History: When we first began trying to conceive, my wife and I expected that my medical history and the fact that we’re an LGBTQIA+ couple would present challenges. But our fertility journey ended up being more complicated than we expected.
Occupation: Medical Research
Household Income: $100,000 (£71,000)
Deciding we want a baby
My wife and I have been together for years, but this is the first time we begin seriously discussing having kids. We join groups on Facebook that are dedicated to LGBTQIA+ people trying to conceive. They’re extremely helpful and eye-opening, but due to my medical history, I’m not even sure it would be safe for me to go through pregnancy. When I was 25 years old, I developed bilateral massive pulmonary embolisms — blood clots in the lungs — and almost lost my life. I know pregnancy naturally increases the risk of developing blood clots, so this worries me. We decide to book a doctor’s appointment with a reproductive endocrinologist (RE) to see what’s possible, and they suggest we see a maternal foetal medicine (MFM) specialist.
The Final Verdict
The MFM says I can safely get pregnant, as long as I’m monitored by both an MFM doctor and a haematologist. Weighing the risks of my medical condition with that of my desires to have a family is really hard. My wife and I decided that we’ll proceed with IUI (intrauterine insemination). Since I’m older, I’m planning to try to get pregnant first; if all goes as planned, my wife will try to have our second baby. I’m so appreciative just to have the chance to try and have a little one, and am excited for the next steps.
Cost: $60 (£43) total for co-pays for two appointments.
May through August 2017
After a test reveals a large polyp in my uterus and I have surgery to remove it, we pick a sperm bank and choose a donor — a very personal decision. We have three vials of sperm shipped to our clinic.
I attempt my first two IUI cycles in July and August. They’re both medicated cycles, which means I’m taking the drug Letrozole to encourage my follicles (which hold eggs) to grow — a low dose since I have polycystic ovary syndrome (PCOS) and the doctors want to see how my body responds.
Unfortunately, both of these cycles don’t go as planned, and I ovulate before my follicles reach maturity. I’m very frustrated. For these two cancelled cycles, my biggest expense is my time; my out-of-pocket costs are minimal.
Cost: $1,170 (£840) total. $1,150 (£827) for three vials of sperm and shipping. The surgery is covered by insurance, and it’s $20 (£13) for medication. Everything else is covered.
September through December 2017
Try, try again
Finally, we find the right dose of Letrozole, and I’m able to go through the entire IUI cycle. Getting the sperm injected into my uterus is quick, easy, and painless. Graciously, the doctor allows my wife to inject the sperm into the catheter, essentially “performing” the IUI herself. While she was initially hesitant, it becomes the most “exciting” part of the process. Afterwards, my wife and I take a few minutes in the room alone to reflect. After the experience of the past few months, just getting to do the IUI seems monumental.
But… with only about a 10% success rate, it’s not surprising that this first IUI fails. In the next few months, we do three more of them, all without success.
Cost: $4,105 (£2,887) total. $3,200 (£2,301) for four IUI procedures, which are not covered by insurance. $800 (£575) for two additional vials of sperm plus shipping, $100 (£72) for medication, $5 (£3.50) for pregnancy tests. Labs and ultrasounds are covered in full.
Clearing our heads
After four discouraging outcomes, we’re hesitantly giving this another shot.
We take a relaxing trip to Denver to celebrate my wife’s birthday, and the day after we get back, I go in for my first monitoring ultrasound. Our nurse encourages me to use an Ovidrel trigger shot that night. I do, and to my extreme shock, 13 days after the IUI, a second pink line shows up on a pregnancy test. I run screaming into our bedroom and wake up my wife to tell her the news.
Cost: $855 (£614) total. $800 (£575) for the IUI, $35 (£35) for medication, and $20 (£14) for pregnancy tests.
A tragic turn
My pregnancy is going very smoothly, until one day, everything changes. At 38 weeks, I go to the hospital after not feeling movement for several hours. My son has passed away from a true knot in his umbilical cord. I have also unknowingly developed severe preeclampsia — a serious condition when your blood pressure becomes abnormally high — and am very sick.
Despite my son being stillborn, meeting him was one of the happiest days of my life. I laboured endlessly, which was hard and traumatic. As the customary celebrations of birth were absent that day, I simply heard a voice say, “Look who I have!” And then the moment happened — the moment when the lights came on, and the engines roared to life. I looked over and my wife was holding our son. It was the most beautiful moment of my life up to that point.
