I'm 40, Have Little Savings, & Just Spent $26K On IVF. This Is My Fertility Diary

History: Two Mondays ago I turned 40, and the next day I went in for monitoring for my first (and only — if my biggest birthday wish ever came true) IVF cycle. I remarried two years ago, and since then it’s been three IUIs, and lots of natural...erhh, trying that got me here. I’ve never been pregnant (despite previous attempts with my first husband in my late 20s), and at this time have not been diagnosed with endometriosis, PCOS, or any other conditions that would hinder my efforts. So what I’m working with is a big ol’ question mark that we in the game call “unexplained infertility,” and *Marisa Tomei foot-stomping voice* my biological clock is ticking like THIS.

Age: 40
Location: New York, NY
Occupation: Editorial Director

My partner and I first decided to meet with a fertility specialist a few weeks after we got married because we’d been “casually trying” for months. I say casually because I wasn’t taking hormones, wasn’t peeing on any ovulation sticks, and was simply tracking my cycle on an app. I was 38 and he was 36. I was also previously married and tried for a baby in my late 20s with no success, so I was worried there might be something wrong. The doctor we made an appointment with was recommended by a trusted friend who had been through an unfair share of miscarriages and other fertility hurdles.

So, two weeks after our mini honeymoon, we went to visit a doctor at a highly regarded clinic. We liked her immediately, so after the appointment, I researched her, asked around, and found a few more people who went to her and had only positive things to say. We then decided to move forward, and get all of our blood work done. This included basic STD checks along with thyroid, CBC panels, and DNA testing. My husband also had a sperm analysis.

Cost: $250 for consultation, $150 for sperm analysis, and $300 for DNA testing. I believe the doctor’s office did some voodoo with the coding because my insurance at the time did not cover any fertility assistance

I scheduled a hysterosalpingography (HSG), also called a uterosalpingography, a.k.a the dreaded “ink test” to see if there was any blockage happening. This test blows, TBH. But, it’s not as bad as I worked it up to be. After countless Google searches about how painful the ink test would be, and reading way too much on it, I finally settled on telling myself: “Listen, you want a child, so if you can’t handle a five-minute ink test, then this may not be the path for you. So shut up and stop whining, self.”

This is something I continue to say over and over again throughout my fertility journey. Anyway, back to the test. It was uncomfortable, it feels unnatural, the machine is too loud, it’s messy, and it made me weirdly nauseous while it was happening, but it was over fast. Also, the results are pretty immediate, and my doctor told me I was in the clear. My tubes were not blocked — hurray! Despite being 38, I was the perfect specimen of fertility health. I am Venus, goddess of fertility, now get me the F out of this hospital, I thought.

Cost: $600; my insurance at the time did not cover any fertility treatments or testing

It had been almost a year since we met with the doctor and got everything checked out. Looking back, I wish I hadn’t waited that year, but life happens. We were enjoying our first year of marriage, “trying” naturally, and I switched jobs. My partner also lost his. We traveled and dealt with a few other big life things. I definitely felt the pang of disappointment each month when I got my period, but I just... I suppose I wasn’t ready financially (my last job didn’t cover any fertility treatments and my husband was now independently employed). I was also so busy with other things. I wasn’t really focused on the medical assistance route. My tests all checked out, I was only 38... but now I was 39 and nothing was happening. So back to the doctor we went to speak about next steps.

Since my new insurance covered IUI treatments, my doctor suggested we try three rounds. She said three was the most I should try at my age, since if it doesn’t work in three tries, the probability of it working at all drops. Intrauterine insemination (IUI) is pretty noninvasive, and it’s a good first step to get your life accustomed to all the clinic visits and monitoring.

Cost: $30 copay, since my new insurance covers IUI treatments, I mostly have $30 copays now

So it’s two months since we decided to move forward with the IUI treatments, and we’re finally going for the first one. The reason two months went by is that November is the busiest month of work for me, and I was still new at the company. I was overwhelmed. In December we took a vacation while I was ovulating. When you start assisted fertility treatments of any kind, you have to plan on focusing on it. Not meaning you need to agonize over it at every moment of the day (although that’ll inevitably happen in waves), but you need to be present to make it a priority. We got back from holiday, it was a new year, and we were finally ready to do the thing.

