What No One Tells You About IVF Treatment

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To mark National Infertility Awareness Week, Refinery29 is dedicating a full week of coverage to an open discussion about becoming a parent. Check out more here.

What do you think of when you think of in vitro fertilization? Is it babies growing in test tubes; hospital gowns and needles and operations; grim prognoses delivered via medical mumbo-jumbo? Is it the Octomom?

To me, once upon a time, it was all of these things. Which is why, when I first stepped foot in a fertility clinic last April, I had already drawn a firm line in the sand: no IVF. Granted, I didn’t have a totally firm grasp of what the process actually entailed. All I knew was that it was unnatural, invasive, and expensive.

A year later, I’m doing IVF. Not just willingly. gladly. Today, I’m shocked at how little I understood when I wrote it off: not just about the medical side, but about the people who do it. People like your friends and family and neighbors. People like me.

In 2012, the most recent year for which the Society for Assisted Reproductive Technology offers data, fertility doctors performed 165,172 IVF procedures, resulting in 61,740 babies. But although IVF now accounts for 1.5% of live births in the U.S., the number of misconceptions about it is staggering.

But this isn’t about statistics. It’s about me.

Because behind every IVF statistic, there are real people who want a child more than anything in the world. We all have a story. Today, in honor of National Infertility Awareness Week, I’m sharing mine.

behind every IVF statistic, there are real people who want a child more than anything in the world.

I always knew it might take me a while to get pregnant. In college, I was diagnosed with PCOS, or Polycystic Ovarian Syndrome, which can cause irregular periods and lack of ovulation (among other fun things, like sudden obesity and excessive body hair). It can make getting pregnant hard — but, I was told, certainly not impossible.
Personally, I was optimistic. I’d heard great things about Clomid, a drug that can induce ovulation and is often considered the first line of defense in infertility treatment. It supposedly worked wonders for women with PCOS, and I personally knew at least two who had gotten pregnant on it right away.

When I first visited a fertility clinic at the age of 33, after trying to get pregnant naturally for over two years (twice as long as doctors recommend, because I was bullheaded and naïve), I honestly believed that Clomid was the answer. My doctor seemed to think the same. When the pregnancy test came back negative, I was shocked. So I tried again. And again.

After five cycles of Clomid (two with timed intercourse and three with intrauterine insemination, in which my husband’s sperm was manually inserted into my uterus with a catheter), I was no closer to motherhood than before.

At this point, I was told I had “unexplained infertility.” On paper, there was nothing wrong. All my hormone levels fell within normal range. I was growing good-sized follicles (the sacs on your ovaries that usually contain eggs) and ovulating within a normal timeframe. My husband’s sperm were little super-jizzers, above average in every sense. The next step, we were informed, was IVF. And suddenly, we had a really big decision to make.

When the pregnancy test came back negative, I was shocked. So I tried again. And again.

I’m sitting with my husband in a noodle bar in Chelsea, crying into my ramen because I just waited an hour to have a conversation with my doctor about IVF, only to be told that my (terrible) fertility clinic had mixed up my appointment, and she couldn't see me until the following week.

It’s a month during which I’ll cry almost daily. Clomid, that supposed miracle drug, has wreaked havoc on my hormones. I burst into tears whenever I see a stroller: problematic, since I live in Brooklyn’s notoriously family-friendly Park Slope neighborhood.

“Can we please consider adoption?” I beg, trying to hide my bloated, tear-stained face from the concerned waitstaff. I know that adoption is another rocky road, paved with uncertainty and heartbreak. But if Clomid is this bad, I can’t imagine what IVF will do.

My husband looks pained. He confesses that he’s always wanted his own biological children. Our biological children. I thought we talked about everything before we got married, but somehow we missed this.

“What if we try just one cycle?” he suggests. “And if it’s really bad, we can start filling out adoption paperwork and I’ll never bring it up again.”

Through my hormone-saturated haze, I think maybe that could work. I’ve tried a lot of seemingly terrifying things “just once,” like SCUBA diving and a tantric sex workshop I won in a raffle. Usually they turned out okay, and one time I even saw a sea turtle.

I agree to try IVF. But I’m done waiting an hour for a doctor who never shows. If I’m going to invest that kind of time and money, I’m finding a new clinic.

if Clomid is this bad, I can’t imagine what IVF will do.

IVF stands for in vitro fertilization. It’s a blanket term for the process of introducing a sperm and egg outside of the body, in a petri dish. Although in vitro is Latin for “in glass,” the term “test tube baby” is a bit of media sensationalism that, in my opinion, isn’t doing any of us any favors. Mixing some DNA in a petri dish doesn’t sound so bad, but Frankensteining a human baby in a test tube? Horrifying.

After choosing a more user-friendly fertility clinic, I scheduled a meeting with their full-time financial specialist. This was a necessary evil, since IVF is expensive as f*ck. It’s also, infuriatingly, covered by almost no insurance plans, despite the fact that infertility is a verified medical condition and the success rate of treatment with IVF can be as high as 77%.

