What is the probability of IUI success?

Our Doctor told us that we have a 20% chance of success with our IUI treatment (Letrozole Day 3-7, Ovidrel trigger 36 hours before IUI procedure and progesterone suppositories (50mg) for two weeks after IUI).  After three rounds, that would be a cumulative chance of success of 60%.  But this probability is a calculated estimate based on many factors that our doctor knows about us.  For example, if you were diagnosed with unexplained infertility the probabilities of success are lower than if you have been diagnosed with an ovulation related dysfunction.  Age, number of years trying to conceive and sperm quality are all examples of other factors that will influence your probability of success.

Success rates for IUI?

Success rates for IUI?

There are many predictive models out there to determine likelihood of success of IUI.  Each model seems to be slightly different, but in general they tend to range between 9-23% success for unexplained infertility, and the important factors that determine this success also seem to vary from model to model.  This is probably the real reason why that if you were to google ‘the probability of IUI success’, you won’t find much of a straight or clear answer.

Why do I care?  The difference between 10% (a one in ten chance) compared to 20% (a one in five chance), is psychologically different and I’d like to prepare myself for these seemingly different odds!  I trust my doctor, but I want to know more about why it’s 20%.

I spent several hours trying to find something useful that explained the most recent stats.  But the website with the most useful statistics explaining the different probabilities is www.advancedfertility.com.  However, the website is confusing, statistics are hidden away in text paragraphs that require reading several times, multiple hyperlinks to different pages that break up ease of understanding, how recent is this information and it is not always clear where their statistics have come from.

If you google ‘the probability of IVF success’ there is a plethora of useful information and supporting data (because the govt mandates the data is collected by clinics), also there is a really good resource, Society for Assisted Reproductive Technologies (http://www.sart.org/) who summaries the most recent data at the clinic level and the national level.  They even have a patient level ‘Predict my success’ interactive tool.

So, I herby call for greater transparency and clarity on IUI success rates, similar to what can be found online for IVF success rates.  I’m not looking for exactness, just more openness.

If you know of good resources to help understand success rates of IUI, please comment below and share!

On occasions I forget that there are two of us on this journey

I was really mean to Chris the other night.  I mean really mean and I feel bad about it.  We were in bed together and just about to switch out the lights when Chris asked

“Can I touch your tummy?”.

Now, I hate, hate  hate  my tummy being touched after eating dinner, I just hate the feeling, something probably related to my Irritable Bowel Syndrome (IBS).  But even so, Chris wasn’t just being polite….so with a slight quizzical look said

 “No!! Why???”

Chris rather coyly replied

“Because…..well….there might be a baby in there!”.

Oh.  I can’t remember exactly what I said next because I had mixed thoughts at the time.  But I know whatever it was, it wasn’t very thoughtful.  I argued that that he shouldn’t get his hopes up because the chances of our success were low.  Then we argued about the statistics of IUI vs natural conception.  And so we rolled away from each other after our mini dispute agreeing to disagree and the lights went out.  After about 30 seconds in the dark, I felt guilty, terribly guilty.  I have been trying to not get my hopes high with this IUI because I’m afraid of them just being put back down, again… so there I was, trying to put Chris’s hopes down too.  In the darkness, I quickly apologized for being mean.  He said it was OK.  I couldn’t get to sleep for an hour or so after this brief incident because I was lamenting on why I felt so guilty.  Really it’s because I realised I had not considered him and his feelings, I was selfish and temporarily forgot that actually there are two of us on this journey together and I am not alone.

Our journey together

This is our journey together

Do I spend more $$ when I am my most “fertile”?

Do I spend more money when I am my most “fertile’? Probably seems a bit of a strange question coming from someone who has been diagnosed with ‘unexplained infertility’.  But never the less, assuming my most fertile period is when I ovulate (give or take a few days either side), do I spend more on ‘discretionary’ items?

