Answers to FAQs

Through my IF journey I've had a lot of people ask me what PCOS and Endometriosis were, what IUI entails and what the different drugs I've been on are/do.  I thought I'd take a minute out of my terribly busy day (hah) and explain all of them.


PCOS: This is an endocrine disorder that commonly (but not always) causes infertility.  In my case, it causes cysts to appear on my right ovary monthly that look like a string of pearls.  These cysts make it impossible for an egg to release because the follicle cannot grow large enough to mature it.  Most people with PCOS have extremely long, irregular cycles.  My cycles are relatively normal in length (27-37 days) but very irregular, and it is rare for this to happen.  PCOS can also cause (or be caused by) insulin resistance (IR) and excess androgens (estrogen/testosterone).   This is why I'm trying to lose weight.  In many cases losing 5-10% of your body weight can get rid of IR and decrease the amount of estrogen/testosterone in your body.  It can also cause/be caused by obesity and when IR is also present, losing weight can be quite the struggle without insulin sensitizing medications such as Metformin.  


Endometriosis:  This is a disorder caused by the uterine lining developing outside the uterus.  There are four different stages each characterized by a # of lesions/adhesions.  It causes painful cramping during menstruation, and also causes infertility in many women.  This is the reason I had the laparoscopy.  It was intended to rule out endo but showed that I had either stage 2 or stage 3.  Using a laser during a lap can help relieve symptoms by temporarily getting rid of lesions but they usually return and there is no cure.  


Clomid: Used for ovulation induction in women with PCOS or other ovulatory disorders (and in some women with unknown fertility problems).  Clomid is dosed from 50-200 mg (though many doctors hesitate to go over 150mg) and is effective at causing ovulation about 80% of the time.  Though it causes ovulation it cannot guarantee a pregnancy and only about 40% of those who use it for 6 months will become pregnant without further intervention.  It also causes a 10% chance of twinning vs. the "normal" chance of about 1%.


IUI (Intrauterine Insemination):  I have done two of these, only one of which I would deem a successful insemination as far as timing goes.  Most IUIs utilize ovulation induction through Clomid or other drugs like Follistim and Gonal-F.  When used with fertility drugs IUI will bring chances up to about 8-17% per cycle, as compared to the "normal" rate of 20%/cycle.  Many doctors also use human chorionic gonadotropin (hCG), which is the chemical released by the placenta in a pregnancy, to further induce ovulation by simulating the natural leuteinizing hormone (LH) secreted by the body 24-48 hours before ovulation occurs.  With ovulatory dysfunction, LH is either not secreted or oversecreted during the cycle in many cases.  What the hCG "trigger" does is cause all of the mature eggs created by the ovulation induction drugs to burst from their follicles and ovulate about 24-48 hours later.  A lot of the time 1 IUI is done about 36 hours after the trigger shot, but in my case I had 2 IUIs, one at 12 hours and the other at 36 to supposedly increase my chances.  With my first IUI I can be sure that our timing was decent because of the trigger shot I was given.  With the second, I was not given the shot because I had a positive LH test so the IUI was just done the next 2 days.  Stress caused my ovulation to not occur when predicted so we missed our opportunity that month.  If we have to return to IUI, I will insist on having the trigger shot each time.  My hope is that losing weight will force my body to behave, so to speak, and that we will have a break cycle baby.


Hopefully this helps explain what I've been doing as far as IF treatment goes.  I'm always happy to answer any questions because I firmly believe that the more information people get about it the less stigma there will be associated with it and the less "OMG you're going to be Octomom" will occur.