IUI & Fertility in SSC

[solanks]

Hi everyone,

I've struggled to find any groups that are focussed specifically on same sex couples trying to conceive (that do not have any fertility issues).

My partner and I are currently on round three of IUI using donor sperm. The first two tries we did we attempted the natural route (so no medication and no ovulation trigger injection). We decided to go down the medicated route on our third try and are currently in the two week wait, waiting for our results today!

This whole process has been emotionally, physically and financially challenging, so much more than we ever expected, and we would love to hear from other same sex couples on this topic who are in a similar situation to ours. We want to exchange stories, offer each other support, give advice and also recommendations (as there is so much conflicting information out there and each clinic's protocols vary too, which we found bizarre).

Looking forward to hearing your stories; be they successful, unsuccessful, or even if you are completely new to this journey ✨

@strawberrylaces12
@ProfessorplumBilliardroomCandlestick

I know you have both mentioned this briefly on the chat and I hope you don’t mind me asking as I’m a little confused (probs coz our clinic never mentioned or did any of these progesterone tests), but:

~ why does cycle length influence whether pessaries are needed or not, and;

~ why does your progesterone affect the decision on going medicated/unmedicated?

@strawberrylaces12 Sorry that you’re having a bad period 😔 they’re bad enough already without them being extra heavy / clotty too 😔 Despite this, glad you’re enjoying your time off (and I bet that glass of wine went down a treat!) My partner and I have also decided not to be AS strict on our next attempt when it comes to things like caffeine etc. We lead a fairly healthy lifestyle anyway but just try to be that extra bit well behaved when TTC.

@solanks so until now only progesterone tests have been mentioned/carried out from my experience. I had one test done in June as part of the GP checks before we were referred to the clinic and then one this cycle too to 'confirm' that ovulation has happened that cycle. But I mentioned to the clinic in my email that my cycle was 26 days this month in case that impacted on the progesterone test result (only about a day shorter than normal and I have had shorter cycles in the past) and as part of the email reply, the fertility nurse mentioned about progesterone pessaries:

"We can discuss when you come to your next appointment about using progesterone pessaries, if your cycle started early."

That's all that I know and has been mentioned. I don't know if I'll actually need it as my cycle this time was not significantly shorter than normal for me. But I guess the option is there if the clinic feel it is needed. From my very slight knowledge of it, I think progesterone usually peaks around a week after ovulation and then drops off if you're not pregnant. But with pregnancy it continues and helps to maintain the lining of the uterus if pregnant (so a period doesn't happen). Please do fact check that though! 😅

I'm just glad that the two progesterone tests that I have had have both confirmed ovulation those months 😊

@solanks thank you! Yeah I stopped having any caffeine drinks (coffee and tea) in the tww. But back to have one caffeine cup a day now which I would have normally, I don't tend to have more than one of two caffeine cups as I then can't sleep and/or feel anxious anyway. I'll probably try caffeine free again in any future tww but may not be quite as strict, will see how I feel. Wouldn't have any alcohol in the tww though personally.

But yeah just going to try and be a bit less strict and have fertility stuff as part of life rather than currently it feels like the main focus 😅

@solanks the way I understand it, in response to each of your questions is:

"why does cycle length influence whether pessaries are needed or not":
a short cycle typically means that the bit that is missing is the luteal phase, after you ovulate. The cause for that to happen regularly is typically because you don't have enough progesterone for that phase to happen. Pessaries are for progesterone, to substitute that lack of a luteal phase. Because progesterone increases in the luteal phase.

why does your progesterone affect the decision on going medicated/unmedicated?:
Why does this matter? You need progesterone to keep the baby in you. So if you are low on progesterone, there's more of a chance of a fertilised egg not sticking round. In those cases, fertilisation isn't the tricky bit about getting pregnant. It's getting that fertilised egg to implant and stay. You need progesterone for that. So if your progesterone is typically low, medication may be a better way forward otherwise you're shooting perfectly good sperm up in there and it won't hang around long enough to make a baby. It's a deeply flawed metaphor, but, if it helps, think of progesterone as the hormone you need to make good embryo glue. Without the glue, nothing sticks, no baby. If you don't have enough hormones yourself to make the glue, you gotta get it from somewhere else. Hence the pessaries.

