What Doctors Don't Tell You About Fertility Medications

Before you started your first intrauterine insemination (IUI) or in vitro fertilization (IVF) cycle, did you know that you would most likely end up injecting yourself with hormones several times a day for as many as three months? I didn’t. Possibly so as not to discourage potential patients, reproductive endocrinologists do not go into detail regarding your medication schedule until you are already emotionally involved and committed to complete the treatment.

My IUI Medications

Intrauterine insemination (IUI), like most other fertility treatments, typically relies on medications to stimulate the production and release of eggs. Usually, Clomid (or its generic version clomiphene citrate) is the first drug prescribed to women who do not ovulate regularly. It is inexpensive and often effective. However, not everyone responds to it or can tolerate its side effects. In such cases, Clomid can be replaced with injectable medications to encourage the formation and ovulation of eggs.

My IVF Schedule

In vitro fertilization (IVF) schedules are highly personalized and often adjusted. The length of the ovarian stimulation phase can vary significantly from one patient to another (based on one’s response to medications). The type of medications will differ as well (based on physician’s preference and/or patient’s circumstances). The timing of the transfer too can vary (depending on the development of the embryos and whether genetic/chromosomal testing is performed). All IVF schedules, however, contain seven distinct stages: (1) preparation of the ovaries for stimulation, (2) ovarian stimulation, (3) ovulation trigger, (4) egg retrieval, (5) monitoring of the development of the embryos, (6) embryo transfer, and (7) pregnancy test.

My IVF Medications

In vitro fertilization (IVF) protocols in the United States typically utilize three main types of medication with the following distinct purposes: to suppress ovulation, to stimulate the growth of multiple eggs, and to trigger the final maturation of the eggs. In addition, IVF is often followed by medications that aid the thickening of the uterine lining to support implantation.

IUI #4: Final Attempt

With two almost successful pregnancies, I knew that intrauterine insemination (IUI) could work for me. The question was how many more attempts would I need before I managed to have a truly successful pregnancy. Since my insurance covered most of the cost of my IUIs, I decided to give the procedure another chance.

IUI #3: Chemical Pregnancy

Even though my second intrauterine insemination (IUI) attempt did not make me a mother, it did prove that I was able to get pregnant and stay pregnant during the most critical months. To the reproductive endocrinologist who treated my infertility, this was encouraging; the aneuploidy was merely bad luck. Surely, my age had a lot to do with the unfortunate diagnosis, but since the chances of having another fetus with trisomy 13 were close to nil, I was eager to try to get pregnant again, hoping that the odds would now be in my favor.

IUI #2: Quasi Success

Seventeen days after my unsuccessful first intrauterine insemination (IUI), I began preparing for my next attempt. Since I had experienced rare but severe adverse reaction to Clomid, this time I had to order an injectable medication (Menopur), which was significantly more expensive but presumably had milder side effects. At this point, the cost didn’t matter. I just wanted results.

IUI Cost

Many couples who choose to pursue assisted reproduction opt for intrauterine insemination (IUI) first. Their physicians have informed them that the procedure is relatively simple and fast and would require lower doses of medication (if any). These are undeniably true statements, but they are typically followed by a much fuzzier claim regarding IUI cost. Here are some points to consider.

IUI vs. IVF: Cost Factor Revisited

When we are faced with multiple options, we typically consider not only their efficacy but also their cost. This is especially true with regard to assisted reproduction. Although the efficacy of a procedure can never be guaranteed, the cost can be substantial and, for many of us, even prohibitive. But is the least expensive option necessarily the first line of action you should pursue? The answer often depends on your age.