According to the American Society for Reproductive Medicine, the average cost of an IVF cycle is $12,400. Since I’d be paying out-of-pocket for a service my insurance plan didn’t cover and, realistically, may need more than one cycle before I saw success, the financial specialist offered me an intriguing option: a package deal that allowed me to pre-pay for multiple cycles upfront. This plan would even return a percentage of our investment if we didn't, in the brochure’s words, “take home a baby.”

The package was offered through a third party, and I had to meet certain age and health requirements to qualify. Essentially, this third party is betting on IVF getting me knocked up, and fast. I took the bet.

I pre-paid $26,800 for three rounds of IVF. It was more money than I’d ever spent on anything, but ultimately it wasn’t a hard decision to make. I liked that I only had to pay it once and wouldn’t have to deal with billing for every procedure (something that had been a nightmare at my last clinic). Psychologically, it gave me peace of mind to have an end-point: If my three cycles didn’t pan out, it would be time to try something else.

I put it all on a brand-new Delta Amex (which I immediately began paying off by working 60-hour weeks at two different ad agencies), and was instantly bumped to Gold status on the airline — something I couldn’t enjoy, because from the time I signed on that dotted line I was essentially tethered to NYC by the hope of an umbilical cord.

IVF is expensive as f*ck. It’s also, infuriatingly, covered by almost no insurance plans.

Ironically, the first prescription my new IVF doctor wrote was for the birth control pill. This would put my reproductive system into a neutral state where it wasn’t producing eggs or ovulating and, because I’ve always had irregular periods (thanks, PCOS!), I would need its help to trigger a period within a normal timeframe. At that point, we’d start me on the serious IVF drugs: the hard stuff.

In a typical IVF cycle, you take a bunch of hormones that essentially trick your ovaries into freaking out and producing as many eggs as possible. In a normal, non-medicated cycle, a woman will produce one mature egg. With the help of these drugs, you can get up to 20. The more viable eggs you have, the more are available to mix with sperm and turn into embryos. This is a numbers game, and it’s important to start strong.

But here’s the thing about those drugs: they’re shots. Like, with needles. That my husband and I had to somehow finagle into my body every morning and night.

When my ice-packed, mail-order package of IVF drugs arrived, it was so big I could barely get my arms around it. It contained a bewildering assortment of glass vials and terrifying-looking needles, pill bottles and cotton pads, alcohol wipes and a red sharps disposal container covered in menacing logos. Some of the vials had to go into the fridge right away. Everything else took over a closet.

I’m pretty squeamish, so my husband was in charge of mixing the potions, prepping the syringes, and inserting them into my belly. All I had to do was stand there and wince. To my surprise, the pain wasn’t anything to write home about. The needles, though sharp, were small, and for the first time in my life I was happy about the extra padding around my midsection: It provided more real estate for the injections. In addition to two shots a day, I was also taking a prenatal vitamin and an extra pill of folic acid, and midway through my cycle I began progesterone suppositories (little goop-filled pods that I inserted twice a day like a tampon) and estrogen pills.

And it was working. Every two to five days, I visited the clinic for a blood draw and vaginal ultrasound. As the doctor penetrated my most intimate places, I watched her count and measure the egg-containing sacs on my ovaries: 16 good-sized follicles on my right ovary, 10 on my left, and growing. My doctor was psyched, and so was I. If this was a numbers game, I was winning.

I lay on a table in a vaguely pornographic position as a nurse pressed down on my belly with an ultrasound wand.

After two weeks of doing shots (and not the fun kind that make you show your tits at Mardi Gras), it was time for my “extraction”: the clinical term for getting knocked out and having the doctor go all up in my business to collect my eggs.

To prep for this, I had to take a trigger shot of HCG, a pregnancy hormone that signaled my body to release the eggs. The injection had to be timed exactly 36 hours before the extraction — a moment which, as luck would have it, fell on a Saturday night when we were throwing a massive birthday bash for one of our friends. This wasn’t the first time my husband and I had disappeared into a bathroom at a party together (we like each other, okay?), but it was the first time we emerged carrying a vial and a syringe. This was also around when I started coming clean to friends about my IVF treatment. It was either that or have them think I was a junkie.

My extraction was that Monday. I woke from a blissed-out anesthetic haze to learn that my doctor had harvested 11 eggs. Of those, nine were considered mature enough for fertilization. An embryologist manually inserted sperm into each egg under a microscope, using a process known as Intracytoplasmic Sperm Injection (ICSI, pronounced “ick-see”, for short). A day later, I got a phone call telling me that eight of the fertilized eggs had made it to the first stage of embryo development.

Again, this was a numbers game. I knew that some of the embryos would develop abnormalities or simply stop growing, indicating that they probably would have made a not-so-healthy human and been rejected by my body very early on. But the more healthy embryos we had, the more chances we had of growing a baby. Because having a goal seemed important, I prayed for a 50% success rate.

