I specifically moved from my OB/GYN to see a fertility specialist and reproductive gynocologist for IUI… in our case, this would be our third IUI. I also wanted to discuss what he thought could be an explanation for our unexplained secondary infertility. At this point, we were not seeking IVF – mentally, physically, and financially – it didn’t align for us at this time. I really think if we did not already have our first born, we may have more heavily considered it. We had rationalized that we had already conceived twice, once to term, without assistance and we came to an agreement with IUI, unless there was another option that we were not aware of that matched us better.
I researched to no end: on evidenced based websites and research articles, on blog and chat platforms, through word-of-mouth experience. I tried to gather all my thoughts prior to the consultation. I got onto my online medical charts and printed off all previous labs and procedures in chronological order. I wanted to be sure he knew what we had done up to this point and wanted to ensure a smooth consultation. Ironically, I think all this organization is also how I calmed my nerves; I was stressed, anxious, dreading but also oddly hopeful for this new path we were about to take meeting with a fertility specialist.
A recap if you don’t want to read back on the blog posts, for us in particular, we had conceived our first without any trouble and right away, then we tried for what was nearing 2 years at this point with one miscarriage. We were labeled with secondary unexplained infertility. So, the questions I share here are geared toward our inclusive situation and specifically toward IUI process. I ended up maybe asking 1 or 2 questions. The consultation was very thorough and flowed more like a conversation versus an interview. Regardless, for me, it felt good to be prepared and a bit more educated so I could also make informed decisions.
ANYWAY, I wanted to share my list of questions which may serve as a quick reference to you if you are going through something similar. If you are wondering what questions to ask a fertility specialist, reproductive endocrinologist, or reproductive gynecologist, or any doctor in your care about IUI, here were our questions:
What to expect with the IUI process here?
- IUI rules? Recommendation on intercourse? Night of IUI and then after procedure? Abstain before?
- Pre/post wash counts? Should we do a repeat sperm analysis if IUI has a sort of sperm analysis before?
- Do you prescribe progesterone for everyone or do a mid luteal draw?
- Do you get betas two weeks after IUI or wait until positive home test?
- Do you use clomid or letrozole? Will you adjust the dosage if needed?
- Do you use trigger shots? Pregnyl or ovidrel?
- Do you do a baseline US and blood work at the beginning of each cycle?
- What amount of follicles can I have before you cancel?
- How many times will I come in before the IUI for bloodwork and US?
- Do you show the IUI via US?
- Does my husband give his sample at home or in clinic?
- Husband travels, if timing becomes a constant issue can frozen sperm IUI be an option?
- How many IUIs before moving on to discussion for other treatments?
- Such thing as over mature follicles and being too viable? Hear 19-23 is ideal, triggering early will shorten follicular phase is that bad?
- Do you do a blood draw in conjunction with measuring follicle size to help time?
- Have you heard of a double IUI at 24 then 48 hours
- Read somewhere on timing of trigger shot, higher pregnancy rate in cycles where shot was given after IUI (19.6%) instead of the 24-36 hours before the procedure (10.9%)
- Does a trigger given at 42 hours have better outcome?
- Financially: IUI each cycle is a lump sum or does each blood draw/US cost?
- Recommended tests? Labs to request:
- CMP – comprehensive metabolic panel
- CBC- complete blood count
- Lipid panel
- Homocysteine and hs-CRP
- HgA1C, fasting glucose, fasting insulin
- Full thyroid panel
- Is HSG required for everyone before IUI?
***It ended up they had their own extensive protocol for labs which was more than enough for me… I ensured they did complete a FULL thyroid, that was important to me.
- Since I’ve been pregnant does it rule out some tests?
- Could it be scar tissue not causing implantation?
- Endometriosis even though I am asymptomatic?
- Polyp on uterus?
Hope that helps. Let me know if you asked anything different or had any other thoughts to add!