The Unseen Side of Intra-Uterine Insemination

Fertility treatments can be emotionally and physically demanding, and each person's journey is unique. In this blog, Suchandra shares her personal experience navigating IUI treatment and recovery in the Netherlands. What began as a smooth and hopeful process took an unexpected turn due to a rare complication she hadn’t anticipated. Opening up about the highs and lows of her experience, Suchandra hopes to offer insight and encouragement to others on a similar path.

Boss Naari: Hi Suchandra, thank you for being here with us. Can you tell me a bit about yourself, what brought you to the Netherlands?

Suchandra: Yeah, sure! I came here in 2015. I accompanied my husband, who got an on-site opportunity here, so I came along. Initially, the plan was to stay for a year and then go back and resume my job. I didn’t have to quit, as I had taken a leave without pay. But once I came here, I liked it and thought I’d give it a shot and try to find work for myself.

Back then, nothing was certain. We didn’t know how long we’d stay, but my husband’s contract kept getting renewed, and I continued working at a local job here. Eventually, we took the necessary exams and switched to Dutch citizenship. It made more sense as it’s a stronger passport. So now, it’s been almost nine years, and we still don’t know how long we’ll stay.

Boss Naari: Coming to the next question, can you tell me what made you choose IUI as your fertility treatment option? Did you look into or consider any other alternatives before deciding on that?

Suchandra: Well, I didn’t explore a lot of options, mainly because the Dutch medical system follows a very structured protocol when it comes to fertility treatments. They have a fixed sequence of treatments that patients are expected to follow, and you don’t get much flexibility to choose or ask for different options. So, when you start fertility treatment, IUI is the first step they offer. If it doesn’t work, they ask you to try it multiple times, usually six attempts in total. Only after those six tries, if it still doesn’t work, do they offer other options, which tend to be more complicated and invasive. So, in a way, you don’t have much of a choice; it’s more about following their recommended path step by step.

Boss Naari: When you first started going through it, how did you feel? Were there any moments that were challenging for you?

Suchandra: Yes, IUI is the initial step here. The whole process is a bit invasive, so there was some physical discomfort, the procedures and medications can be tough on the body. But emotionally, I was quite hopeful. I felt like it was worth trying, even though I knew it might not be easy. The uncertainty was hard at times, but I was motivated to see it through and give it my best shot.

A snapshot from Suchandra’s pre-partum journey

Boss Naari: Can you share what was the most emotionally challenging part of your IUI journey?

Suchandra: Honestly, I didn’t get very emotional during the process because the first round of treatment worked for us. I know for couples who have to go through fertility treatments for months or years, it can be emotionally exhausting. But for us, it just clicked the first time, so we didn’t have much chance to feel worried or question our choices.

Boss Naari: How did the decision to go for IUI impact your relationship as a couple?

Suchandra: The moment you start thinking about involving a third party like doctors and medical procedures, the relationship changes. Hopefully, for most couples, it changes for the better. The physical discomfort and pain mostly fall on the woman, so I think men become more caring and supportive when they see their partner going through all of this. IUI is less invasive than IVF, but still, it takes a toll, and women going through repeated treatments need a lot of support from their partners. In our case, my husband was very emotionally present and always reminded me of the bigger picture of why we were doing all this. So overall, our relationship grew stronger through this journey.

Boss Naari: Coming from an Indian background, did you feel any cultural pressure or stigma around fertility treatments?

Suchandra: Not at all. My sister and my husband’s sister both went through IVF years ago, and there were no issues or negative reactions from the family. Honestly, I don’t understand why some people would have a problem with fertility treatments, these are the same people who want you to have children! If you can’t conceive naturally, then seeking medical help should be completely okay.

For us, we had the baby quite late into our marriage, so the only question people asked was why we didn’t try fertility treatment sooner. But the truth is, we didn’t want a child for a long time. When we finally decided we did, we were open to trying treatments. So I’d say it’s fine to not want kids for a long time, and then decide to have them and seek help if needed. At the end of the day, have children only when you’re truly ready for that responsibility. And yes, I’ve heard people say, “If you had done IUI sooner, it would have been easier” but I wasn’t ready mentally, emotionally, or financially before.

Boss Naari: And coming to Dutch healthcare, how was it? How was the accessibility and the whole process? Can you walk us through the whole journey from when you began?

Suchandra: The Dutch system asks you to try for one or two years naturally before you get into fertility treatments. We did that, and then we consulted a general physician. Here, you don’t go directly to the hospital, you have a General Physician (GP) assigned based on your address. You discuss anything that concerns you with them, and if needed, they refer you to a specialist.

When we spoke to our GP about not conceiving after trying for some time, considering my age, she referred us to the hospital in our city. There, they did some basic fertility health checks for both of us, including internal sonography to check the position of my ovaries and the health of my uterus, and to see if any other treatment was needed before fertility treatment. Then, there was this “ink test” where they inject a colored fluid into your reproductive system and do an X-ray to check if the fluid passes through properly, this shows if there are any blockages in your fallopian tubes. It’s said that minor blockages sometimes get cleared during this test.

Boss Naari: That sounds like a very systematic approach. How did the actual IUI process unfold for you after those tests?