In response to comments about abstaining from various things pre-pregnancy (or even in pregnancy), I just read Emily Oster's pregnancy book "Expecting Better : Why the Conventional Pregnancy Wisdom is Wrong and What You Really Need to Know" and she does a deep dive on all the actual research behind all the different recommendations (like no caffeine, etc) and then makes it a lot more accessible by condensing it into like the "headlines" and explains why some of the research is a bit misleading, or whatever. Also talks about the TWW and how different people might interpret the data on what to avoid/limit, etc. So for instance, although too much caffeine is bad for you pre/pregnancy, one cup of coffee is still well under the amount considered to be "too much". There's too much in the book to summarise, but it's helped me figure out what sort of decisions are still important for me.

But then I'm definitely the kind of person with a perfectionism streak. For weeks I wouldn't take proceive supplement at the same time as caffeine, or too late in the morning, because that makes it less effective, but if I don't have my coffee I'm less likely to remember to take the proceive smoothie in the first place. So now I don't worry about it because a circumstances-reduced-strength-proceive is way better than no proceive at all.

@ProfessorplumBilliardroomCandlestick really useful info about progesterone!

And yeah I know it's completely fine to have a cup of caffeine coffee sometimes I just find it easier to remember to stick to decaf rather than just one caffeine coffee a day (quite often I'm on auto pilot and mix up the decaf and caffeine coffee jars so during the tww I just kept the caffeine jar away in the cupboard for ease). Also caffeine is in chocolate and diet coke etc too which I wouldn't completely cut out necessarily. So yeah more just a cutting back sort of thing for me personally during the tww 😊

Tomorrow I've got my day 11 scan to check follicle development. I think I'm due to ovulate over the weekend or Monday, not completely sure as my cycles seem to be 26-28 days. I'm not sure if they'll say to go ahead with an attempt tomorrow (potentially with a trigger shot to ensure ovulation) or they'll say to wait until Monday or that it can't happen this month. Got to wait and see what the scan and ovulation test shows. I'm quite tempted to get some ovulation tests to have at home to track it too out of interest (e.g. over the weekend).

I'm feeling quite anxious currently, not completely sure why, just the unpredictability and unknown of it all I guess. I think I'm a bit less excited about it this time, last month was our first attempt so I guess I hadn't experienced the disappointment yet. I know we're really early on in the journey though 😊

How is everyone else doing?

Hi @strawberrylaces12 It’s all such an anxiety inducing experience, especially with how much each try costs.

I’m sure the team tomorrow will be able to advise the best course of action, so try and do some self care this evening and know you will likely have a definitive answer tomorrow.

I found IUI quite difficult too, I definitely worried about timings also.

I also have a scan tomorrow (baseline for IVF) hoping to begin stims in the next few days and am also in an anxiety spin (if it is any consolation) so you are not alone. We just have to remember the staff do this everyday, and try and find the excitement again.

Good luck with your scan tomorrow, keep us posted!

@strawberrylaces12 I think it's wild how much each clinic varies on what they recommend to track ovulation. If you think it'd help your anxiety why not get a box of ovulation tests? The clear blue ones are super easy to use and it would give you a better idea of if you're closer to ovulating or not. My clinic recommends using those as well as all the scans, so I don't think it can hurt. All the best for this month's trying!

@Twomumfamily exciting times for your baseline scan! That's such a good point about how everything is routine for the clinic so we need to keep the excitement ourselves. I'll try to remember that one!

No huge progress here, but our donor sperm is now with the clinic so my next cycle will be an admin cycle (ovulating scans and clear blue ovulating tests, a few final blood tests, etc) then ready to try IUI in my February cycle. Very exciting! I was loosely anticipating the sperm to take forever to arrive but actually it was only 4 days and that included a weekend, so I'm reassured there'll be no delay if we need to order more.

@Twomumfamily thank you! Will see how it goes and give an update when I can. Yeah very true, thinking about it properly I remember being pretty anxious and nervous about the first attempt too (as well as excited), I'm just an anxious person and I'm hoping that the anxiety doesn't affect fertility too much! 🤞

Ooh I hope that the scan goes well for you too!

