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Infertility

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) treatment involves a laboratory procedure to separate fast moving sperm from less active sperm, thereby selecting the best quality sperm. The fast moving sperm are then placed into the woman’s womb close to the time when the egg is released from the ovary in the middle of the monthly cycle (ovulation). It can be done without drugs or with a medicated cycle that will stimulate the ovaries to produce more eggs. IUI is associated with a higher risk of multiple pregnancies.
 

Maggie liked the simple, quick and low tech aspect of IUI but was uncomfortable about the feeling...

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Age at interview: 36
Sex: Female
Age at diagnosis: 30
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So intrauterine insemination is basically a procedure where semen is taken away, and it can be donor’s semen if there’s a male fertility issue. But in my husband’s case he had to provide a sample, take it up to the hospital or the fertility clinic. That was washed and spun to, I think to get the optimum sperm, to kind of get the best swimmers for want of a better analogy, and then inject those back in a procedure that was fairly similar to a smear. It, there was nothing painful or uncomfortable about it really. It was just fairly straightforward. Kind of wham, bam, thank you, ma’am. It was very very simple and quick, and low-tech I think. I think I was surprised by that. I expected things to be a little bit more scientific. But it did seem fairly basic. And I think also IUI for us, it did feel very much like, you know, “Well what is it, what is different about IUI than what we’re doing naturally?” I couldn’t really see the benefit of it. But I carried on with it because I wanted a baby and I was told that this was the route that I needed to take. And I guess something about being infertile and having this label of infertile did make me question myself on so many different levels. I started to question everything, all the, all my decisions, what I knew about everything. I think because a fairly fundamental part of my life I wasn’t able to do, I started to wonder about everything. How, I started to feel inept and that did have an effect on everything that I did. It made me question my own decision-making abilities. And in a way I just, I certainly feel as though I handed over responsibility for my, for making a child over to fertility specialists. Because I clearly didn’t know how to do it. And I was like, “There you go. You get me pregnant.” And it was almost absolving myself of responsibility, of feeling unable to achieve something. So my husband’s sperm was taken off, washed and spun, and then injected back into me. I would lay down for a few minutes at the clinic, and then that was it. It was just kind of, you know, the two-week wait, which a lot of women and men will be familiar with. We had three attempts at IUI. We were recommended to have four attempts, but actually on the third one my husband needed to be away with work. And so he’d taken his sperm sample down to the clinic. It was washed and spun and then injected back into me. But I remember lying there, and this was the first time that he hadn’t been there with me, and I remember lying there on this hospital couch thinking, “If I get pregnant now, my husband wouldn’t have even been in the same room.” And that really was a wake-up call for me. I think this, this would have been about three or four years into, or four years into making the decision to start trying to have children. And I remember thinking this was so far removed from the kind of rosy-tinted notion of making a baby that I’d had. And I decided then to put a stop to fertility treatment. I decided not to have IVF, and to, to leave it there and to try and regain some kind of control of my life, our life.

IUI is often a first (or sometimes second, see ‘Fertility drugs’) stepping stone to further treatment. For example, Lulu tried three cycles of IUI before being referred for IVF treatment (which worked for her first time). It is cheaper and less invasive and thus often chosen before IVF (In vitro fertilisation) or ICSI (Intra-cytoplasmic sperm injection).
 

Saskia and her lesbian partner went through 10 IUI cycles with donor sperm before moving on to IVF.

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Age at interview: 38
Sex: Female
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And then we had, we started IUI and we had – they said we will do six. Because they did a few tests and everything seemed fine. So they said, “Let’s do six IUI’s and see how we go. If they don’t work then let’s think then about IVF. And on the sixth IUI there was some evidence of being some implantation. It was a very low HCG level and that then made me feel more confident that things weren’t blocked, that thing’s weren’t, you know, that it could happen. So they said, “Well let’s do another six.” 
 
I mean at every stage they gave me lots of choice. It wasn’t, but six, another six sounds good and we did another four. So we’d done ten in all. And I think I just became dispirited. I thought that’s enough. Let’s do IVF. Because it’s really expensive you know, if you do ten, you start getting to thinking well we could have done a couple of IVFs. So we said let’s do the IVF. And they were really supportive about that. There was no sense that they were… I never felt they were pushing me one way or another. But if I said to them, “What would you do if you were me?” They would often, they would say. But at the end of the day it’s our choice.
 
And the IUI’s you did them in six months. Did you do them in six months on the trot or …?
 
They wouldn’t let you. They made you have a month off in between. I always suspected that was for mental reasons rather than physical reasons I think, but I would have been much happier just doing that. And, a couple of times they gave me Clomiphene, a couple of times I grew some little cysts and they made me have another month off which is awful. I hated, I hated the months off. They drove me more mad than the months of doing it. I would have been really happy to do… and it’s my understanding as well if you did six in a year you raised your chance of I don’t know, ovarian cancer, some, some, it was some health risk, but at the time I was just thinking I want to get pregnant. And I want to get pregnant now. That was my main… 
 
So I used to pester them into letting me not have months off and I think when I grew the cysts, I said, “Well let’s do it without the Clomiphene then.” So I think a couple of those six were done without the stimulating drugs.
 
