Lesson 1

In my last post (click here to view), I wrote about our first year of infertility treatments and our first miscarriage.  I threw out some terms/procedures you may not be familiar with: saline ultrasound, Polycystic Ovarian Syndrome (PCOS), Intrauterine Insemination (IUI), and D&C. I thought how I would do these educational blogs is explain in my own words what these things are and then add links to the bottom for you to read more about them.  Being a nurse, I may get a little technical but please ask me anything and I will try to answer. So here goes…


In My Own Words

Saline Ultrasound. The doctor passes a small tube through the cervix via a speculum. The speculum is removed, leaving the small tube in place, and the probe for the ultrasound is inserted. The doctor injects a small amount of saline into the uterus which allows better visualization of the uterine lining.  This procedure can detect abnormalities, like polyps which is what I had removed.

Because the uterus is a sensitive area, any stimulation can cause a contraction of muscles (in other words, cramping).  The tube being passed into the uterus AND the injection of saline can cause quite a bit of discomfort. I have heard women say they had little to no pain during a saline ultrasound but most women say it is pretty uncomfortable.

Click here for more information on saline ultrasounds.


Polycystic Ovarian Syndrome (PCOS). The most common cause of infertility in women, PCOS is a collection of symptoms that women may experience.  Most websites will say scientists think PCOS has a genetic component but no one knows for sure the exact cause; however, there was a study that came out fairly recently identifying the cause.  The theory is that the mother of the woman with PCOS had a higher level of anti-Mullerian hormone (AMH) during pregnancy which caused the daughter to develop PCOS in utero. I must admit that I cried when I heard about this study because it means they may be one step closer to finding a cure (which won’t help me because of my “advanced maternal age” but could potentially help so many women in the future)

PCOS causes a myriad of symptoms – some women experience 1 or 2, some women experience them all and it changes as the woman gets older.  I, unfortunately, experience at least a little of each symptom. Some of the main symptoms are irregular menstrual cycles, facial hair, acne, thinning hair, and weight gain.  Weight gain happens in women with PCOS for different reasons but one is because of insulin resistance which can cause infertility issues alone.

I honestly could go on and on about the things I’ve learned about PCOS and my own personal experience but I think you get the idea: PCOS sucks.  For more information (there is tons more), see the links below.

Click here for more information on PCOS.

Click here for more info on the new study looking at the cause of PCOS.


Intrauterine Insemination (IUI). This infertility treatment is sometimes one of the first invasive things they try when couples are having difficulty conceiving.  A baseline ultrasound is done about day 3-5 of the woman’s cycle to make sure there are no ovarian cysts and to check the uterine lining. If there is a cyst or abnormalities in the lining, the cycle is canceled and the couple has to wait until the following cycle to try again. If the all clear is given, the doctor prescribes medication to stimulate the follicles to mature eggs for release.  My first time, I used letrozole only but eventually we found that a combination of letrozole and menopur worked best.

After about a week, a second ultrasound is done to check the progression of the follicles.  They count how many follicles are stimulated and measure each one. If there are too many stimulated, they will cancel the cycle and instruct you to not have intercourse to avoid multiple pregnancies (twins, triplets, etc.)  

If everything measures correctly, the doctor then prescribes HCG, also known as the trigger shot.  HCG stimulates a maturing follicle to rupture and release the mature egg (ovulation). The clinic will give specific instructions when the shot needs to be given so that the scheduled IUI procedure is performed around 36 hours later (when ovulation should occur after the shot).

The procedure itself is much like a saline ultrasound except instead of saline, semen is of course used. The man gives a semen sample the morning of the procedure which is examined and then concentrated into a small amount of fluid.  The doctor passes a small tube through the woman’s cervix via a speculum. The semen is injected through the tube into the uterus. Some doctors use an abdominal ultrasound to see the small amount of fluid enter the uterus.

HCG is that is the hormone that is detected in home and laboratory pregnancy tests.  Because HCG is used to trigger ovulation, the couple must wait a full 14 days to get an accurate indication of a positive pregnancy test.

Click here for more information on IUI.

For more information about letrozole use in infertility, click here.


Dilation and curettage (D&C). Procedure performed to remove products of conception after a miscarriage.  The woman is sedated (I had general anesthesia) and the uterine lining is scraped using a curette (sometimes, a vacuum is also used).  If a D&C is done for a miscarriage, the products of conception is usually sent to lab. They can test to make sure the tissue is truly the products of conception but they can also test for genetic abnormalities.  

Most websites say there will be mild cramping after the procedure. I, however, was in a great deal of pain – no more than during the worst part of my period but the worst part of my period has some very strong cramps.  There’s also bleeding but thankfully, this was mild for me.

Click here for more information on D&C.

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