The Potential Costs of IVF…

Although I’m still hopeful that I’ll get pregnant with less invasive and expensive means, I have to be realistic that we may have to resort to IVF in order to have a kid (or, at least, any faint hope of having a kid.) IVF, i.e., “In-Vitro Fertilization,” is a fairly common practice nowadays. When I tell people that I’m having trouble getting pregnant, everyone  jumps to share with me how they know “so and so” who got pregnant with IVF. Simple.

In many cases, these friends of friends lived in a state where IVF is covered by insurance. They mention their friend had to “pay a lot,” but don’t realize that “a lot” is actually co-pays and deductibles, which is still a lot, but it’s not the a lot a lot that is what IVF costs without any infertility coverage, which is the case for most women/couples in America. (Only Massachusetts, New Jersey, Maryland, Connecticut and Illinois require insurance coverage of IVF — elsewhere it’s up to your company if and what they want to cover, which is usually nothing unless you work for Facebook or Google or a giant bank.)

The average cost of a “fresh cycle” of IVF in the US is $12,000-$16,000. Think that’s a lot of money? That doesn’t include any of the medication required  (that’s an extra $3000-$5000+), or optional add ons, such as embryo biopsy and screening. If you get enough eggs out in round one, they can be frozen (and fertilized), for an annual fee, and then frozen cycles later are a little cheaper, at $3000-$5000+ per cycle, plus medications and the optional costs.

According to AdvancedFertility.com, IVF with preimplantation genetic testing (with meds) and a subsequent frozen embryo transfer usually costs about $17,000 – $25,000 in the US.

For women under 35, there is a 47.5% chance that $25,000 will amount to a child. There’s more than a 50% chance that you won’t get pregnant, and that $25,000 will be out the door, never to be seen again. When you turn 35, your chances of live birth decrease slightly to 39.6%. After you turn 38, those go down much more to 28%.

It’s a strange industry — medical clinics set up to give you hope, but also provide a realism in how you’re throwing substantial money at something that may not work, not to mention that if you do have a kid you really need that money to feed, clothe and shelter it. As a woman gets older, the clock is ticking, and suddenly money seems less important than just giving it all you’ve got to have a child. Maybe it won’t work, and maybe you’ll be $100k poorer for it, but at least you’ll know you tried.

Or, perhaps, you move to a state where they cover a cycle or two of IVF.

First HCG Shot: How it Felt and the TWW

Last night, I had to – for the first time in my life – self-inject a drug into myself. I realize that diabetics and others have to do this regularly, and it’s not that big of a deal, but I let my fear-of-needles take a hold of me, which led to an hour-or-so panic attack and my poor husband trying to help me calm down, accomplished only by a shot of whiskey and finally getting up the guts to poke my stomach fat with the needle, injecting 1cc of HCG and water mix to “trigger” ovulation.

Admittedly, it wasn’t that painful – the injection itself didn’t hurt (I guess it’s a good thing I have so much fat) and it was only slightly uncomfortable when my husband helped me inject the substance – and then it was over. There was slight soreness at the site of the injection, but mostly I just felt a little dizzy and warm for a few minutes – I’m not sure if that was the medication or me just breathing for the first time in an hour.

The process of setting up the injections wasn’t that hard — we had a vial of water and one of powder, and we had to mix 1cc of water into the powder vial and shake it for 30 seconds, then the mixture was ready to be stabbed injected into my body.

As per doctor’s orders, we are to have TI twice this week, once after the injection and once two days later for the the best chance of insemination. I really wonder if this will work — there are so many variables that have to be right to get pregnant, it’s amazing anyone ever does. Now we enter the “TWW” – two week wait – and see if anything stuck. I don’t expect to get pregnant this cycle, though it could happen.

Cycle 1 CD11 2nd Ultrasound & Trigger Shot

So far, so good. I went in today for my second ultrasound of the cycle (another $350) and was informed that each ovary has one mature follicle — 17.7mm on my left and 19.4mm on my right. My lining is 9.6mm, which is good I guess (they didn’t tell me anything was abnormal with the lining) and DH and I are set to stab me (ahem, take my first “trigger shot”) tonight and then we’re instructed to have TI twice this week. And then we have our TWW (two week wait) and see if it worked – if not, we repeat the same thing again.

I wasn’t thrilled with my doctor’s bedside manner today – I understand he is much more engaged with patients who require IVF and my current treatment is fairly basic, but I’m paying $350 per appointment, it would be nice if I didn’t feel like I was being a nuisance asking questions. Apparently I should have taken better notes during the consultation (which was almost a year ago because I took some time before I decided to get started) — or I’m asking too many questions in general and should just do what they tell me to and not really know what is going on. I like to understand things, esp. medical-related things happening to my body, so I do ask a lot of questions.