Theoretically, multiple embryos can be transferred back into the female body: That’s what happened with the Octomom. For patients over 40, doctors may transfer up to five embryos in the hope that at least one will stick. But because I was relatively young and healthy, this was my first IVF attempt, and multiple pregnancies carry a higher risk, my doctor recommended transferring just one. The rest would be frozen for future use. When the time came, all they had to do was thaw one out and pop it in, like a microwave burrito.

In an ideal scenario, doctors wait five days between the extraction and the embryo transfer. This gives them time to track the development by keeping an eye on things like cell division and symmetry. For me, those five days were both nerve-wracking and delightful: nerve-wracking as I waited for news about our precious embryos, and delightful because, since I wasn’t currently hosting any potential humans, I could have a glass of wine.

When I arrived for my embryo transfer, I was told that I had two beautiful, perfect embryos, and three that may or may not make it. I was devastated. All that work, for just two chances? And if only one-fifth of our embryos were viable, what did that say about us? All the statistics I’d tried so hard not to read about egg quality declining sharply in your mid-30s came swooping down on me, re-opening questions I thought I’d put to rest about my suitability to be a mom. The transfer was not off to a good start.

I also had to pee, viciously. I was told to arrive with a full bladder, which helps push the uterus into a position that enables the doctor to insert the embryo via a catheter. I have to pee every half-hour, religiously, and my transfer was running 40 minutes late. A nurse instructed me to go to the bathroom and “let it out for the count of three,” which is one of the strangest and most unpleasant sensations in the world. Finally, it was time to enter the operating room.

I lay on a table in a vaguely pornographic position as a nurse pressed down on my belly with an ultrasound wand. I could see my bladder, shaped like a big black jellybean, and a staticky mess that was supposedly my uterus and vaginal canal. The embryologist entered the room carrying what looked like a tiny white wand: this was the catheter, and our maybe-future-baby was nestled in its tip. My husband and I held hands and watched on the ultrasound monitor as the doctor threaded it up inside of me, a slim white line among all that static. When she removed it, a glowing white dot remained. This wasn’t really the embryo (it’s too small too see), but the dye surrounding it, telling them it had hit its mark.

If IVF has taught me anything, it’s to be patient with my body and myself.

My clinic’s IVF success rate for women my age is about 50% per transfer: a coin toss. I’d prepared myself mentally for the possibility of the first round not taking, so I was sad, but not completely devastated, when the news came back that my pregnancy test was negative. Since all four of my developing embryos had made it to maturity, I was comforted by the fact that I had four more chances before my next round of egg-harvesting.

But that’s when I learned one of the most surprising — and hardest — lessons about IVF: the cycles take twice as long. In order for my hormones to return to a neutral state, I had to go back on birth control for three weeks, get another period, and then begin a new five-week ordeal of shots, pills, and monitoring. What used to be 30 excruciating days was now stretched to 60. Yeesh.

My doctor assured me that this cycle would be easier, but I think she must have meant easier for her. Because we were suppressing my system in preparation for a frozen embryo transfer instead of pumping it full of egg-producing hormones, I only had to go in for monitoring once a week.

My home life was a different story. Thanks to a barrage of new tests that my doctor ordered after my first transfer failed, I had some fresh diagnoses and a whole new regimen of drugs. These included 10 pills a day, a painful injection of blood thinners that left giant bruises on my abdomen, and daily hormone shots, which required my husband to shove an inch-and-a-half long needle into my butt every night. IVF was becoming a pain in my ass — literally.

But it would all be worth it if it resulted in a child.

IVF was becoming a pain in my ass — literally.

By the time you see this post, I’ll either be celebrating my IVF success with sparkling cider and a onesie shopping spree or weeping into a bottle of Jack. Even if it’s the former, my joy will be cautious: Because of my new diagnoses and encroaching “advanced maternal age” (I turn 35 in a month), I’ll be facing a high-risk pregnancy fraught with as much fear as hope.

If it’s the latter, I’ll dry my tears and start the whole process over again.

If IVF has taught me anything, it’s to be patient with my body and myself. Every cycle is an opportunity to learn something new, whether it’s about my body’s autoimmune responses, the correct way to inject a blood thinner, or my own seemingly bottomless capacity for resilience. I’ve learned that I can go to the very depths of despair and resurface a few days later, ready for more. I’ve learned what it is to want something so badly that nothing will stand in your way.

Ultimately, the hardest thing for me about IVF was the decision to do it. To get there, I had to let go of my dream of conceiving easily and spontaneously. I had to come to terms with the fact that I was going to need medical intervention to have a child, and that wanting to try IVF before adoption isn’t necessarily selfish: It’s about giving my body a chance.

Mostly, I’ve learned to speak out. Women have suffered infertility in silence for centuries, steeped in shame over something that simply isn’t their fault. It’s that silence that leads to myths and misinformation, and it’s one of the things that prevent us from seeking treatment when we need it the most.

IVF, though certainly no picnic, hasn’t been nearly as horrible in real life as it was in my head. And while I wouldn’t wish infertility on anyone, my hope is that someday, everyone who needs this level of care to start a family will be able to receive it.

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