There were no tears in the OR that day, not from us at least. Somehow, there was no room for grief in those first moments, meeting him for the first and last time, all at once. Those were moments of true love.
Cost: $0. My hospital stay was covered in full.
In a moment of desperation, as I grieve, I purchase three more vials of sperm and ship them to my clinic. I can’t let my pain decimate our dream. After purchasing the sperm I feel dead inside. I wish there was a way to fill this gigantic hole where my son should be. It’s important to me to be able to carry a piece of him forward, and so I want to make sure I can use the same donor when we try again. This was always a part of our plan, but we didn’t plan for our baby to die, so now is not the time to take chances. While it’s extremely unlikely that our donor would not be available in the future, I rationalise this in my head as the “right” thing to do right now.
Cost: $1,150 (£827) for three more vials of sperm and shipping.
January through June 2019
My wife and I lean on each other after the loss of our son. We feel isolated and alone but connect with our feelings through therapy and support groups. Meeting others that survived the pain we feel gives us hope and a sense of community, even though it’s one no one ever wants to be a part of. Slowly, we begin to work with our medical team to discuss resuming fertility treatments. They tell me I must wait nine months to try again because I ultimately had a C-section with my son and need to heal. I am crushed, but understand this is for the health and safety of both me and a baby.
Originally, our plan was for my wife to carry next, but I feel a deep urge to try again myself — a “vendetta” of sorts to “right the wrongs” of what has happened. After talking it over, we decide that I will try again.
We take a trip to Yellowstone and the pure beauty of the park, the space, and the animals help restore my fragile soul. Several days prior to leaving, I completed my sixth IUI, the first after my stillbirth. I have a dream that my pregnancy test is positive. My dream comes true, but this time I only feel fear. Can I really do this again?
Cot: $855 (£614) total. $800 (£575) for the IUI, $35 (£35) for medication, and $20 (£14) for pregnancy tests.
August to September 2019
My fears are validated when I go for my first ultrasound and the pregnancy is measuring behind. The doctor is clearly not comfortable having difficult conversations, but we plead for transparency and honesty about what is going on. She tells us “not to lose sleep” over this news. We try to wrap our minds around such a statement after all we’ve been through. We cry in the car on the way home. Without the support of my wife, I feel like I could not have navigated these difficult times. She is always a pillar of strength, even when I know she is struggling, too. She tells me how helpless she feels, and I feel like I am letting her down again. She doesn’t deserve this pain; no one does.
After living in limbo for over two weeks, the heartbeat is no longer seen on ultrasound. I have a procedure called manual vacuum aspiration (MVA) to help things along. It’s a holiday weekend so I have to wait extra time and we receive very poor care. My wife is repeatedly mistaken as the patient, and then once I am taken back for the procedure, she is never updated by the medical staff. I am heartbroken.
A fresh start
After two more failed IUIs, we decide to turn to IVF. We hear about a clinic in New York that’s more affordable than the local ones. We decide to schedule a consultation and are shocked that they can get us in within two weeks. We end 2019 feeling hope for the first time in a long time.
Cost: $1,823.26 (£1,311.23) total. $1,600 (£1221.86) for the IUIs, $70 (£50.34) for medication, and $5 (£3.60) for pregnancy tests. $148.26 (£106.62) for gas, food, and tolls. We used hotel points to stay one night for free near the clinic.
January through 2020
We start the process of getting medications for my egg retrieval. We are able to take advantage of a medication benefit through the insurance provided by my employer. We also arrange and ship a vial of sperm to our new clinic.
We ultimately travel to New York for the egg retrieval, which yields 13 eggs. After a very stressful week, we learned that only one embryo has made it to the stage where it can be implanted in my uterus. But first, we have to have genetic testing done on it to make sure it can even survive. We’ve got our fingers crossed.
Cost: $5,553.54 (£3993.92) total. $1,144.47 (£823.06) for medications and supplies for my egg retrieval and frozen embryo transfer. $530 (£381.16) to transfer and ship our sperm to the new clinic. $3,700 (£2660.91) for fees for the egg retrieval; travel costs include hotel points for a one-night stay, $77.71 (£55.89) in gas, $82.36 (£59.23) for food, and $19 (£13.66) for tolls.
Right into the fire
I hide in our supply closet at work to receive the news that our one embryo is okay — no genetic abnormalities were found. Stunned, I called my wife crying with relief that perhaps this could actually work out.