Were they happy to do that?
 
Yes, I mean they said, “It’s less likely to happen.” And I said, “Well not less likely then not trying.” Because I mean in a lesbian relationship you’re not going to accidentally get pregnant in the month off. So, you know, and I felt that I was getting older, and also I’m impatient anyway. And wanted to get on with it.
 
So yes, they were pretty good at advising but then going along with what, but most of the time I think it coincided with what they thought. 
 
While some found it reasonably straightforward others told us that the need for precise timing of IUI caused problems for them. Belinda and Carol both found the time commitment required for trips to the clinic very hard to balance with their jobs.
 

Carol had not wanted to tell her work about her treatment and so found it very stressful juggling...

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Age at interview: 39
Sex: Female
Age at diagnosis: 27
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Anyway when the time came it was very obvious that I was going to have problems and I asked to be referred and we went down the IUI route and we had two cycle of that, but before that we had had six goes with Clomid and it didn’t seem to be making any difference what so ever. I wasn’t falling pregnant. 
 
I did the IUI and I found that be very, very stressful, because at the time I was trying to fit in the fertility treatment around work and trying not to say anything to anyone because I didn’t want to be seen as somebody who would potentially get pregnant very quickly and then couldn’t deliver the goods in terms of performance. So all the way along I have kept very quiet and not said a thing to any colleagues. Which has been very difficult, because I am naturally a very open and honest person and sometimes I just want to literally say, look I am having a bad day because I am having this treatment, and I have not been able to do that and that has been very difficult.
 
 
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Belinda, a nurse, found it hard to change shifts for her latest IUI cycle.

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Age at interview: 35
Sex: Female
Age at diagnosis: 34
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So in a two week period you would have five or six trips up to the clinic?
 
Yes.
 
And how do you manage to juggle that with work and things like that?
 
It is very difficult [laughs]. The first time it worked out perfectly and I wasn’t working on the days that I needed to go, whereas this time, it has just been a complete nightmare. I was working every day that I was meant to go. And because I am a nurse as well, then it is not you can even say, “Oh I will come in a bit later.” Because it is just not possible. So it’s a case of having to swap shifts round which is always difficult because people have plans, and it depends what hours you are working as well. So I have found that really, really difficult at the time. But literally from the point of view of not being able to swap shifts rather than anything else. But luckily the clinic are really, really good and they do try and be flexible. So that does help.
 
Other difficulties described by the women we talked to included that IUI could be time consuming, frustrating and emotionally draining. Those who used medicines to stimulate the ovaries sometimes had unpleasant side effects (see ‘Fertility drugs’).
 
The timing of IUI is crucial, a fact that could be distressing to women when a cycle had been abandoned because their ovulation fell on days when the clinic was closed. Lulu did three cycles of IUI but kept missing months because she didn’t ovulate in time or the clinic was closed. When Maggie was told that Clomid hadn’t worked and the next step was IUI, she felt as though she was on a treadmill. She was a bit concerned that the clinic relied on the date of her last period since her fertility drugs had made her cycle rather erratic.
 

Looking back, Maggie wondered whether her clinic had been as scientific as they could have been...

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Age at interview: 36
Sex: Female
Age at diagnosis: 30
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So I tried Clomid for three months. And then we went to see our fertility specialist, who said, “Okay, you know, that hasn’t worked. We’ll move on to IUI.” 
 
I asked him then what would happen after IUI if that wasn’t successful, and he said, “IVF.” Again burst in, into tears because it just, I felt, it felt really relentless, it felt we were on a kind of treadmill. Things didn’t seem to be working. I guess a lot of the time I felt rushed into making decisions as well. And I guess I didn’t really think about what we were doing. I just, just carried on because I was desperate to have a baby. And I think once we’d started fertility treatment as well, it felt as though the clock was ticking. We had three goes of this, and then we moved on to three goes of that and then three goes of that, and it just felt like this churn. It did feel like a churn for us. So we, we went along, we had, IUI was the next step for us. IUI is intrauterine insemination. And I think there are various different ways that you can do this. The, the route that our fertility specialist used was a fairly, a fairly simple process. I think there can be methods where people, you know, monitor body temperature and that kind of thing and hormone levels to make sure that the procedure is done at the correct time. But at the clinic where I went to they would base the date of the procedure on the date of your last period. So my cycle had become fairly erratic as well, and I think m-, probably linked to the fertility drugs, I found it difficult to predict, you know, how long my cycle was going to be. So I’m not sure how scientific the timing of IUI was for us. And with IUI timing is crucial. So that was something that I think was at the back of my mind. I remember one time the, the optimum day would have fallen on a Saturday, but our clinic didn’t work on a Saturday, so we did it on Monday. And I knew, you know, that this wasn’t the right thing to do and that the chances of it working were fairly slim. Because, you know, an egg only lives for a certain amount of time, or is only fertilisable for a certain amount of time. So there was that feeling at the back of my mind. And of course it didn’t work. So we had three attempt at IUI. 
 