If this cycle works, great. I’ll be freaked out in the way anyone is when they realize they’re about to bring another life into the world and there will be a nine month wait when they blow up like a watermelon leading up to the most painful experience in a normal human’s life (other than, you know, death, or, as my husband reminds me, stepping on a lego) — but also, ecstatic. And odds are still very slim right now… even super healthy women at my age only have a 20% or so chance of getting pregnant each month.

There’s also a slim chance that I’ll get pregnant with twins. I asked the doctor if the trigger should might make both of the mature follicles release eggs and he looked at me like I’m dumb and said “might? It will.” Now, just because two mature eggs release does not mean both (or either) will be fertilized and even if they are there are a host of things that could go wrong which is why it’s unlikely in any given cycle I’ll get pregnant at all. I’m saying this based on Internet research, not based on what my doctor told me, because he didn’t seem interested in explaining much of anything to me.

If it works, it works. I guess the TWW starts on the 13, with testing starting on the 27. That’s all we do at this point… trigger… TI… x2… then wait. It’s basically like normal reproduction with the added help of ensuring mature follicles and knowing when you’re ovulating.

Please send baby dust our way.

The Emotional Rollercoaster of Infertility

At my electrolysis appointment today, zapping those pesky laser-resistant PCOS chin hairs and cringing in pain (fun times), my face zapper told me about her experiences taking Clomid for her third child, sharing the multitude of emotional challenges and miscarriages faced before she was able to get pregnant and “it stuck.” I took a deep breath, in between the deep breaths of pain zaps, and wondered how I will be able to survive this emotional rollercoaster which lays before me to attempt having a child.

Having a kid is hard – as in, actually being a parent. Kids don’t give a shit about how your day is going, they need your attention and love and patience. Getting pregnant, when you have PCOS and don’t ovulate normally, is a whole other different kind of hard, and I am not sure I have the emotional strength for this. I think I can handle not getting pregnant — if it works it works, if it doesn’t, it doesn’t. But the very high risk of miscarriage as a woman with PCOS freaks me out. I know after the first 10 weeks the risk goes down a bit, but later-stage miscarriages do happen, and miscarries in general are quite common when your body is a metabolic disaster.

There are many woman who go through infertility treatments and eventually get pregnant and stay pregnant. There are others who try for years and give up, only to have a “miracle” child naturally years down the line. I’m trying to take this all one day at a time, accepting that what will be will be, but it’s really hard when you know you have only a set numbers of years left of peak fertility, and your mind starts drifting to wonder if you would have been better off being a teen mom and dropping out of high school vs waiting so long to establish yourself, find the perfect partner, and start trying with so little time left. I mean, even in a healthy person with normal ovulation, you only have 12 chances in a year to get pregnant are 20% in any given month. And that’s IF both partners are 100% healthy on the fertility fronts.

The odds start dropping fast when you have infertility problems. Sure, there are a lot of modern medical interventions to help, but they aren’t perfect, and plenty of couples have spent tens of thousands of dollars for only a whole lot of heartache. It’s just a lot to handle on top of all the other things one has to manage in life — and unlike other health-related problems which, granted, I’m grateful I do not have, infertility is something you must deal with silently. You have to take time off work, but don’t want to tell your boss that you’re getting blood tests or going to yet another ultrasound appointment. You are on meds that mess with your emotions, but no one can know that your sensitive state is caused by drugs you’re taking to try to induce ovulation, or that, even if you do get pregnant, you’re distracted by fear that you might miscarry, since the risks are so high.

That’s part of the reason I started this blog – I need an outlet to talk about this stuff, and it certainly won’t be something I bore my friends with outside of perhaps any major successes or losses. Here, I know that others who are going through the same thing will find a similar story, and hopefully we’ll all gain some comfort in knowing that we’re not alone. Maybe I’ll be lucky and the infertility portion of the blog will be short-lived… maybe this first round of Femera will make my body figure out how to work and poof, I’ll be pregnant in a heartbeat. But chances are, there will be many more blog posts to write, and many more stories of emotional and physical challenges to tell. Until next time…

Getting Pregnant with PCOS: The First Attempt

I’ve known since I was 15 that getting pregnant would be a challenge, but I didn’t think much of the said challenge then – I was worried about college and getting life started, not having kids with my “haven’t-met-him-yet” husband. Fast forward 18 years and I’m now married with a great partner, and we’re ready to have our first kid… however, it still won’t be easy.

