I was very fortunate to not need IVF in the end, but I did start the process. What I learned was very interesting and I wanted to share it because people should have more information about their reproductive choices.
But before I go into IVF, let me go on a rant about people who criticize people who choose to do IVF.
Yes, IVF (even when covered by insurance) is expensive, but people have a right to determine how they choose to create their family, whether it’s not to have children at all, stepchildren through marriage, IVF & other fertility assistance, surrogacy, or adoption, etc. I find it absolutely infuriating when people criticize and scorn people who choose to do IVF. Adoption is frequently given as the “morally correct” way to have children if you cannot conceive naturally.
Let me tell you why this is 100% wrong.
Adoption is NOT any easier, and often times it is not any cheaper, and in fact, in many cases it’s actually more expensive than IVF. In April 2020 Shalane Flanagan and her husband adopted a baby boy and she received a lot of praise for adopting and not doing IVF to create her family. I am not criticizing Flanagan’s decision to adopt, I am criticizing people’s praise that adoption is somehow a better option for everyone who wants a family, but can’t do it through natural conception. While I don’t know the exact adoption process for Flanagan, I do know 1) she adopted a healthy White baby boy in the US, and 2) she was able to get custody of the baby right after birth. Based on this, I surmise that Flanagan did a private adoption (types of adoption). My mother who used to work in fostering and adoptions in LA County agreed with me in this assessment. Private adoption is the most expensive type of adoption with an average cost of around $40,000. The average cost of basic IVF is $12,000 (not including medication and genetic testing). Yes, there are ways to make adoption cheaper, like fostering-to-adopt, but no matter which route you take in adoption, it is difficult. Adoption does not guarantee you a child. I have friends who have gone down the adoption route and not all were able to get a child in the end. In adoption, you’re relying on social workers to deem you to a suitable parent and and in some cases, biological parents to pick you as being a suitable parent. I can only imagine the emotional pain that people feel when they are not approved for adoption or not selected. It’s one thing if you think your body is failing to give you a child. It’s a whole other level of emotional pain if other people think you don’t deserve to be a parent and deny you your chance to be one. I am not criticizing the process that of making sure that the potential adoptive parents are not abusive, can financially support the child, etc, but this is a hurdle that people seeking adoption must go through that you don’t need to go through for natural conception or assisted reproduction. The adoption process, especially if you’re doing foster-to-adopt, can take years. Adoption is not a simple solution to having a child. It is one way in which people can become parents. Okay, rant is over.
In New York state, health insurance must cover IVF and my insurance covers three rounds, but even with this, I would have had out of pocket costs. Medication and genetic testing are not covered. The cost of medication would have been anywhere from $3000 – $7000 per round, depending upon the types of medication the RE (reproductive endocrinologist) prescribes and where I source them. Genetic testing would have depended on the number of embryos. I don’t remember the cost they quoted me for, but if I remember correctly it would have been a few hundred dollars per embryo. Plus there could have also been other medical treatments that I needed to prepare for a cycle that would have been out of pocket as well. In short, I was mentally planning on paying about $10,000 per IVF cycle.
I was very naive about the entire IVF process because I knew so little about it. Literally before I went in for the consultation, I thought all it involved was going to the clinic, getting the medication that day, and then I start jabbing myself in the stomach. Before you even get to the stimulation stage (i.e., injecting yourself with hormones), there’s a lot to do and depending on the clinic and where you are in your cycle when you first go in for a consultation, it’s usually about one to two months before you can start stimulation.
I chose the Fertility Center at NYU Lagone, mostly because my friend and his wife chose that clinic. They had already done extensive research and since in the past my decisions and choices aligned with theirs in a variety of matters, I felt very comfortable in choosing the same clinic. They were about a month ahead in the process and I found it really nice to have someone to talk to about what to expect. I found the prospect of IVF intimidating because 1) ALL THE INJECTIONS and 2) I had no idea what was going to happen. Having someone to talk to and was going through the same process made IVF less scary. The other thing I found helpful was watching YouTubers talking about their IVF journey. I learned a lot and found comfort from other women who talked about and showed how scared they were of the injections but they learned how to give it themselves and what they did to make the process more tolerable.
The other thing I liked about this clinic is that they had a full-time person whose job it was to walk through insurance coverage and payment. So I knew exactly what my insurance would cover and what they wouldn’t cover and how much those things would cost.