Yesterday I heard on the radio that a Texas university discovered that ladies buy more things when they are in their fertile period of their cycle.  Well this caught my attention considering not long ago I wrote a post on the weird science of ovulation.  So yesterday I started to look at my own spending habits, and of course I have my credit card data, and my ovulation data from the 15 months, what do they look like together overlayed?  Is there any possible correlation?  I plotted ‘discretionary’ spending, which is basically any type of spending where I had a choice (I excluded groceries, bills, fuel and work expenses), against ‘peak ovulation’ days.  Ovulation day is the highest orange peak, with 2 days either side of ovulation day.  Here’s what my chart looked like….

SpendvOv

Nope…doesn’t look like much of a correlation!  But it was interesting to see my ‘waves’ of spending habits!  This analysis is really rudimentary.  What was the radio show really talking about?  There must be some particular way I need to look at spending v ovulation or perhaps I don’t fit the profile because I am actually infertile?? Haha. OK, I’m being mean to myself here.

So this evening I hunted down the source of the research…Asst. Professor Kristina Durante from University of Texas.  Here is her webpage, it has a link to all her research papers on it.  She has done a lot of interesting social science research on ovulation and social effects.  She has even given a TED Talk – Fertile, Flirty & Feisty (I love TED  Talks by the way!) her approach is all related to evolutionary theory.

It turns out her research is in fact far more in depth than the radio makes it out to be…Chinese Whispers etc.  Indeed, the paper merely discussed that ovulation affects women’s preferences, which might contribute to spending on positional goods such as cars and jewellery.  Well the majority of my ‘discretionary’ spending included decaf skinny vanilla lattes and cookies so I think we can safely say my chart is null and void.  But it was interesting anyway whilst it lasted 😎  One way to keep me busy in the 2 week wait and distract from horrible cramps and leaky vaginas – geek out!


Abstract from: Money, Status and the Ovulatory Cycle*

Each month, millions of women experience an ovulatory cycle that regulates fertility. Previous consumer research has found that this cycle influences women’s clothing and food preferences. The authors propose that the ovulatory cycle actually has a much broader effect on women’s economic behavior. Drawing on theory in evolutionary psychology, the authors hypothesize that the week-long period near ovulation should boost women’s desire for relative status, which should alter their economic decisions. Findings from three studies show that women near ovulation seek positional goods to improve their social standing.  Additional findings reveal that ovulation leads women to pursue positional goods when doing so improves relative standing compared with other women but not compared with men. When playing the dictator game, for example, ovulating women gave smaller offers to a female partner but not to a male partner. Overall, women’s monthly hormonal fluctuations seem to have a substantial effect on consumer behavior by systematically altering their positional concerns, a finding that has important implications for marketers, consumers, and researchers.

* Durante, K.M, Griskevicius, V., Cantu, S.M. & Simpson, J.A. Journal for Marketing Research, 2014

Half way through the two week wait and feeling low…

So this is it…the half way point in the 2 week wait (AKA the 2WW).  I am feeling a little low.  It is probably as a result of a mix of things – first of all, being stuck inside all weekend behind a computer, second of all, I am impatient being in the middle of the 2WW, thirdly I am fed up with the progesterone suppositories leaking everywhere.  Is there a chance that my feelings are related to hormones and medications?  Maybe, I can’t tell.

diesel worried

Diesel don’t look so worried, it’s gonna be OK

My lowness hasn’t been helped that I had two course projects due this evening.  Both were programming assignments….the first project I developed a web app that uses the CDC’s most recent data on Assisted Reproductive Technologies (Here is some info on it).  I was unable to fully deploy the app online before the deadline. It worked perfectly yesterday on my computer and all day today I have bee trying to figure out why it won’t go live. Sooooooo frustrating.  Hopefully my graders will see my code and be generous.

My second project was a little dull, statistics and investigating relationships in cars between Miles Per Gallon and transmission types (amongst other things).  I completed my report, but in the last hour before the deadline I could not get it to convert to a pdf file.  Such a simple task.  I am gutted.  I will have to re-take this module as it counts for 60% of the grade.