Suchandra: After these initial tests, they explained that I would need to start taking hormones with my next period. Around the 13th day of my cycle, they’d check the size of my follicles. These hormones help enlarge the eggs more than they would naturally at ovulation, which increases the chances of conception. This is where things got a bit tricky for me. On the 13th day, they found two large follicles and one medium-sized one, meaning my chances of conceiving were high. So around day 14 or 15, which is the prime ovulation time, both my husband and I had to come to the clinic for insemination.

My husband provided a sperm sample in the morning, which they processed to select the best sperm, and then a few hours later I went for the insemination. After that, you wait two weeks before taking a pregnancy test. That was my first cycle, and it came back positive.

Then, they did blood tests and a sonography a few weeks later to confirm the pregnancy, though they didn’t do an ultrasound immediately because the embryo was too small to detect. On day 29, I started feeling extreme pain on one side of my abdomen. Again, you can’t just go directly to the hospital, you have to inform the GP, who referred me to the hospital after hearing my complaints. The ultrasound showed that one of the follicles, which hadn’t been fertilized, was growing larger and causing the pain. I don’t know why this happens in some cases, but this big follicle was causing discomfort throughout my pregnancy.

Boss Naari: How did the medical team handle the situation once the enlarged follicle was detected?

Suchandra: Since I was pregnant, they were scared to do anything. They said if I delivered by C-section, they would take care of the cyst then. But if it was a normal delivery, they would look at it again six months after delivery. The cyst started as a follicle, but as the pregnancy progressed, it grew bigger around 16 to 18 cm towards the end. Because of that, they avoided intervention during pregnancy.

Interestingly, as my baby grew, the cyst stopped causing pain. I think it got stuck or fixed somewhere. The doctors didn’t want to touch it during pregnancy because it wasn’t causing much trouble. What surprised me was that nobody had heard of this side effect from hormone injections before. This is an uncommon complication.

Suchandra with her art, which supported her in tough times.

Boss Naari: That sounds challenging. How was your experience with delivery, given the cyst and the complications?

Suchandra: I was scared of normal delivery. I felt it was very painful, almost inhuman. I hoped for a C-section. But here in the Netherlands, people told me that a C-section is done only when something has gone wrong. They try normal delivery first and operate only if necessary. So you go through the pain of contractions and pushing, and then if something is wrong, they operate which means suffering the worst of both worlds.

In my case, the cyst wasn’t causing much trouble by my due date. Since there were no other complications, a midwife, nurse, and I handled the delivery smoothly without seeing a doctor face-to-face. One stigma here is about normal delivery without pain management. The most common pain relief is an epidural, and my advice is: don’t be a hero just take the epidural. It made my delivery process much more comfortable. After the epidural, I felt calm and warm during contractions.

The delivery went without complications. The anaesthesia team was very skilled, and the midwife was fantastic during pushing and delivery. My baby was delivered safely. However, the cyst was still there. They said they would wait six months post-delivery before deciding what to do.

Boss Naari: What happened after delivery with the cyst? Did you have to undergo any treatment or surgery later?

Suchandra: About one month after I delivered my baby, I had such intense pain one night that I had to rush to the emergency room. They did a scan, but again, they didn’t give me any pain medication until all the checks were done. I went to the ER around six or seven in the evening, but they only gave me pain relief at five in the morning. This is something I don’t like about the system here, they don’t do anything to ease your pain until they’ve completed all their checks. I had an operation the next day. They punctured the cyst, and 2 liters of fluid came out. It had been accumulating fluid and getting bigger and bigger. When the intense pain happened, the cyst was so large that it was twisting my ovary. After the operation, I lost 2 to 3 kilograms just from the fluid that had built up in my body.

Boss Naari: That sounds tough. Looking back, do you feel anything could have been done differently during your delivery or treatment to avoid this situation?

Suchandra: I would say two things went very wrong for me. First, this rare side effect from the hormone injections that I had no idea about. Second, when I initially said I was scared of delivering normally and asked if a C-section was possible, especially since I had this cyst had they done a C-section and removed the cyst then, I wouldn’t have had to go through this intense pain, the emergency, the operation, and the long recovery from a twisted ovary. This whole episode happened last July, and it’s March already. I’m still not my previous self. I feel like the doctors can help me, but the recovery has been really hard.

Boss Naari: I’m sorry you had to go through so much. Do you have any advice for someone going through IUI or facing a similar situation during pregnancy?

Suchandra: I did feel that they explained the entire process and the possible side effects, but I ended up being a victim of a very rare and unheard-of complication. So my advice would be: speak to your healthcare provider in detail, and ask them what can be done if something unexpected like this happens.

My main reason for doing this interview is to share that while the IUI process was smooth for me, it worked on the first try, and the delivery also went well, not everything is always smooth sailing. What went wrong for me was something no one warned me about.

In India, many people see IUI as hopeless and jump straight to IVF. I would say give IUI a chance once or twice because it's less intrusive and less expensive than IVF. But at the same time, be informed. Know that while complications are rare, they can happen, and it’s important to know how your healthcare system will handle them. Please be aware of my story, and make sure you talk through all the possible risks and backup plans with your doctors.