Every clinic has a different process, so your experience with IVF may not be the same as mine and remember, I never went through the entire process. During my first visit, I just had to give a blood sample so they could measure my AMH (anti-mullerian hormone) level. This test is done to estimate the ovarian reserve, or how many eggs a woman has left. They wanted this done first so the RE would have the result when I went in for the consultation. A woman is born with all the eggs she will ever have (1-2 million). Now I thought because usually a single egg is released at each menstrual cycle and you’re born with over a million, this meant you had PLENTY of eggs. Not true. Apparently hundred to thousands of eggs die each month, so you have considerably less eggs when you’re older and you might have run out of eggs long before you reach menopause. WHY DOES NO ONE TEACH YOU THESE THINGS IN THE “HERE’S HOW BABIES ARE MADE AND NOW DON’T GET PREGNANT” lesson?
A few weeks later I met with the RE to discuss reproductive options. Originally I had (another naive) idea that I would pursue less aggressive treatments, like Clomid (medication to increase the growth and release of eggs) and IUI (intrauterine insemination, aka artificial insemination) before IVF. The RE was very frank with me about my options. Clomid and IUI each only increase the likelihood of getting pregnant by 1% for each cycle (Who knew it was so low? I didn’t.). The overall success rate for IVF for each cycle is about 35% (but obviously very much dependent upon age of the woman, actually the age of the egg). I was 42 when I saw the RE and he said, “While I don’t want to say you’re running out of time, time is not on your side.” Basically at my age, every six months fertility drops considerably and at 43, it would be very difficult for me to get pregnant. I really liked the doctor and appreciated that he laid out all the facts and let me choose. Basically I saw that my only real option was IVF, so I told him that I was ready to start.
We went over my AMH level, which was very good (equivalent to a woman in her early 30s) and he conducted an ultrasound to look at the health of my baby-making parts. Everything looked good. He looked at the ovaries to see how many maturing follicles I had. He figured that with medication, I could quite possibly produce as many as 20 mature eggs, which would be great because at every stage of IVF, you lose eggs/embryos. Having as many eggs as possible increases the odds that you’ll have a viable embryo to implant at the end of the cycle.
They took another blood sample to do genetic testing to see if I was a carrier for any diseases and other tests. Ben also would have needed to go in to do tests to see if he had any infertility issues, if I hadn’t gotten pregnant later that month. (If you want to learn about what it’s like for a man to give a sample for fertility testing, please see this from Mike Birbiglia in his show The New One. I sent that clip to my friend and he said while it was accurate, apparently his actual experience is even worse than what Birbiglia described.)
At the end of the month they called me with the results from the genetic testing. They tested for over 350 diseases and remarkably I was not a carrier for any of them. This is actually unusual because most people are a carrier for something. It’s usually not a problem because the disease is rare, so it’s unlikely the partner is also a carrier for that same disease. If both you and your partner are carriers, then they would been to do a screening on the embryos to see if the embryo has two copies of the gene with the disease. The other result that they informed me was that I did not have any immunity against the measles so I would either need to get a doctor’s note stating that I had received the second vaccine for MMR or get the MMR vaccine again and wait a month before I can start IVF because the MMR vaccine poses a risk to a fetus. This is what I mean when I say you don’t know what’s going to happen in IVF because something could always come up to delay the start.
The timeline was roughly late November for first visit to the clinic, mid-December for RE consultation with expectation of a January start for IVF, but needing the MMR vaccine would have caused me to delay to a February start. The timing of the IVF cycle is important because I also learned at the consultation that while you’re taking the stimulation drugs, you will need to go into the clinic every day or every other day so that they can monitor the growth of the follicles (so travel is out during this period). Also exercise is not permitted during this time because of the risk of ovarian torsion (because of the hormones, the ovaries grow in size and there’s a real risk that the ovaries can twist upon themselves).
This obviously would have interfered with my Boston Marathon training because at this time we didn’t know about the HORRIBLE AWFUL PANDEMIC that was about to come down upon us. If I had more time, I would have delayed the start of IVF until after Boston, but I was running against a clock so I made the decision that I would start as soon as I could and if I had to stop training in the middle of a marathon training cycle, well, then it would be what it would be.
I left the consultation feeling really good about my decision and plan. We had one more chance to conceive naturally before I start IVF. I remember thinking on New Year’s Eve that if all went well, then in 2020 I would have a child in my life.