@ProfessorplumBilliardroomCandlestick last attempt I did do ovulation tests at the clinic using clear blue on day 11 (empty circle) and day 12 (static smiley so they did the trigger shot on day 12 and did the IUI on day 13). It would just be interesting to test over more days at home, I've read since that the clear blue tests can take time to 'get to know you' so can often show an empty circle the first day of using them regardless. Depending on how the appointment goes today I may get some! 😊

Happy New Year, everyone ✨

@ProfessorplumBilliardroomCandlestick
Thanks for your replies. Did not know about the luteal phase/progesterone connection so this info will be really helpful for me when I start this process as my cycles are generally short and vary from 24-26 days. My partners are more regular and of a 'normal' length.

The progesterone and medicated vs. unmedicated query mattered to me because StrawberryLaces12 previously said: "Depending on my progesterone levels would depend if they advised medicated cycles." I was therefore curious to dig a little deeper on this topic as my partner has gone through medicated and unmedicated cycles and in all three of our attempts not once were there any tests done to check her progesterone levels. I therefore found it a bit odd that our clinic would always push and encourage her to take pessaries post treatment, despite not having any tests done to check her levels, but also because she had a negative response to them each time.

Great news about your sperm delivery by the way and I hope all goes well with your admin cycle 🙂

My day 11 scan today showed two follicles developing (one on each side, one 17mm and one 12mm). Last month on day 11 I had one developing on my right side at 18mm (and when scanned on day 12 it was 18mm too). Ovulation test was a blank circle, but when she took the test part out (didn't realise you could do that!) there was a line just not as dark as the control line. Last month I had a blank circle on day 11 and a solid smiley face on day 12, treatment was on day 13.

We were given the choice of IUI tomorrow (didn't realise they could do it when it's a weekend) which may be a little early or wait until Monday but may potentially miss ovulation. So we've arranged for treatment tomorrow because hopefully the sperm can live a few days and wait for the egg if needed and hoping that the trigger injection helps. And I just hate the idea of completely missing ovulation.

Since the appointment this morning (which was nice and early at 8am) I've started to have some possible ovulation pains/follicle development pain in the last hour ish. Started with a headache yesterday which I still have and I've been nauseous too - not sure if this is due to upcoming ovulation or just being quite anxious. No CM but I only got it briefly on day 13 last month and usually only get it for a day or two. So I'm hoping all of this that means that ovulation is only a couple of days away.

For those who ovulate, do you get symptoms? And if so what?

(Sorry for the long posts again, just helps me to type things out and process 😊)

@strawberrylaces12

Hope everything goes well with your scan today! ✨

There is no harm in doing more ovulation tests at home. If anything, these extra bits of information can only be a good thing when trying to time things right for treatment 🙂

Although I am not due to start my IUI journey for a few years, I have started to do some tracking now as we have lots of spare tests that my partner now won't need. I use the Premom app with the Premom tests (as well as doing my BBT every morning). The graphs are so useful (and interesting!) and by doing this I have come to learn a lot about my body/hormones/cycles etc.

@solanks I had a progesterone test on day 21 (approx a week after ovulation) even at the GP before they referred to the clinic to check about ovulation back in June. Then again last month to check for ovulation after the IUI attempt. Both were fine so that's why they've not recommended medicated cycles currently. Yeah it seems strange that they wouldn't do that test. But I think the progesterone pessaries may be for maintaining progesterone (especially with shorter cycles) so that if the egg is fertilised/implants it stops the progesterone levels dropping to cause a period. I may be wrong but please do ask the clinic about this!

Progesterone pessaries weren't actually mentioned today for us but I will try and remember to ask tomorrow and see if they think they are needed for this cycle. My cycles are usually 25-28, occasionally longer, probably averaging around 27 days.

An update on our side - we have decided to wait for Feb's NHS appt (for potential and hopeful IVF referral) to see what that holds and then re-evaluate our next steps once we have this information 🙂

@strawberrylaces12

That's great that your clinic is open and available on weekends and having the procedure tomorrow sounds like a good call 😊What time did you / will you take the ovulation trigger? Will you take another ovulation test tonight or tomorrow morning?

I don't get ovulation pains but my partner does! She gets snagging / dull aches / sharp pains on the same side every month.