I will admit that I have screamed and cried at my computer several times this weekend.  I am not very good at not being in control of it!

Our cats, Sushi and Diesel, have been overly affectionate the last couple of days.  I am sure they can sense when we are down or ill.

Next week is a new week, no more snow, warmer temperatures, back to some gentle exercise, and the end of the week we are having friends over to watch rugby, eat some bad foods, and play some board games.  Something to look forward to.  With all that fun it will then be time to take the test. Which incidentally, will be the same day as our 3 year wedding anniversary – it would be a good present to ourselves if we got the big fat positive.  Monday Monday!!!

These guys help when I feel low

Sushi and Diesel being cute together, can’t help but me smile

go home cat, you're drunk
go home cat, you’re drunk – Classic Diesel

Oh no applicator? Nice one freedom fertility pharmacy…

At my last visit to the fertility clinic I asked the nurse if she had any tips or hints on the progesterone suppositories.  She looked at me funny and said slowly,

‘Well, they are trans-vaginal’.

OK so I got that part, but they look a little awkward to insert?

‘Ohhhh, well it’s easy with the applicator’.

Ahhh, well I don’t seem to have been given an applicator.

‘Oh I am sorry, that’s not really helpful’ the nurse sympathized.

No, not much.  I’ll figure it out.

Last night was the first evening I had to ‘insert’ the progesterone suppository.

Progesterone Suppositories: Greasy little things

Progesterone Suppositories: Greasy little things

I have to take these for at least 14 days just before I go to bed.  These suppositories help to thicken the uterine lining, increasing the chances of a successful implantation.  The suppositories are quite small, certainly no bigger than a small tampon.  They are oily and greasy, feel like a cross between warm candle wax and hair wax.  I think they would melt very quickly if held in your hand longer than a minute.

I forgot to cut my nails.  Mistake #1.

When I started walking it began to fall out, I had not ‘deposited’ it in a suitable place.  Mistake #2.

I am very much aware of the sticky and greasy residue and so have worn a panty liner for most of the day.  When I got home I thought I was done with the leaking.  Mistake #3.

I haven’t had any side effects from the progesterone noticeable as of yet.  I’ve had a sore lower back, but that could be from trying out a standing desk for the last couple of days. Fingers crossed I won’t get any. Ha…famous last words!

The weird science of ovulation, the things I didn’t know

A few days ago when I was curled up in bed wishing my ovaries would stop hurting, I did a google search on ovulation.  I wasn’t looking for information on how women ovulate (I studied that at GCSE biology ), but more about what else happens to a woman’s body when she ovulates.  My google search terms were based on a question I had earlier on whether there is a correlation between the side of ovary a woman ovulates from and an increase in boob size.  So my search lead me to ‘ovulation symmetry‘.

There are two articles of interest I would like to share with you.  The first is an academic paper, the second is a blog post from a website called 1Flesh (advocates for natural family planning).  Both were interesting and got me thinking how much of a dark science ovulation is to the unsuspecting.

I’ll actually start with the 1Flesh blog post, called “9 reasons ovulation is pretty much like witch craft” by Marc (yup he’s a guy talking about ovulation, that’s pretty cool!).  He talks about 9 things that happen when a woman ovulate (links to supporting studies are provided in his blog post):

  1. Women become more beautiful when ovulating – lips, ears, fingers, breasts and other soft tissue parts of the body become more symmetrical, thus making us more beautiful.
  2. Gaydar initiated – the better women become at discriminating men who are a good match for them.
  3. Higher voice – again a more attractive thing to men…apparently!
  4. Smell better.
  5. Naturally want to look their best – in fact women’s self esteem lowers around ovulation, and to compensate for this tend to dress better, put make up on, even sway hips unconsciously.
  6. Spidey senses –  women have an increased ability to spot and avoid danger (I must chart this one in particular!!)
  7. Increased sex drive – unsurprising.
  8. General well being – women are less stressed and have fewer headaches.
  9. Get smart – why didn’t I know this sooner??! I could have made sure I took all my exams on these days!

