Cycle Tracking for Conception with Home IUI
Timing is everything when it comes to conceiving with intrauterine insemination (IUI). There are a few factors at play: first, once an egg is released (ovulation), that egg is available to be fertilized for up to 24 hours. After 12-24 hours, if not fertilized, the egg will degenerate in the uterus. Second, sperm used in IUI is only viable for 12-24 hours. This will vary somewhat depending on whether you attempting to conceive with fresh or frozen sperm (fresh are able to survive a bit longer than frozen). Given these short windows of opportunity, it important to time the IUI well so that the sperm and egg are both present at the same time. There are a number of methods used to track ovulation. Most fertility clinics rely solely on ultrasound monitoring. Here, we find it helpful to observe other physiological signs of fertility and hormone testing, as well as also using limited ultrasound monitoring and medications. Below are some of the methods used for cycle tracking and ovulation identification:
How long can sperm live?
You may have heard that sperm can live for 3-7 days in the vagina prior to ovulation. This is true in cases of intercourse or vaginal insemination with fresh sperm because sperm, where sperm can survive for quite a while inside the cervix if there is fertile cervical fluid present. Fertile cervical mucus provides nutrients and the proper pH for sperm survival. But, with IUI the cervix is bypassed and sperm are deposited directly into the uterus, which decreases the length of time they can survive. Therefor, with IUI, we are looking at a window of up to 24 hours, rather than days.
When Doing Home IUI with Midwives, Timing is Everything
So, given these biological limitations, it’s crucial to time the IUI just right so that sperm are being introduced at a point where an egg is viable and ready to be fertilized. Below is an overview of some of the main methods that can be used to track ovulation and give you the best shot at a successful IUI. None of these methods are perfect, and everyone’s body is a bit different, so combining as many of these methods as possible will give the best results.
Testing for Luteinizing Hormone (LH)
Luteinizing is the main hormone that triggers ovulation. It can be detected in urine using a home test kit. Sometimes referred to as an “ovulation prediction kit” (OPK) or LH test, these over-the-counter test strips look similar to a pregnancy test. LH levels become detectable in urine, on average, 24 hours prior to ovulation. Everyone is different, and the range of time from when an LH test will turn positive to the time of ovulation ranges from 12-48 hours, with 24 hours being the most common.
LH levels rise gradually, so the beginnings of the LH “surge” that proceeds ovulations start when the test line is as dark or darker than the control line on the test strip (a faint line simply indicates some LH is present, but it’s not considered a positive result for peak fertility until the line is dark).
There are a wide range of OPK or LH tests available on the market.
Some are cheap and simple, and just measure LH as described above. Other tests sync with phone apps and give a quantitative reading for LH levels. Some tests look at other hormones in addition to LH, most often estrogen and sometimes including progesterone as well. I typically recommend starting simply and just getting the basic LH tests. They tend to work just as well, or better, than the more complex tests, which have a tendency to be inaccurate.
Cervical Mucus
Assessing Cervical Fluid: Color, Consistency, and Quantity
The color, consistency, and quantity of cervical fluid changes throughout the cycle. At peak fertility, the cervical mucus is the texture of raw egg whites, clear in color, and is usually more copious than at other points in the cycle. If you were to hold a glob of fertile cervical mucus between your thumb and index finger and try to stretch it between your two fingers, it will be malleable and stretchy, as opposed to a non-fertile cervical fluid that will snap or clump rather than stretch. It is usually clear, as opposed to non-fertile mucus which is often white/creamy or cloudy.
Methods of Assessment
There are various ways to assess cervical fluid. Some people make observations just based on what is in their underwear or on the toilet paper when they wipe. If possible, I find it most effective to go straight to the source and do an internal check at least 1x per day. Place a finger inside the vagina, feel as far back as possible for the cervix, and then do a scooping motion to bring out a small amount of cervical fluid on your finger to examine its color/texture.
Cervical Position, Opening, and Texture
Similar to the ways that your cervical fluid changes throughout the cycle, as does the cervix itself. During peak fertility, the cervix will be high up in the vaginal canal (more challenging to reach with your finger), and firmer, and the os (opening of the cervix) will be slightly more open. These changes are very subtle and will be difficult to detect if you don’t have a good sense of your cervix already. It’s best to assess your cervix daily, for a number of months, so that you can attune to these slight changes in position and feel.
Some people check their cervix by feeling it with a finger, and some people actually use a speculum to get a visual assessment.
Basal Body Temperature
This method is more so for confirming whether or not ovulation has already occurred, rather than tracking the lead-up to ovulation, which makes it slightly less useful for gauging IUI timing. The basic principle is that your body’s temperature rises slightly after ovulation has occurred (due to the influence of progesterone, the dominant hormone in the second half of the menstrual cycle). The temperature change is so subtle, it requires a specialized type of thermometer to detect the rise.
Where and How to Purchase a Basal Body Thermometer
You can purchase a Basal Body Thermometer at most drug stores for under $30. To get an accurate result, it’s crucial to take your temperature first thing upon waking in the morning, after at least 4 hours of uninterrupted sleep, and at around the same time each morning. There are also wearable devices on the market that track your temperature at many intervals throughout the night and give an average temperature in the morning. This allow greater flexibility.
Your Own Intuition and Knowing Your Body
In addition to the methods listed above, it’s also important to listen to your own intuition about what’s happening in your body. Some people get a physical sensation of ovulation, often experienced as a slight cramping or pain on one side or the other. This physical sensation of ovulation is termed mittelschmerz (German for "middle pain"). Other people notice other signs, like changes in their body’s scent, an increase in sex drive, or changes in mood. All of these are subtle signs, but the more you tune and track these changes over time, the better sense you may get of how they fit into the picture of your cycle and fertility.
Putting It All Together
Since there is no fool-proof method, other than a well-timed ultrasound of the ovaries showing the egg being released, it’s ideal if you can spend at least three cycles prior to beginning IUI tracking your fertility signs and getting familiar with your body’s unique signs. It’s also helpful to keep all the data in one place, which will help you put the various clues together and see how they relate to each other. There are a number of free apps to assist with cycle charting, and there are also templates available if you prefer to chart with paper and pen.
Working with home IUI with midwives in Berkley, CA who can help you make sense of the various signs is also very helpful. In my practice, I am available by text and phone in the lead-up to IUI to help my clients analyze the various data points so that together we can select the best timing for IUI. And, keep in mind, even when all the signs match up perfectly and the timing is just right, not every IUI will be a success and it often takes multiple rounds in order to achieve a pregnancy. I also offer fertility consultation appointments to help you learn to track your cycle accurately and to otherwise prepare for conception.
This blog was was originally published by Emunah Midwifery, read it here.
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