 
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Martha was very frustrated that, having started on an IUI cycle, the clinic was closed on the...

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Age at interview: 34
Sex: Female
Age at diagnosis: 30
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It would have been a few months because I took that, I would say it was sort of, I think that we had our first consultation at [hospital] I think it was like April time and it was probably the May, June, July or may have even been April, May, June, that I took the Clomid and then it would have been. Oh no, I do remember this because it was September when we got the letter through saying oh you are going to do your IUI on the next cycle. And I was like oh yes, we are finally doing this. So … and this is where I come to my major beef for [hospital] which is nobody ever told us that they closed four times a year. And what that means is if you are doing IVF it is not really a big problem. They just sort of like keep you in a holding pattern if you like for the few days that they are closed and then carry on with it. But if you are doing something IUI it is really, there is no way of controlling it, it is contingent on what your own body does and how it reacts to the drugs, and so what that means is if you go through this whole thing and it happens to fall during the time that they are closed, you have done the whole cycle for nothing. They won’t do it, they won’t, you know, there is nothing that they will do for you.
 
And so we got this thing through and they said call when you start your next cycle or something and so I called when I started my next cycle to make my appointment and they said, “Oh actually we are closing. So you will not be able to do it this cycle either.” And that was the day I completely lost it on the phone and [daughter] was crying and I actually, okay, this is again, I don’t know if it is because I am American and we have different kind of health care system. But I was completely…. I said, “How can you put people through this and not tell them that this is a possibility?” I mean nobody had ever mentioned this and by this time we had been on their books for, you know, a good six months. Or so. And you just think and why did nobody sort of mention that this was one of the downsides of picking this kind of treatment or you know, for this or that or the other and so [laughs] so I was giving off my opinions about this to the nurse on the phone. And she said, “I will put you through to your consultant.” And so I said this to the consultant, and she was saying, “Oh don’t get upset.” I am thinking how can you tell me not to get …. And all I can say is, “I can’t believe that nobody has ever said this to you before, you know. Is this really the first time you are hearing this? This is horrific. I have been waiting years for this and suddenly you tell me, oh no, you can’t do it now either.” And at that point she said, “Okay. Okay. You know, we will duly note that and we will take that down.” But I said, “Like how can you be running this place this way. This is, you know, supposed to be the best one of things in Scotland and yet you are just treated like, I don’t know, nothing, another income I suppose.” 
 
So we didn’t actually get to do it then. We had to wait. Well you know, because by then you have to wait for the whole of the cycle to start. So it is probably, it would have been into October some time when we finally started it and then that was the one where I hyper-stimulated. Another cycle and then that was the one that started in December. When they said, it was in December they said, “Oh you might not get through it.” I just completely blew my top, I just couldn’t conceive how they could run the place that way, really I just couldn’t. I thought, you know.
 
Was it the consultants you were dealing with?
 
No this was the other thing. There was always nurses. And you know through the entire process from the time that we were booked in with [hospital] to the time that I had [son]… I never met my consultant. And we were private patients. You know, we never met my consultant. You are just yes, yes, and the only time I ever spoke to her on the phone, I spoke to her on the phone that one time when they put me through to her because I was completely having tizzy about them cancelling it and the other time I spoke to her, was when I insisted on speaking to her at the beginning of the IVF because she prescribed the same amount of the whatever it was that I had hyperstimulated on before. And I spoke to her then and that is when she told me that that was the standard procedure and that is what they were doing so, get on with it. Which I think is pretty, that would be bad enough on the NHS, but if you are a private patient, you know, I mean you expected like may be something. Or a little bit of some, you know, yes.
Belinda described how hard she found it emotionally, worrying about whether the treatment was going to work or not work, when one of her treatment cycles was cancelled. 
 

Carol found the uncertainty of her IUI cycle very difficult to cope with.

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Age at interview: 39
Sex: Female
Age at diagnosis: 27
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Probably because when I had the Clomid it was just a question of taking tablets and then going at the time for a scan, which they don’t do any more and if it didn’t work that is when you had a period. In terms of the IUI, the thing that I found most stressful, was that depending which nurse I saw, everyone seemed to have a different opinion as to what was going to happen. So what was happening, I had two or three follicles developing nicely and I was expected to go for treatment two days later to actually have the eggs released and my husband’s sperm to be processed and put into the uterus and at the time I expected that all to happen. I went in the next day and another nurse, nothing had changed, and the nurse said, “Oh no, there is more than two follicles we can’t let this proceed. You would be an ideal candidate for IVF, but we are not going to take that risk.” And at the time I had to cancel business plans, tickets to a meeting in Switzerland and it was just so very devastating. Nobody pre-warned me that that could potentially happen. And I found that very, very difficult to deal with. 



Last reviewed July 2017.
​Last updated July 2017.
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