@strawberrylaces12 Sounds like a great plan to inseminate tomorrow, we did it earlier (rather than later also) as our embryologist said even frozen sperm can live up to 72 hours. Good luck for tomorrow!

@ProfessorplumBilliardroomCandlestick Great news that your sperm arrived quickly, its always so nerve racking while it is in transport. Hope your admin cycle goes well, it sounds like a great way to get to know your body and the process.

@solanks Bring on February, I really hope your NHS appointment goes well and you get some much awaited answers!

My scan went well today, I had some bloods taken so if they come back okay I will start stims tomorrow evening (I had a tiny cyst on the ovary I ovulated from that they want to check hormone levels for). Looking like egg collection week commencing 15 Jan eek.

Regarding reciprocal IVF, unfortunately, my wife will not be able to use any of the embryos we collect from this cycle as the law still states we need to do genetic testing which is a further £1.5K. We decided not to spend the money yet as we don't know how I will respond to the meds and if we will need to pay for a second round of IVF for me down the line. Hopefully, the new law comes into effect in February and these additional tests will be removed for same sex couples! The HFEA got back to me and said they have told clinics to 'deprioritise same sex couples for additional genetic testing' (whatever that means - so vague) but at the end of the day the clinic still has final say until the law goes fully through.

@solanks they will do the trigger injection tomorrow (I think so it gives my follicles that bit longer to keep developing) and hopefully should time around my natural ovulation which I think will be around Sunday. No more ovulation tests at the clinic no, as the treatment is booked for first thing it'll go ahead regardless (as they'll have/will be preparing the sperm first thing) so I don't think a test is needed. But I'm tempted to get some anyway more out of interest, tried to pop into the pharmacy and a supermarket on the way back from our appointment today but neither had them so may try and get some tomorrow, not sure if it's a waste though? As it won't change the outcome!

Ah yeah I'm having quite dull aches currently, a bit like period cramping. But I'm taking it as a good thing!

@Twomumfamily thank you! Glad to hear the scan went well and best of luck with the test results! Oh wow that's not long away now, keeping everything crossed for you 😊I didn't realise that the law will change from Feb? Does that cover all same sex fertility treatment? I knew it may be from April but knowing our Government I thought it would be ages yet!

Edit: sorry is that law specific to genetics testing? I think I got over excited that it was to do with all fertility treatment costs 😂

@strawberrylaces12 It is just due to reciprocal IVF genetic testing I am afraid. Currently, if your partner wants to carry your egg you need additional testing which you have to pay for yourself, hopefully in Feb these added tests will no longer be a requirement. I read somewhere this is being pushed through first (probably as it doesn't cost them anything to do as testing is being fully removed lol).

As far as I know, it is still up to each CCG to decide what their criteria will be for same-sex couples and funded treatment, unfortunately (and unfairly). They have just made a recommendation of what they think should be implemented in the next few years - I have a horrid feeling it will be a while before all CCGs offer funded IUI, although I know my one (Lambeth) is offering free IUI from April so there is hope!!!

Hi@Twomumfamily Havent posted in here since October but keep up to date with the comments. We are currently 20 weeks pregnant and did reciprocal IVF. We didn’t have to do any genetic testing? I am assuming you are doing IVF on the NHS and this is a criteria they are imposing? Just curious to know as it didn’t affect us.
good luck with the stims!

@Ivffirsttimer7 Congratulations on being 20 weeks, gosh time flies! How are you both feeling? If I remember correctly your partner is carrying? Hope they are feeling good now they are in their 2nd trimester!

Yes, it is an NHS cycle and we mentioned that if we have any left over embryos my wife might like to carry them. More of an insurance policy I guess as opposed to straight up reciprocal, but it was an additional cost. If its private reciprocal IVF it may be factored into the cost of the treatment but they may not flag that it is genetic testing (?) however it is a requirement under HFEA as far as I am aware (at least with our NHS clinic).

Did they not mention it to you at all, I am pretty confused by it all tbh! Maybe some clinics have their own protocol?

I even contacted the HFEA and they said it was necessary but being ‘deprioritised’. It’s good to know that if we go privately next it may not be an issue though!

Thank you, first meds tomorrow I’ll let you all know how it goes!