Cost: $30 copay

The mindset of “do the thing” is a cruel joke for those dealing with infertility. You have almost no control. I’ve been taking Clomid, a follicle-stimulating hormone that helps increase egg production, for about a week, and that shit makes me nuts. I cry easily, I am weirdly emotional, and I’m all of a sudden feeling helpless. I don’t think it was all on the Clomid, but something switched once I started visiting the clinic — which, by the way, is not a terrible place. The nurses were kind, it was immaculate, and if you got there early enough (I arrived at 6:45 a.m. the first time because I thought I had to), you got your bloodwork and ultrasound done with care and in lightning speed. I was in and out in 15 minutes.

Cost: Free as insurance covers all IUI monitoring

The second time I went to the clinic, armed with the knowledge that you can go at any time you want between 6:45 and 9:30 a.m., I arrived at 8:15 a.m. Big mistake. The place was packed. It felt like half the women in town were here doing exactly what I was doing.

Cost: Free

The third time I went to the clinic, my test results showed that it was time for insemination. Before this happens, you sometimes get a trigger shot. This shot is done to trigger ovulation and help time it so that it happens 36 hours later. That’s when I’d go back to get the IUI done. I can be a giant baby sometimes — for example, I eat prenatal gummies because the pills are just too. damn. big. — so I did not like the looks of the giant needle. I trusted the clinic and the nurse, however, so I pulled down my waistband, faced the wall, and got a shot right on top of my butt before heading off to work. It stung a little, but in the end, no biggie.

Cost: $50 copay for the trigger shot

On the day of the IUI, my husband and I went up to a quieter floor of the clinic where he “produced” his semen. Since I’m apparently not as mature as I should be, I had many questions about this specimen room. We joked about how he had it easy. The clinic then washes the semen, and handed us a small vial of concentrated sperm — just the best guys apparently. That’s the point of washing. To clean out the duds and make sure you’re getting the most mobile straight shooters you can get. I then took this vial back down to what was basically Grand Central Station (since it was now prime time at the clinic), and awaited to be inseminated with my husband’s sperm. The insemination process itself was so quick and noninvasive that I questioned how it could possibly work. The doctor on call took the sperm, attached it to a catheter and then inserted it into my cervix so it could reach my uterus. After, I continued to lie on the table for 10 minutes. Then I got up and left. It didn’t hurt, and I was sort of like, that’s...it? Yep, that’s it. Basically, it’s just like giving the sperm a running start. A slingshot towards the finish line, if you will.

Cost: $60 copay

If you ever embark on your own fertility “journey” get ready for the acronyms. Lots and lots of acronyms. They range from legitimate scientific terms like FSH (Follicle Stimulating Hormones) to cutesy ones like BFP/BFN (Big Fat Positive/Big Fat Negative). Fertility boards are littered with these, and I’m still a bit under water when it comes to all the terminology. In case it’s helpful, I sometimes use this handy-dandy TTC (Trying To Conceive) glossary from Co Fertility. I’ve gone figuratively running from an online forum once when a woman dropped the SBD acronym into the convo and wrote in parenthesis (sideways baby dance). You know what else is three letters? The word SEX. But, what I’ve learned from this experience is that everyone needs to deal with it in their own way. Whatever helps you cope or lightens you up during this dark, distressing time — do it.

Anyway, the 2WW (two-week wait) is the worst. This is the time between ovulation and your period where anything and everything can be a sign that you’re indeed pregnant. My salad smells weird — heightened sense of smell! I had a cramp — *Googles can you feel implantation?* Apparently not, but maybe I can. A baby on the train looked at me — it’s a sign from God, I must be pregnant! Spotting the day before my period is due... perhaps that’s the implantation and not actually my period coming? Nope, it’s my period. Tears in the office bathroom. Will try again next time.

Another IUI that didn’t take. This seriously sucks, and it’s becoming harder to act like a normal, non-weepy person around my best friend who’s due in June.

