In the Cosmos Tarot, the Six of Earth depicts the Dorado constellation. In some traditions Dorado is a swordfish and it also has links to El Dorado, the Golden King who submerged himself while clad in gold as part of an initiatory rite. I find this card interesting: the piercing of smaller prey by the swordfish is violent yet necessary. It is the law of nature. But it is also representative of the things that one must do in order to attain the goal or treasure. I think fertility care can be like that. The many needles and instruments that are inserted into the body create a lot of discomfort, but we allow this to happen because we believe in the greater purpose. Maybe this next treatment is the unicorn of hope that we've been waiting for! But remember that there's always a level of risk with every treatment, which is precisely what the Dorado constellation tells us. Become informed so that you can make empowered decisions. No one else is responsible for your health.
When I first started discussing Western fertility treatment options with my doctor, an Intrauterine Insemination (IUI) sounded like such a big deal. But it’s really simple! If you’re thinking about undergoing an IUI cycle and want more information, or are simply curious as to what it is, here’s a summary of the protocol at my clinic for a heterosexual couple (please note that other clinics may have different protocols): On Day 1, the female partner is asked to call the clinic to advise that a new cycle has started. If she intends to proceed with an IUI cycle, two things usually happen. First, she is sent several documents to read and sign. These are the legal agreements pertaining to the use of the couple’s reproductive material (i.e. fresh sperm), the risks of the oral medication and IUI procedure, and the cost of the sperm wash. Make sure to read these closely and that you understand the risks involved. Sometimes, if there is a period of “discount” (that is, the government is funding part of the procedure), a document regarding this funding will be provided as well.
Second, the nurse will prescribe Letrozole, the dose will vary depending on what has been agreed upon with the doctor prior to starting the cycle. Oral medication will begin on Day 3 and is to be taken daily for five days. Around Day 10, the female partner will be called in for bloodwork & ultrasound (empty bladder) to check on the status of her eggs. By now, we can expect 2-3 eggs to be nearing maturity (depending on her health conditions). When at least 1 egg has reached the right size, she will be sent home with a kit of Ovidrel 250. (Here’s an instructional video for anyone needing a refresher. Also, Ovidrel has to be kept cold. If purchasing in the summer, bring a thermal bag with an ice pack.) The timing of the trigger shot will depend on the scheduling of the IUI procedure. For example, if the IUI is scheduled to start at 7am on a Wednesday, the injection will need to be on Monday night, at 7pm. Around this time it’s also common to pee on an ovulation test strip daily to check for an LH surge.
On the day of the IUI procedure, the male partner will come in first to provide a fresh sperm sample. The sample will then be “washed,” meaning that the healthy, motile sperm will be separated from the non-motile or dead sperm and the seminal fluid. This takes about 60-90 minutes. Once the sperm is ready, the female partner is called into the IUI room. Her partner is allowed to be present during the IUI. The procedure is rather uncomfortable but not necessarily painful. In a nutshell, the sperm is injected directly into the uterus. It can feel a bit like a sonohysterogram but typically lasts a few minutes longer. Hang in there! (My last IUI was actually very uncomfortable because the nurse had to reposition the speculum several times.) After the procedure, she will be asked to remain lying down for 15 minutes and to pick up progesterone suppositories on her way out. There is at least one scientific study stating the importance of lying down after an IUI to increase the chances of success. Some people debate this, but there’s really nothing to lose. Even if it doesn’t work for it, it certainly won’t work against it. (Practice savasana or listen to music; 15 minutes go by fast.)
On the same day of the IUI, mild cramping & spotting is normal. Soaking in water and any heavy lifting is to be avoided. (This is a great time to practice restorative yoga or meditation & chanting. Or perhaps you can journal some intentions.) Regular sex will be suggested for the same day or the next morning. On the next day and for the following two weeks, progesterone suppositories will be inserted into the vagina twice daily until the pregnancy test. If the result is positive, suppositories will be continued. Their purpose is to maintain progesterone at the right level during the Luteal phase and beyond. As a side note, progesterone increases internal body temperature. And a warm body creates a warm environment for the embryo to grow, just like with gardening. Otherwise, if the result is negative, this is when we would stop using suppositories to allow for oestrogen to increase for the start of the next cycle. And voilà!
You can try asking for the IUI success stats at your clinic. At my clinic, supposedly the success rate for women under 40 is between 15-20%, and around 10% for women over 40 (very textbook numbers if you ask me). It is said that IUI is usually successful (if it’s successful at all) in the first 3-4 rounds, but doctors may have different recommendations based on each couple’s health profile, e.g. when there’s an issue with the sperm, or when the pH of the cervical mucus is not optimal. I’ve also read that some insurance companies may only agree to refund an IVF if a couple has first attempted 3 rounds of IUI. It’s always a good idea to check with your insurance company before undertaking any ART treatments.
Last piece of advice: Even when the pregnancy result is negative, I still highly recommend taking another test at home a week later, even if you get your period. Had I done this, I might have been able to detect my ectopic sooner, especially since I took a break from treatment after my first IUI. But otherwise, that’s it! It’s usually very straightforward and your fertility team will be guiding you every step of the way, so not to worry. Good luck on your IUI journey!
🌑 ♒
Decks featured:
Oracle of the Unicorns (Cordelia Francesca Brabbs, various artists)
Cosmos Oracle & Tarot Deck (Light Grey Art Lab, collab deck)