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How to Best Prepare for IUI

hi everyone thank you for watching

tonight's like whisper show my name is

dr. Amy and I'm a fertility expert in

the San Francisco Bay Area the topic of

tonight's show is how to best prepare

for I you I I you I what does it stand

for you might ask it stands for

intrauterine insemination this is a

procedure that's very commonly done in

fertility clinics all over the world so

I thought it would be a really good idea

to teach people everywhere the tips and

tricks that I talk to my patients about

so that they can have the highest chance

for an IUI pregnancy so let's get

started the first thing oh wow

you'll see that I'm wearing a shirt that

has the same logo to my left the tissue

method so the first thing I do is I make

sure I know my patients fertility

diagnosis you hear me say it over and

over

fertility diagnosis before treatment so

talk to your doctor about these five

things these are five simple steps that

you can take to figure out what's going

on with you to make sure that I UI is

the right treatment plan let's start

with tubes t we do a hysto cell Pingo

gram to make sure the tubes are open if

one tube is blocked and one tube is open

you can still do IUI but you want to

make sure you're monitored because the

cycles that you're ovulating from the

block side are probably cycles you don't

want to do I UI in and when we ah've you

late it's not like we all ate every even

month on the left side or odd month on

the right it's literally a flip of a

coin so without monitoring with a pelvic

ultrasound and we use the term

follicular scan or follicle check you

would have no way of knowing you is the

uterus an ultrasound of the uterus I

wish I can find an easy way so that

patients could get their uterus checked

without driving all the way to my office

you know I'm thinking a wand that can

hook up to your phone and you insert it

vaginally and then I get pinged or we

have an appointment where I can take a

look at a screen and tell you exactly

what's going on but we don't have such a

thing so without a pelvic ultrasound to

look at the uterus you wouldn't know if

you have cysts on your ovaries a polyp

in your uterus a fibroid in your uterus

could block the pathway for an embryo to

implant so get a uterine ultrasound done

before you consider IUI treatment what's

the next letter s for obvious reasons

you want to look at sperm health there's

so many things that you can do to get

sperm to swim even faster and better

lifestyle factors vitamins supplements

make sure there isn't a varicocele

so unless you check the sperm health you

wouldn't know what you could do on your

own to increase your chances of

pregnancy see my thing is my shtick is

that I actually want everyone to get

pregnant on their own without my help I

certainly know that that's not possible

but if I equip people with this

information guess what

treatment might be more successful so

that's why I find that checking the

sperm is really really helpful you know

I often hear things like dr. Amy I was

diagnosed with unexplained infertility

they said the sperm was slow but they

said it was unexplained and I said you

know what since they told you what the

explanation is but I don't know why they

didn't explain it better for you

the next letter the next step is the H

hormones

TSH prolactin these are hormones that if

they're not balanced can cause problems

with fertility so before you start your

IUI treatment make sure you do a

preconception panel including things

like rubella varicella a blood type how

many of you guys know what your blood

type is well there's a reason why you

want to know before pregnancy and that's

because if you're Rh negative there's a

shot you'll need if you have any

spotting in your pregnancy the last

letter is Y which is your genetic

profile making sure that the egg and

sperm are genetically compatible is

super important to me

and that's why I like to do

preconception genetic testing before I

start an IUI cycle so those are the

elements of fertility diagnosis so that

you can start your ioi cycle and feel

like this is the right treatment for you

one of the questions I ask my patients

is this how many kids do you want and

then I look at their age I look at their

fertility factors and then we talk about

what do we have to do to plan for your

future so if for example you want two

kids and you're starting I you I at 41

well rethink that and talk to your

doctor about what can I do to give

myself the highest chance of having the

family size that you want what does that

family look like so

there's so many different ways of having

a family and I want you to reach your

goals and have the family size that you

want so let's talk about the nuts and

bolts of a fertility calendar so some of

the terms that we use are ovulation

induction and IUI

and you're probably asking wait Amy you

said this was a show on how to best

prepare for I you I why are you talking

about ovulation and that can sometimes

be confusing I have patients that

ovulate regularly and now I'm

introducing ovulation pills well there's

a reason for that see every month you

