And open the vial very slowly and very carefully because there will be some pressure built up like a can of pop. (Yep, pop. Guess where I live based on that term!)

Now we come to the actual IUI of which there are no pictures (sorry not sorry!) Basically, I lie down on an elevated surface and spread my legs out (you can 'butterfly' your legs but I prefer to just bend my knees and place my feet flat on the surface), and my husband places the speculum inside my vagina. This can take some practice and patience so I recommend you work this out beforehand. Oh, and my husband has scrubbed and scrubbed and scrubbed his hands because he is the one actually doing the IUI.

He puts the flashlight in his mouth (this is where a headlamp would be especially useful) and gently positions the speculum to where he can see my cervix. Now this is the part where knowing your body really well (feeling your cervix during your cycle) can come in handy if your partner has trouble locating it. Sometimes he can't see my cervix at all and he takes the speculum out and tries again. Since I've had a vaginal birth my cervix is always open a little but even when we conceived the first time we had no problems with this. I've read online accounts of IUI's done by medical professionals where the cervix was closed tightly shut and needed to be opened manually, but if you are inseminating at the peak of your fertile phase, it should be at least slightly open. Again, it can depend on your individual body. Then he very carefully and slowly inserts the catheter into my cervix until it meets resistance, which is usually about 6 inches or so. Next he carefully and slowly pushes the plunger on the syringe until it's emptied, then carefully and slowly pulls the catheter out. I stay lying down for about a half hour after this to ensure all the swimmers are headed up where they need to go. There is usually some leakage, which is likely from cervical mucus rather than sperm coming back out, so don't be alarmed if this happens.

And that's it! You're onto the 2 week wait! Pretty simple once you get down to it. The main things are: getting your timing right, going slowly and having patience, and taking proper sanitary precautions. We've done a total of 9 at home IUI's and I've never had any bleeding, pain, or infections. 2 of those IUI's have resulted in successful pregnancies! Happy inseminating!

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