I have Polycystic Ovary Syndrome (PCOS, for short) which is fairly common among women and causes a whole host of issues and health risks, with the most relevant to this blog post being that it often causes infertility. Women with PCOS (usually) do not ovulate regularly, or at all, which means it is not possible to get pregnant. Luckily for us ladies with PCOS, there are medical interventions which have been proven to increase the chances of getting pregnant, even though they can be expensive and there are no guarantees.

In most states, medical interventions for infertility are not covered by insurance. My insurance does not cover these costs, so I’ll also be documenting how much is spend on this journey here. We really want to have kids (two, ideally, though starting with one) so we’re currently of the mindset that we’ll do whatever it takes… but eventually the financial and mental toll could add up to too much, and we’ll have to either adopt or accept that we’re not meant to be parents.

I’m not ready to throw in the towel yet – since we’re just getting started. In order to begin treatment, the infertility specialist / clinic required that I have an ultrasound (to determine the quality of my ovaries and follicles), a bunch of blood work, including costly genetic testing, and my husband also needed some tests done as well (he’s perfectly healthy.) Once this was completed, the doctor told me I can start my first “Cycle,” i.e. first course of treatment starting the day you get your period and up until your next period.

Given that these appointments are costly and most places with good reputation are booked months, if not years in advance, I’ve opted not to get multiple opinions on these issues (yet.) I’m trusting this well-reviewed establishment will do the right things in order to increase my chances of getting pregnant, instead of wasting time shopping around.

During the ultrasound, the doctor said the good news is that I have a lot of follicles — the not-so-good news is that they aren’t maturing. Every month, one follicle from either right or left ovary is supposed to get bigger and eventually be released. If it isn’t fertilized, then you get a period. But, it’s also possible to get a period without ovulating at all, as the body can do weird things due to hormones and such.

The other thing I learned this year – opposed to what was taught in high school sex ed – there are actually only a few days per month a woman can get pregnant. The reality is that you can’t know what days those are exactly and cycles can get off, so you may be ovulating early or late, and since you can’t know then you could get pregnant at any time of your cycle. But – chances are you’re going to ovulate somewhere in the middle of the cycle, around day 14-18 if you’re ovulating regularly each month. This makes it easy to time intercourse with a reasonably high chance of getting pregnant if you do this for a few months in a row. However, with PCOS and irregular periods, you have no idea when you’re ovulating – so unless you have sex every day for a year and you happen to ovulate occasionally, your odds of getting pregnant are very low.

I’m not going to get pregnant “naturally,” so the doctor decided to start me on Femera (Letrozole), which is a drug that was originally intended to treat breast cancer, but is now used to help women ovulate. The better-known infertility drug is Clomid, which is another option should this not work, but he prefers to start with Femera because there are less side effects and less chance of multiples (I wouldn’t mind twins, esp given my age and goal to have at least two kids, but any more than that and I don’t know what we’d do.)

Although I’ve read online that most women are told to take Femera on CD (cycle day) 5-9 or 3-7, my doctor told me to take it on CD 1-5. I go in for an ultrasound on CD 9, and he will see if any of my follicles have matured. He mentioned that one of my problems (if not the only problem in this case) is that the “signal” from my brain to my ovaries is not sending straight, so the medicine can make that signal a lot stronger and make me ovulate. If the ultrasound shows that I am indeed en route to ovulation, then this is a very good sign. Even if it does work, there’s only a 20% (1-in-5) chance that we’ll get pregnant in any give cycle and the added challenge that women with PCOS are more likely to miscarry. Overall, I’m trying not to get my hopes up — not until I deliver a healthy child.

I don’t exactly feel ready to be a mother, but if not now than it will never happen. I’ll be 34 in November, and I’d like to have my first child before 35 if possible, with my second before I turn 37 or 38 at the latest – which already makes me an older parent. Side note, it’s incredibly strange now being a (potential) older mom, when I don’t feel so old at all. There really needs to be an extra decade of life between one’s 20s and 30s. I’m avoiding thinking about the fact that in 6.5 years I’ll be 40. Life goes too fast, hence the name of this blog… I’ve always loved the saying “life is what happens when making other plans.” Thus, this blog today is about planning for having a kid, but it may end up being about not being able to have a child – or, it may be about having children and striving to be the best mother I can be. For now, I’ll document my infertility journey and share any learnings along the way. Hopefully, in the next 24 months, there will a picture of my  beautiful son or daughter that I can share, along with a huge smile on my face. I genuinely look forward to meeting my future child. I hope I will be able to, one day.