After the fourth try with natural intrauterine insemination through our local LGBTQA-friendly healthcare provider failed to produce a pregnancy, we decided to start working with a local fertility center. The local LGBTQA-friendly healthcare provider we had gone to for the first four tries was only involved with natural inseminations and did not do any kind of advanced reproductive assistance such as drug-assisted cycles or in vitro fertilization (IVF). We met with a reproductive endocrinologist at a fertility center to discuss what options we had if we wanted to be more aggressive in the alternative insemination process. After a normal hysterosalpingogram, the doctor suggested we try using the oral fertility drug Clomid with ultrasound monitoring around the time of ovulation and drug-induced ovulation using subcutaneous injectable Ovidrel as the next step in our process. While most people probably wouldn’t pursue fertility drugs such as Clomid until after 6 unsuccessful natural IUI cycles, we were interested in being as aggressive as reasonably possible, while keeping the side effects of such medications in perspective. We used Clomid, ultrasound monitoring, and Ovidrel as the next step.
Clomid (clomiphene citrate) is an oral fertility drug taken on Days 3-7 of the cycle. Although many people think Clomid is an artificial follicle stimulating hormone (FSH), this is actually not how it works. FSH is primarily responsible for the development of follicles in the ovary (each follicle should contain one egg). The presence of FSH in the body, and thus a primary follicle on the ovary, results in negative feedback that tells the body to stop producing FSH – Clomid blocks this negative feedback so the body continues to produce its own FSH. Therefore, multiple follicles are produced, and these follicles produced while on Clomid are a result of the body’s own, natural follicle stimulating hormone. While taking fertility drugs increases the risk of a multiple pregnancy, the risk of twins using Clomid is only about 10%, and the risk of higher-rate mutiples is less than 1%.
The first planned ultrasound is done on Day 12 (in Molly’s case – this may differ for others depending on cycle lengths). They note how many follicles are present and their size. Future instructions depend on how large the follicles are on the ultrasound and how they are progressing. Follicles should be at least 18mm before the ovulation-stimulating drug Ovidrel is given. Sometimes the instruction is to come back the following day for another ultrasound, and sometimes the instruction is to go ahead and give the Ovidrel – it all depends on follicle size and progression.
Along with the fertility drug Clomid and ultrasound monitoring, we also used the ovulation-inducing drug Ovidrel to hopefully narrow down the window of the time of ovulation and better time the IUI. Ovidrel (choriogonadotropin alfa) is a subcutaneous injection that can be given at home, and ovulation occurs about 36 hours after the injection. Unlike Clomid that does not act as a hormone itself (it blocks the negative feedback mechanism, resulting in your body producing more of your own FSH), Ovidrel is a recombinant human Chorionic Gonadotropin (r-hCG) and it acts the same as the body’s natural hormone that causes ovulation. Insemination is performed about 36 hours after the subcutaneous injection is given.
The insemination visits for the Clomid-assisted IUI are much the same as the visits for the natural IUI visits, despite it being at a fertility center instead of at our local LGBTQA-friendly healthcare provider. The biggest difference was that they didn’t require lying down for 15 minutes after the procedure, but everything else was very similar.
Part of the monitoring with using fertiltiy drugs involves a blood pregnancy test two weeks after the insemination. Ovidrel can cause a false positive urine pregnancy test so we just waited with patience the two weeks between the insemination and the test, hoping for the best.