In the middle of preparation for my frozen embryo transfer, life as we know it is changing rapidly. COVID-19 has taken over and I’m glued to our clinic’s social media channels to keep up-to-date on possible closures or cancellations. We make the difficult decision to drive directly from Michigan to New York overnight, complete our transfer, and return directly to Michigan. We only stop for gas, and we take food with us. It’s so stressful. When we return home, I fall down a flight of stairs. I’m convinced everything is ruined.
However, nine days later, that faint second line appears again on the pregnancy test, like the rising sun.
Cost: $2,358.59 (£1,696.22) total. $1,650 (£1186.62) for genetic testing of the embryo, $600 (£431.50) fee for the frozen embryo transfer, $30.45 (£21.90) in tolls, and $78.14 (£56.20) in gas.
April through September 2020
Should we do this again?!
Our clinic is offering a discount for patients who pay for an IVF cycle upfront. Although our one embryo has resulted in pregnancy, we know it’s not a promise that this baby will be born alive. We also would like to have more than one living child, so we think we’ll need to do another IVF cycle at some point in the future anyway. After much debate, we decide to purchase a second cycle. A frozen embryo transfer is included in the price.
Due to the complications I’ve had so far, we decide my wife will undergo IVF this time. We already knew that she also has PCOS, but lab work shows that her thyroid levels (TSH) are a little high, so she’s started on medication to control it.
Cost: $3,705 (£2,664.51) fee for one future IVF cycle. $4 (£2.88) for the thyroid medication. The HSG and labs are covered in full, as we are both covered under my employer-based insurance plan.
A beautiful breath
Navigating pregnancy after loss is incredibly difficult. I get through it with the help of my wife and community. Ultimately, I deliver a healthy baby girl. It does not undo all of the pain I’ve felt over the past four years, but I do feel a release of the anguish and grief that had been following me on each step of this journey.
Cost: $0. My hospital stay for myself and my daughter was covered in full.
Watching the clock
The pressure to complete our next IVF cycle for my wife is mounting. I’m consumed with worry that because she also has PCOS, she may have a low number of embryos too. I want to get this going so we know what we are working with. Our medication benefit through my insurance, which only covered a portion of the more expensive medications, has now run out. To save, we are using some of my leftover medications.
Cost: $190.66 (£137.12) for medication for a stimulation cycle; labs and ultrasounds leading up to egg retrieval are covered in full.
We pack up our hopes and family and take off for the New York clinic for the egg retrieval. Due to COVID, I stay in the car with the baby, though I wish I could take her inside to thank the staff for giving us our miracle. My wife comes out and is feeling really good. They were able to retrieve 13 eggs, the same number as I had. I am not sure how to feel about this, but she helps me remain positive.
After an extremely long week of waiting, we find out that we have eight embryos to send for genetic testing. I am so, so shocked and thankful. I know our chances are good to have some of those that test normal.
On the day our daughter turns six months old, we find out that seven of my wife’s embryos have tested for no abnormalities. We dance and laugh and cry with happiness. For the first time, I feel relief that we can work with that number of embryos to complete our family.
Cost: $3,324.68 (£2,391.00) total. We pay $2,650 (£1,905.79) in fees for genetic testing, $350 (£251.71) for yearly storage of our new embryos, and $150 (£107.87) fee for monitoring at our local clinic. Travel costs include $79.42 (£57.12) in gas, $72.26 (£51.97) for food, and $23 (£16.54) for tolls. The IVF cycle fees were paid last year and we had sperm leftover from the first retrieval. We also did not have hotel costs, as we received a free night’s stay.
Total Cost: $25,150.73
Reflection: Going through fertility treatments opened my eyes to the disparities in healthcare that LGBTQIA+ individuals face. Fertility treatments are prohibitively expensive.
At different times, we had to advocate to be treated with respect. We sourced much of our knowledge from the internet and often felt alone. We also learned how truly hard it is to become (and stay) pregnant and how many people suffer in silence. While IVF worked for us, it is not a guarantee that you’ll bring home a baby. It’s a very personal journey that can carry a painful stigma. I realise that I come from an extreme place of privilege. Looking at the total number that we spent, we are well below the average that people often spend on fertility, and we have one living baby with a chance for more.
Additionally, pregnancy loss is an isolating and sad journey and I often found it difficult to connect to those that could not be with me in my grief. My daughter does not replace my son, but I am learning to love him through her. I’ve learned that love and grief can both exist at the same time and I am forever grateful that this experience brought my wife and me closer together instead of tearing us apart. In good times and bad, our love for our children guides us each and every day.
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