only ovulate one egg but some people

have the well a lot of people have the

potential to ovulate more eggs so what

do we do well we want to populate maybe

two eggs and I tell people when you take

fertility pills for example you'll

ovulate 1.5 and the reason for that is

some months it might be 2 and someone it

might be 1 and there's certainly some

protocols if you add injectables or you

do a straight injectable IUI cycle that

you'll automatically for the most part

ovulate two or more eggs if that's your

potential so talk to your doctor about

what the goals are with treatment what

your pregnancy rate is and how many

cycles they expect you guys to do before

you change the path to pregnancy meaning

at what point Rhys are you gonna say

this probably isn't working for us and

we should change course so let's go

through this calendar in detail so first

thing that happens is your period starts

so once your period starts I tell

patients think of me and email me

because that means my work is not done I

look at my notes from our personalized

fertility care plan that we've developed

together and then I formulate the

calendar based on all the things that I

just told you then on cycle day number

three you're gonna start a medication

called Samara you've probably heard a

lot about clomid and if you've heard me

talk about it I call it crazy clomid I

say sure you can take that drug if you

want to schedule your exorcism later

because it totally can mess with your

brain a lot of my patients deal with

depression and anxiety just because of

the fertility problems they're having so

adding a medication that makes them feel

a little bit more on edge isn't

something that I want to do the

side-effects of Samara are things that I

talk to my patients

about slight nausea is not unusual a

slight headache when you first start

taking it and maybe some lower leg

cramps the medications all in your

system for about two days or so those

side effects should go away right away

and if you're having a lot of side

effects you know that you can let me

know and there were certain things that

you can do to lessen the side effects

for example rather than taking three

tablets go down to two and even go down

to one for example if you definitely

don't want to ovulate two eggs and have

a chance for twins the other thing that

you can do is play around with the

dosing alternate three to three to three

or take it three times a day morning

noon and night I tell my patients to

take the medication at night the reason

you don't feel nauseous when you're

asleep so this can sometimes help

there's a reason also why we start the

medication on cycle day number three the

reason is our body picks the egg it's

gonna be late by day five so if you

start earlier there's a higher chance

that you can rescue an extra egg and the

other thing you heard me just say is the

word rescue fertility doctors are egg

rescuers we're not helping you get into

menopause any sooner you're not gonna

run out of your eggs any faster we're

just throwing out little life vests -

your eggs so that you can ovulate an

extra one and hopefully it's kind of

like a twofer two chances or the sperm

two to hit one egg in one cycle so in

some cases that can increase a person's

chance for pregnancy so the next thing

we talk about is sex yeah I talk about

sex all day long from the minute I wake

up until the minute I go to bed it's not

taboo in my office and certainly not

many doctors give their patients

prescriptions for sex the way that I do

a lot of people think that they should

abstain as soon as their period starts

in there I you I cycle they should have

staying from sex

that's not my approach my approach is to

recommend intercourse or sexual

relations or you can have outercourse

and the reason why I say that is this

ejaculation is a good thing think of it

as practice makes perfect I tell the

guys you're preparing for a big day no

pun intended

you're IUI is a day that I want really

great strong healthy sperm cells I don't

want a whole bunch of dead swimmers and

that's what happens if you wait too long

your eye you eye day and a lot of guys

ask me well what happens on the ioi day

I'll get to that in a second so sex is

helpful and the reason is like I just

told you that we want really healthy

sperm but there's gonna be a time where

I may tell you you know what no more sex

because it's time for I you I planning

and my patients will get that

information for me so there's something

called an opk I often find myself acting

like a rap star you know they're all

these acronyms I you I and the opk and

HCG you know I should really have a

jingle so if you're a songwriter out

there call me because I would love to

come up with a tissue method rap song to

go along with these YouTube shows that I

do so with the opk the strategy is to

not miss ovulation imagine that you come

in for your follicle check and you tell

the doctor I have deleted three days ago

and she's like yeah so that means we

should have done the IUI three days ago

why didn't you call me so that's the

thing I'm like 7-eleven I'm open all the

time call me so if you're opk is