So let’s go back to the 1st point – women become more beautiful when ovulating.  This is where the first hit on google provides a link to an academic paper, entitled: “Symmetry and ovulation in women”*.  It was the first line of the introduction paragraph

Many primates show visible signs they are ready to reproduce.

Many primates show visible signs they are ready to reproduce.

that got me interested:

“In primates most females show cues to ovulation.  However, among humans it is generally considered that ovulation is not perceived consciously by others nor is it usually perceived by self.”

This is very true of baboons and bonobos – they could not make it any more obvious to the male that they were ready to reproduce.  Why are humans more subtle?  Actually, I think after a year, I can now tell when I am ovulating, the signs are mostly there.  But I am not sure Chris can really tell, though perhaps he can unconsciously from the more subtle signs like the list above suggests.

The paper presents evidence that asymmetry in ears and fingers is lowest at time of ovulation.  The evidence is compelling (but I’d like to see a larger sample size).  Could measuring and tracking the length of your digits be a more effect way of determining ovulation?  Sounds easier than feeling your cervix, peeing on a stick and taking your temperature everyday!  Clearly as this paper was published in 1996 it hasn’t caught on as I assume the differences are very small and requires an accurate measuring device.  So we will just wait out on that one for now…

D.Scutt & J.T. Manning, Symmetry and Ovulation in Women, Human reproduction, vol 11 no 11, pp 2477-2480, 1996.

Is it my British accent that confuses you?

I have concluded that it must be my British accent that confuses people at the other end of a phone line, namely my insurance company, Allianz, and freedom fertility.  Or they are just morons.  I am sure these big companies wouldn’t hire morons to man their phones, so it must be the former.

You may remember a couple of weeks ago I had a mild panic about whether my insurance company needed a pre-approval before fertility treatment?  When I had called my insurance company the nice Irish lady, who held me the line whilst she thoroughly checked the answer to my simple query, concluded I did not need approval for IUI.  Turns out she was wrong.stop  The only reason I know this is because my fertility clinic requested to see proof that my insurance covers fertility treatment.  So yesterday when I asked my insurance company for an email confirming this, they replied today stating that in fact their representative was incorrect and I needed prior approval.  To get the approval I need to send to my insurance: medial records, history, diagnosis and costs of planned treatment.  I could easily have collected all this the several times I have been at my clinic in the last few weeks, had the representative supplied me with accurate information in the first place.  Is this a normal situation, for insurance companies to request all this? I had thought that insurance companies would usually liaise directly with the healthcare provider?

Who knows what the heck is going on with my insurance.  Chris has kindly volunteered to deal with it.  I don’t mind if we are not covered, but what annoys me is that this process is not exactly the smoothest of rides as it is.  I know people make mistakes, but this mistake is a pain in the backside.  At least Allianz apologised and realised their initial mistake, we had a response back from their ‘senior customer sales representative’.  So I am not mad at them, but all these coincidences of mess ups on the phone, I’ve decided the only common factor is me.  The only obvious explanation is my accent.  From now on it’s email all the way, guvn’r…

Purple sperm and a painless IUI#1

Today Chris and I tried to make a baby without touching each other (well later on we will try the normal way too!!).  Totally weird.

Last night I had killer ovulation pain.  Both my ovaries were painful when I went to bed – the timing seemed to be just right, 12 hours before the scheduled artificial insemination procedure.  Thankfully, I woke up this morning with just a dull ache in my ovaries rather than a sharper pain.

Chris worked from home today and I had a day of leave planned.  We headed out to the clinic for our 10AM appointment and we were out of there by 12PM (with a short interlude to Starbucks).  First of all Chris gave his sperm specimen for washing.  He didn’t take long at all!  Then we headed to Starbucks for a quick coffee and catch up on a bit of work.  Chris collected his washed sperm sample and we waited in the waiting room with his purple sperm for about 20 minutes.  Yup it was purple!

