Expectations: My First IUI

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Expectations is our column about a couple, Lindsay and Charlie, trying to conceive. 

So we move on to intrauterine insemination–anything we can do to improve our odds in the game of “sperm, meet egg.” Don makes an appointment with the sperm bank, where he does what a man’s gotta do into a sterile jar. His donation is then washed (the sperm cells are separated from the other components of the semen), cryopreserved, and set aside for our use.

Meanwhile, Charlie is diligently tracking his cycle on his phone, and taking ovulation predictor kits to make sure the telltale hormonal surge is happening on schedule. Our reproductive endocrinologist (RE) is a brusque woman who calls Charlie by his legal name (even though the fact that he goes by Charlie is in his medical chart), straight-up ignores me during our appointments, and tells Charlie that she doesn’t believe he’s ovulating. Somehow she manages to make this sound like an accusation rather than a concern. But the OPK results are clear–Charlie is churning out eggs right on schedule. It’s just that, for some reason, they’re not ending up fertilized.

Later, we learn that Charlie was diagnosed with infertility as soon as we made the appointment to see the RE. It seems that this diagnosis is required to access assisted reproduction technologies through our insurance, which rubs me very much the wrong way. It’s basically like saying that being queer is an illness. We’ve only been trying for five months, much lower than the normal twelve-month threshold for an infertility diagnosis. We have no reason to believe that there’s anything amiss with Charlie’s reproductive parts – the only thing we know for sure is that I can’t get him pregnant. Honestly, if anyone should be considered infertile here, it’s me. Sperm-production-wise, I’m really a dud.

The RE suggests that Charlie have a hysterosalpingogram, which involves injecting dye into the uterus and fallopian tubes and then taking an X-ray to determine whether anything is blocked. But the nearly unpronounceable procedure would cost more money, and would mean further delaying our conception attempts, since (for reasons I no longer remember) you can’t have a hysterosalpingogram and IUI in the same cycle. Since we’re still optimistic and don’t believe there’s anything wrong with Charlie’s parts, we skip the X-ray and go straight to insemination.

A few days before the IUI, Charlie has to get up early so he can get a transvaginal ultrasound before work. For some reason he’s not allowed to make an appointment for this; it’s first-come, first-served, so he’s awake at the crack of “Are we sure we want a baby this much?” The ultrasound, which he immediately terms the “snatch wand,” checks on his ovaries and makes sure there’s at least one follicle in there big enough to produce a viable egg. Despite the fertility meds Charlie has been taking, his ovaries are a bit behind schedule, so he’s given a prescription for a self-administered injection that will trigger ovulation.

I offer to give Charlie the shot, but unfortunately it has to be taken at a very specific time–the evening before our IUI appointment, while I’m teaching a night class. Charlie is nervous about giving himself a shot, so I text him encouraging messages under my desk while my students critique each other’s essays. It takes him several minutes to work up to the injection, but afterward he says it was actually no big deal at all. With that done, an egg should be released just in time to meet a cohort of concentrated recently-frozen sperm on its way out the door.

At the doctor’s office, we check in, get our sperm vial from the nurse, make sure that the name on the vial matches our sperm donor’s, then take it down to the lab, which is in another building altogether. I don’t fully understand why the sperm can’t just be delivered to the lab in the first place, but I suppose that’s why I don’t make the big bucks. The lab tech is a slim middle-aged woman with spiky blond hair and cat’s-eye glasses on a fabulous beaded chain. She reminds me of one of my favorite teachers from high school, the one who introduced herself by saying “My name is Mrs. S. and I’m just very cool.” I like her immediately. She’s friendly and chatty as she explains that we’ll need to leave the vial with her to thaw in a temperature-controlled environment, and she’ll come find us in 20 minutes when it’s ready.

We wait in the food court area, which is closed and empty, because it’s a weekend. I feel weirdly tense. The food court is decorated with huge, lovingly detailed paintings of various fruits; they have a vague air of fecundity about them, which I hope they will impart to us.

When the lab tech calls us back, she asks us if we want to look through the microscope at the sperm sample. “The count is good,” she says, “but the motility isn’t great. It’s probably good that you’re doing IUI.” When we peer at the slide, we can see what she means: Don’s sperm don’t have the perky, motivated look I remember from middle school sex ed videos. They’re more meandering, some of them clumping together in little huddles as though afraid to face the outside world, some of them moseying in slow circles. We’ve read that this can happen to the sperm of people who smoke too much pot, and we did ask Don to cut back, but apparently there’s only so far a person can be expected to go. This might indeed explain why Charlie is not yet with fetus, but hopefully since IUI lets sperm bypass the obstacle course of the cervix, Don’s slacking swimmers will make it across the finish line this time.

After all the buildup, the procedure is short, though not entirely sweet. The nurse leaves the water in the sink running for fully 10 minutes while we wait for the doctor; this is apparently to get the water hot enough to run it over the speculum to warm it. Then the speculum is too hot, so we have to sit there for another minute while waiting for it to cool down. Once the speculum is an appropriate temperature, Charlie is tilted back in the chair and the doctor inserts the catheter. Charlie flinches, but I’m the only one who seems to notice. Injecting the sperm sample takes only a few seconds; then the catheter and speculum are removed and the doctor is on her way out. “Wait 10 minutes before you sit up,” she says. “If you don’t get your period in two weeks, take a pregnancy test and give us a call.”

I read out loud from the book in my purse to pass the time while Charlie lies back with his hips elevated, both of us willing the sperm eggward as hard as we can. We’ve been trying to stay positive for months, and it’s getting tiring. Hidden inside the book, I cross my fingers.

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