positive and my patients already know

this already you should see all the

messages I get of OB K's and they're

lined up and people are asking me like

is this positive yet and that's the kind

of stuff I like cuz I don't want to miss

it I know how important this is to my

patients and it's just as important to

me that we time things as perfectly as

we possibly can so if the opk is

positive before the follicle check day

then I have patients come in for a

follicle check and then we decide on the

perfect eye uiwindow we'll talk about

that in a second so at the follicle

check appointment what we're doing is

taking a look at the follicles I'm

measuring their sizes I'm looking at the

thickness of the lining of the uterus

and I'm determining when I think the IUI

should be done I'm thinking okay when

should those eggs be in the fallopian

tube and when should I put the sperm at

the top of the uterus so that the magic

will happen okay and so I you I is not

like IVF we have to rely on nature in

order for the egg and sperm cell to come

together the embryo to travel down the

fallopian tube for approximately five

days before it sticks and grows in the

lining of the you

so timing is important but there's

definitely a range

so once I've determined that it's time

for us to do I you I planning that's

when we talk about the trigger shot it

sounds quite violent I don't know who

came up with that that term I don't know

it I like the term maybe the ovulation

induction shot or the last stage of egg

maturation shot I haven't figured out a

good term for it but I'm sure I'll

figure out by the next show so this is a

small injection in the skin of your

tummy I do know that there are some

clinics out there that do it in the butt

but there's nothing in the butt in my

office when it comes to IU I okay so the

trigger shot skin of your tummy and

typically it's time approximately 36

hours before the IU I and again this

timing is individualized for me it's

based on like I said the thickness of

the lining the size of the follicles the

sperm quality as well because sometimes

I like to plan a double IU I so that

means for example if I gave a patient a

trigger shot tonight I actually have a

patient I'm giving her trigger shot

tonight at 11 p.m. I'm gonna do one eye

you eye at 10:45 tomorrow and one eye

you eye on Friday at 11 a.m. so that's

why I'm timing the trigger shot in this

way so ask your doctor

why are you if you don't know the answer

and they haven't told you say how many

eggs do you think are mature than I'm

ovulating and why are you giving me the

trigger shot at the time that you're

giving me and is this IUI being timed

perfect for us and when should we have

sex okay after the IU I I tell patients

sex is recommended but not required

unless of course the sperm counselor on

the lower side if if you hear me saying

you guys you should definitely have sex

after the IU I today I can tell you that

I've probably also discussed the semen

analysis that we've done with the sperm

wash and we'll share with you those

numbers at your appointment so after the

IU I the other thing that we do I know

this sounds so complicated but I want to

make sure that you know all these steps

we start progesterone progesterone is a

hormone that can promote implantation

right it can't be a bad thing but it can

be in some patients and I'll tell you

who it can be bad in people who have

problems with their mood

depression progesterone can totally mess

with your mood so there are two ways of

taking it one is just pop the pill

orally that's how the pill was actually

made or you can take the capsule and put

it in your vagina and I do already own

the website farm China calm for those of

you who just had an idea I don't know

what I'm gonna do with that but maybe

one day

so these capsules can literally with

your finger you can buy a about you know

an applicator online for vaginal

medications you can just place them at

the top of your vagina but you might be

dealing with a messy discharge so what I

find and it's not like I invented this

but what patients report is that when

you place a medication vaginally you

have less side effects so I tell my

patients look you can start it orally if

you feel crummy let me know place it

vaginally if you still feel crummy we

can reduce the dose to 100 milligrams if

you still feel crummy we can stop the

medication all together and that reminds

me I didn't talk about the side effects

of the HCG trigger shot you just heard a

clue HCG yep that means pregnancy

hormone we use pregnancy hormone to

induce ovulation

so don't go checking a pregnancy test

within eight days from the trigger shot

why because the trigger shot can still

be in your system for up to sometimes

it's even closer to ten days but for the

most part it's out of your system by

seven days so now you're almost almost a

fertility expert and I can tell you that

most of my patients know a heck of a ton

about fertility so now let's talk a

little bit about my trips trips tips

when it comes to medications there's a

website good art XCOM I am NOT a doctor

who gets any money from anybody to talk

about anything call me

good Rx I can get paid just kidding no

