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Houston Fertility Journal

What to Expect After IUI

[fa icon="calendar"] Apr 13, 2018 1:08:07 PM / by Center of Reproductive Medicine   

Center of Reproductive Medicine

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Whether it’s your first intrauterine insemination (IUI) or your fifth, the prospect of a successful pregnancy can be exciting -- and a little terrifying, too. Success rates vary from person to person, but overall, a few IUI cycles can offer a very high chance of pregnancy -- particularly for couples with unexplained infertility. So what can you expect after IUI? Here’s what you need to know.

Why IUI?

Before you contemplate what will happen after IUI, it’s important to know why IUI is such a great choice for some people. The primary benefit of IUI is that it delivers sperm directly into the uterus at a time when the woman is known to be ovulating.

This can help address a number of fertility issues, including:

  • Sperm issues. With a low sperm count, IUI ensures that every healthy sperm makes its way to the uterus. For men with low sperm utility, IUI can overcome the issue by delivering the sperm directly to the target location.
  • Timing issues. Some couples are, for various reasons, unable to correctly time intercourse. IUI ensures that the sperm meets the egg when the woman is ovulating.
  • Ovulation issues. Some women have eggs that live 12 hours or less following ovulation. With IUI, there’s a greater chance that the sperm will meet the egg during this short window of time.
  • Unexplained infertility. When the reason for infertility is unclear or undiagnosed, IUI can circumvent a variety of issues, increasing the chances of a pregnancy.

For people considering in vitro fertilization (IVF), IUI offers a more affordable and less invasive option. We often recommend trying IUI first. And for people who know they don’t want to do IVF, IUI is a highly effective alternative.

For Women on Hormone Treatments

At the Texas Center of Reproductive Medicine, we want to maximize your chances of a successful IUI. For some women, IUI requires no special preparation. But for many, IUI also involves hormone treatments.

Some hormones you might use include:

  • Clomid to encourage ovulation. In women with polycystic ovary syndrome (PCOS), as well as women who don’t ovulate or who only ovulate infrequently, Clomid can increase the chances of a pregnancy. Because it encourages timely ovulation, it can also help you do another cycle if IUI more quickly if the first one doesn’t work.
  • Progesterone to support early pregnancy. Some women don’t produce enough progesterone, causing repeated early miscarriages. Progesterone supplements can help you stay pregnant if IUI is successful.

Depending upon your specific needs, we may recommend other hormone treatments. Women who undergo hormone therapies can expect a slightly different experience. There may be more preparation for IUI. Hormones can also make you feel different following IUI. In many cases, these hormones mimic the symptoms of early pregnancy. This can make it more difficult for women to feel pregnant, so it’s important to discuss with your doctor what symptoms you can expect due to hormone treatments.

The Two-Week Wait

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You probably remember your first two-week wait well. You might have been excited and nervous. You probably monitored yourself for every imaginable symptom of pregnancy. You might have wondered how you’d ever make it through two full weeks of waiting.

Over time, as infertility became more apparent, you probably got used to the two-week wait. Perhaps you even came to dread another negative pregnancy test.

With your first IUI treatment, you’ll be catapulted back into the two-week wait. You may feel a rush of emotions -- anticipation, excitement, trepidation. You may also begin monitoring yourself for symptoms of pregnancy. Every twinge, ache, and pain may give you a sliver of hope.

So could you really be pregnant? Here’s a brief primer on what your body does after IUI.

Fertilization

To have a chance at getting pregnant, the sperm has to fertilize the egg. This happens anywhere from a few hours to a day or two following IUI. Even if an egg is successfully fertilized, you won't feel any symptoms of pregnancy and your body won’t be considered pregnant. So in the days following IUI, any symptoms you feel are not related to pregnancy.

Implantation

Following fertilization, the egg must journey down the fallopian tubes and into the uterus. There, it must embed itself in the lining of the uterus. Once there, the body begins producing the pregnancy hormone HCG.

This is the hormone that a pregnancy test detects, and also the hormone that causes pregnancy symptoms such as morning sickness. Implantation usually occurs 5-12 days following IUI. After implantation, it usually takes a few days for the body to register sufficiently high HCG levels to get a positive pregnancy test.

Pregnancy

Pregnancy technically begins with implantation. Many women feel some early signs of pregnancy a few days after implantation. Others feel no symptoms at all. The symptoms you feel aren’t a good predictor of pregnancy, since HCG levels remain low early in pregnancy. Around the two-week mark, you’ll go back to the clinic for a pregnancy test. If the test is positive, you’ll likely also undergo other tests to make sure your hormones are well-balanced and the pregnancy is healthy.

The risk of miscarriage is highest in early pregnancy. In fact, most miscarriages occur before a pregnancy is even detected. And for many women, a fertilized egg simply fails to successfully implant.

The risk of miscarriage drops dramatically after a heartbeat can be detected on an ultrasound, and falls below 1% after the end of the first 12 weeks of pregnancy.

Chances of Pregnancy

So what are your overall odds of pregnancy? That’s an individual factor, and no doctor can give you a fully accurate estimate for how likely it is that you will get pregnant. Nevertheless, it can be helpful to ask your provider some key questions to assess your chances of a successful pregnancy.