Chris's purple sperm

Chris’s purple sperm

The specimen that Chris gave was excellent according to the doctor:

semen volume: 1.7mL

Sperm Concentration: 12.45 million per mL

Percent motile: 64.3%

Number of motile sperm: 13.6 million

After washing (centrifugation)

Number of motile sperm in vial: 6.6 million

Motility:  95.7%

volume of vial: 5mL

recovery rate for processes sample: 49%

It seemed a bit weird sitting in the waiting room whilst Chris held his sperm…but then again I am currently blogging about his sperm, so we are not prudish about it.  It was just weird and I can’t put my finger on why.  We did get a good giggle though from the diagram on the results form. It was more of a cartoon than a diagram because I don’t think it accurately represents a medical procedure of washing sperm.  But perhaps it is, and this is how they wash the sperm, in a nice warm bubble bath.

A highly technical diagram on how sperm are washed

A highly technical diagram on how sperm are washed

I wasn’t nervous about today, just more excited to get it over with.  I was called into the examination room with Chris and the nurse briefed us on the procedure.  Very simple.  A speculum is inserted, without any lubrication (because that kills sperm), then a catheter is inserted through the cervix to the womb.  The sperm are then slowly injected into the womb.  Actually it wasn’t very slow and was over within seconds.  Apparently the doctor pulled a funny face after she removed the catheter.  I didn’t notice as I was concentrating on the picture taped to the ceiling of a happy place – a tropical island beach.  The face was one of puzzlement.  Chris wondered if she was going to say that something didn’t work.  But no, that was it, over and done with in less than 2 minutes.  It was painless and hurt less than a pap smear test.  I was asked to lay down for 15 minutes, and the nurse left a timer.  We laughed about bun making, ovens and timers.  All in all, the process was very easy.  I’ve had cramping for most of the day, but I’d rather that than the sharp ovulation pain I was having any day of the week.

We are now into the two week wait and I have told Chris if he asks me one more time ‘Do you feel pregnant yet?’ I’ll punch him in the face.  Luckily he doesn’t really mean it and we can have a bit of a giggle about it.  No point in stressing, my glass is back to being half full again 🙂

My first ‘self’ injection and my true valentine hero

I wish wish wish I had video recorded my experience with my first ‘self’ injection with Ovidrel.  It would have been pure comedy and had you all rolling around in stitches.  But I didn’t video it because I had no space left on my iPhone and at 1130pm I was too tired to be bothered with all that.

I worked my self up into a bit of a nervous panic knowing I had to do this self injection.  Fortunately, the evening was spent mostly distracted with a romantic dinner at a lovely local restaurant.  There were 6 courses and I was stuffed silly by the end.  The last thing I felt like doing after all that food was grab the fat of my tummy and stick a needle in it.

I watched several you tube videos with other people doing the injection.  The instructions given to me were pretty clear to follow, but I wanted to see other people’s experience with it.

Here is one adorable couple trying the injection for the first time: http://youtu.be/Yv_KvnNfCOg

And another lovely couple: http://youtu.be/Gm7AkZgVHkA

I wanted to be able to do the injection myself, and I tried, I really did.  But every time I came to put the needle on my skin I freaked and stopped myself.  So I asked Chris to do it.  But then he was nervous and didn’t look comfortable doing it.  So that made me more freaked out more.  So I closed the bathroom door and tried to do it again on my own.  But I just could not bring myself to do it.  So I called Chris back in.  We agreed I would hold my tummy skin, and I would look away.  He was just as nervous as me, and is not particularly good with seeing needles either.  So he counted.  On two he stabbed me gently, then counted to three til it was all the way in, then counted one – two whilst he injected the drugs in and was out on three.  So six seconds in total and it was all over with.

It didn’t hurt, but I felt really queasy afterwards, it’s just the thought of the needle that always gets me.  We had a good giggle about it afterwards.  Afterwards I felt overwhelming love for my husband; he overcame his own fear because I was too chicken to do it myself.  This was his greatest valentines gift to me ever.