no chance go to XCOM has been a really

helpful website for my patients

especially with medic in patients who

let's say don't have insurance and

medications who have not gone generic

yet or you know anyone who wants to save

a buck it's really helpful so what you

can see here is I've put in the term

letrozole which is the generic name for

Samara I put in the number of tablets

that I want and my zip code

and here we go you can see that it's

super cheap at Costco 15 tablets is

eight dollars and 70 cents there you go

I would say about 95% of the pharmacists

are pretty cool about honoring this coke

coupon once in a while there's a snarky

pharmacist out there hey man I get

snarky too so you know if you have if

you're having a bad day you're having a

bad day so make sure that if a

pharmacist is kind of resisting that

you're able to use this coupon just walk

away and go to Costco so another

prescription that I prescribe is the pro

metrium or the progesterone same thing

you can see here that I put in the term

progesterone 200 milligrams 30 tablets

at Safeway it's 20 dollars and 80 cents

and you have other alternatives to

Walmart $22 Costco $23 cool and then the

other medication I dispense from the

office and that's the trigger shot or

HCG shot so it's a small shot in the

skin of your tummy and I tell patients

to refrigerate it when they get home or

I also dispense it I also give it in the

office depending on how we want to time

the IUI procedure so now let's get into

the procedure

oh no this thing yeah yeah not our

friend not my friend at least so if

that's not my friend

I'm gonna make sure that I'm doing a

speculum exam on a patient in the

gentlest way possible and look I know

not everyone can tolerate a speculum

exam but that's what's involved in an

IUI procedure so I ask my patients when

you're coming in I make sure that if

they need a valium 30 minutes before

it's already offered and we've talked

about it because a lot of patients will

report and I can even tell when I do a

pelvic ultrasound that maybe they'd be

better off with a valium before the IUI

procedure so I would say probably only

5% or less in my patients need a valium

but I want to make sure that they're as

comfortable as possible so I ask them to

come in with a full bladder that way the

uterus is lean back and then I place the

speculum and then we place the catheter

at the top of the uterus and shoot the

swimmers in and then sometimes I like to

also place an abdominal ultrasound over

the tummy so the

I can take a look directly and see that

the catheter is in the right place so if

you find that your doctor or provider is

having a hard time getting in with a

catheter here's what you can do you can

say you know what guys I think I want to

drink a little bit more water my bladder

doesn't feel too full and then say hey

do you guys have an abdominal ultrasound

I heard it might help you see where you

can go I think sometimes people struggle

and they don't realize that they have

the tools right there to help them a

bladder and an ultrasound so I want to

thank you guys for watching tonight's

show and there are a couple things that

we didn't talk about so here are a

couple of things I'm coming out with a

sperm snuggy I am it's a scarf it has

two pockets so that when you're when

your partner is collecting a sperm

sample at home you can just put in your

pocket and bring it over to the

fertility clinic and it's gonna stay

nice and warm I'm just kidding but

literally sperm can live outside the

body for quite a long time and nothing

can happen to it so if I have a patient

that lives within 30 minutes of my

office there we give them a cup they can

collect at home and bring it in and

their sperm snuggy or your armpit or

your boobs for a pocket okay once it

comes in we identify everybody and make

sure that we have everyone's name

everything is labeled and the sperm wash

to get the sperm sparkling clean takes

about thirty minutes okay

and then when you're in the IUI room I

walk in and I asked my patients do you

want to put your headphones on or listen

to a song so that things can be as

romantic as possible and then I also

asked the partner if they want to push

the end of the syringe if they feel

comfortable doing it so it's a group

effort everyone's involved and

everyone's having as relaxed of a time

as possible so I hope this show was

really helpful I hope that you know if

you know someone going through IUI

treatment and and you think that maybe

the show will be helpful to them you can

forward this to them so I hope you guys

have a great night be sure to subscribe

to my youtube channel listen to my

podcasts and read my articles on medium

and dr. Amy org have a great night you

guys and see you next week

welcome to the egg whisperer show a

program exclusively designed to promote

reproductive health awareness and

discuss fertility preservation options

here is your host a harvard-educated

fertility specialist dr. Amy she's known

as the egg whisperer fertility expert

dr. av+

and you have yet another success story

just launched by an East Bay fertility

doctor

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