Those include:

  • What is your clinic’s IUI success rate?
  • What is your success rate for women like me?
  • What factors increase my odds of success? Which factors decrease my odds of success?
  • Is there anything we can do to increase the likelihood of a successful pregnancy?
  • Will hormonal treatments help? Should we try them?

So what factors make you more likely to get pregnant? Your chances are better if:

  • You know your diagnosis, and IUI is a standard treatment for it.
  • You are younger than 35.
  • You know your eggs and your partner’s sperm are healthy.
  • You don’t have a history of three or more miscarriages.
  • You don’t have a luteal phase defect.
  • You have a fertility issue that is easily managed with hormone treatments.
  • You don’t have a chronic illness.

Any single risk factor won’t necessarily preclude a pregnancy, but the more risk factors you have, the more likely IUI is to fail. For women following their doctor’s recommendations who have a good prognosis associated with IUI, the chances of pregnancy following several IUI sessions is 75% or higher. For other women, the probability of a successful pregnancy can be as low as 5%. Only your doctor can tell you whether IUI is a worthy gamble.

What if I’m Pregnant?

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If you’re pregnant, congratulations! The planning begins. Your fertility doctor will work with you in the early weeks of pregnancy to monitor for complications and ensure you remain pregnant. Then you’ll switch to an obstetrician or midwife. Depending on your medical history, your OB may continue consulting with your fertility doctor to ensure a safe and happy pregnancy.

About 20% of pregnancies end in miscarriage. Unfortunately, the miscarriage rate is higher for women with infertility, including those who try IUI. A single miscarriage does not increase your chances of a subsequent miscarriage. So if you lose the pregnancy, it’s safe to try again without fear.

Multiple miscarriages, however, can point to an underlying problem. The good news is that miscarriages are often treatable, and working with a fertility expert is the single best option for preventing future miscarriages. We will monitor your pregnancy for signs that something might be wrong, and stand beside you if you go through the painful process of having a miscarriage. Rest assured, a pregnancy loss does not have to mean the end of your parenthood dreams.

What if I’m Not Pregnant?

A failed IUI can be painful, particularly if you got your hopes up that this was finally your chance at parenthood. But IUI is a lot like trying the old-fashioned way. Each individual IUI has a relatively low probability of success, but overall, the success rate is high. So if you didn’t get pregnant this time, talk to your doctor about trying IUI again.

There’s also some good news: when you’re trying on your own, each failed attempt is just another failed attempt.

But when you try with the help of a fertility team, each failed attempt can reveal important information about your fertility. You might learn that you’re ovulating very late in your cycle, that you have an abnormally short luteal phase, or that your body doesn’t produce enough progesterone to sustain a pregnancy.

If you don’t get pregnant, we’ll talk to you about what might have happened. We use every failure as an information-gathering session. So don’t despair. It’s back to the drawing board, with a better chance of success next time.

Coping With the Wait

The two-week wait can be agonizing. You may feel anxious, depressed, or out of control. These reactions are normal. After all, the drive to have a child is perhaps the most powerful human drive there is. It’s you against evolution. And evolution always wins. So don’t beat yourself up if you have emotions you can’t run from. Nevertheless, finding ways to distract yourself can be helpful.

Try some of the following:

  • Try acting like you’re pregnant during the wait. This is a great way to encourage yourself to adopt a new healthy habit, such as walking or yoga. And even if you’re not pregnant, you’ll have a new healthy lifestyle choice that can improve your quality of life.
  • Plan something fun and memorable for this time. It’s a great chance for a weekend getaway, a new class, or even just some time in the garden.
  • Talk to someone about your feelings. Having someone to lean on can take the burden off. Your partner may be having some of the same challenging emotions you have.
  • Learn as much as you can about pregnancy and fertility. Understanding how your body works and how pregnancy affects your body can help you better understand what might be happening to you if you’re pregnant.

Most importantly, don’t pin your hopes on a pregnancy. You can be happy even if you get a negative pregnancy test. There’s still hope even if this cycle fails. Obsessing over getting pregnant right now is a great way to set yourself up for sadness and failure.

How to Get More Help

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Infertility is tough. Waiting can be brutal. Knowing that it’s normal to struggle can take the edge off. The Center of Reproductive Medicine is here to help you consider all of your options, feel more hopeful, and feel less alone. We can also refer you to community resources that help you manage your emotions.

Some strategies that can help with the long-term challenges of infertility include:

  • Couples counseling. Infertility is tough on relationships. Get your relationship back on track.
  • Individual counseling. You can get through this, no matter how tough things feel right now. Individual counseling helps you process your emotions and find healthy ways to cope with the struggles of trying to have a baby.
  • Support groups. RESOLVE, the National Infertility Organization, can connect you to community resources.  
  • Online support. Online support is anonymous and accessible at any time of day. Post your questions and get immediate answers. Sites such as FertilityFriend and Two Week Wait offer education and resources that can help you manage the stress of trying to conceive, and the agony of waiting.

Most importantly of all, choose an infertility clinic that offers the best possible odds of success. The Center of Reproductive Medicine often solves fertility challenges that other doctors couldn’t. We know trying to get pregnant is an emotional roller coaster. We’re here for you. Let us help. Give us a call today.

Getting Pregnant 101: Facts, Myths, and Secrets To Fertility

Topics: Infertility Treatment, IUI

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