Cost: $60 copay

IUI number three. At this point I’m feeling like IUI is a joke for me. I wasn’t able to do it in March because of work travel, and I was feeling pretty defeated in April. Everyone, and I mean ev-er-y-one, will tell you that you have to, “Stay positive! Don’t stress! Believe it will happen!” But something about the IUI for me just seemed so lacking. At this point I was just doing it because my insurance covered it. It wasn’t hurting my chances, so why not.

Cost: $60 copay

After three failed IUI cycles, my husband and I went back to the doctor to discuss the next step — IVF (In Vitro Fertilization). But before we started, she wanted me to do blood work again and get another ultrasound to re-check my tubes. This time the procedure was done with saline rather than iodine, so it was a much lighter version of the “ink test.” Again, the results came back fine, but my blood work came back with heightened (TSH) thyroid-stimulating hormone — meaning Hypothyroid disease. I am not going to get all science-y (mostly because I can’t and if I could, it’d get real boring), but since my numbers were a little high, my doctor prescribed Levothyroxine to get me to a better place for what I like to think of as, ultimate fertility domination. I had to take this for two months before starting IVF.

Cost: Levothyroxine is covered by insurance and came with a $15 copay

I was out at a conference that ended early, so I finally had time to talk to my insurance company. When I spoke to them on the phone a few weeks back about coverage for IVF, the rep was super cagey. While I knew they wouldn’t cover the actual IVF procedure, I was hopeful that the medication — which costs thousands on its own — would indeed be covered. Several letters, emails, and phone calls later, I learn nothing is covered. OK, two meds are covered — the cheapest ones. So pretty much zero coverage. I was going to be out about $26,000. And on this day I nearly lost it. June and July were bleak months for me. The financial stress of it all was almost physically painful.

To backtrack a little bit more about my finances — I had almost no savings when I started my new job. I was never very careful with my money and had helped pay for our wedding two years back, which cost most of what I had saved up previously. I also spend a fair amount on travel, which I’ve decided I don’t regret. I do have a retirement fund and some small investments. Knowing that I might be heading into IVF zone with no coverage, we decided not to take any big trips, I stopped most frivolous shopping, and was good about bringing my lunch to work, among a few other cut corners. We had been saving all year, and we now had a combined $40K in the bank, and a zero balance on our credit cards. We now had the money we needed, but the stress of spending it on something that’s not even guaranteed to work is a lot.

I’m a fairly healthy person. I work out (sometimes!), I don’t eat much junk food, don’t smoke, and drink at most two to four glasses of wine a week. Sometimes an Old Fashioned is in the mix. My one consistent vice is coffee — I love it and drink about two to three cups a day. But now that I was embarking on this major financial, emotional, and body-tolling treatment, I was ready to do whatever I could to help improve my odds, so the coffee and wine were out, and gluten-free was in. I don’t speak on behalf of all women dealing with infertility everywhere, but I would take a guess based on my experience and the countless, faceless women commenting in forums, and chatter on social media that we’re a prime group for marketing to. If I read somewhere that pineapple aids conception with its magical anti-inflammatory bromelain enzyme, you better believe I’m eating pineapple. I wanted to be as clean and healthy as possible so I treated myself, and signed up for Sakara Life, and started going to acupuncture. This was an expense but I justified it with the hopes that optimal health will hopefully lead to the best results which would then lead to never doing this again.

Cost: The Sakara Life meal plan was $239 a week and I did this for all of July for a total of $956

I was actually afraid of acupuncture and questioned if it was a good idea to try. I’m not big on massages, and couldn’t fathom how someone sticking needles in you was going to be relaxing. Not only do I know nothing about Western medicine, I also know zilch about Chinese medicine. But, everyone I spoke to said they did it to help their fertility, so I am giving it a try. I think the reason I really enjoyed my acupuncture experience was the acupuncturist herself. There’s a mini therapy-like session at the beginning where she asks how I’m doing, and it really helps to speak with a professional. She’s a great listener and really knows her stuff when it comes to IVF, as acupuncture for fertility is her specialty. Still don’t really get what the needles do (warms you and gets the blood moving?), but being a little pincushion is oddly relaxing, and I usually take a nice lucid nap during my session.

Cost: $140 a session, for July and August for a total of $980

We attended a group class at the clinic that walked us through how to administer all the shots we’d be taking. When they showed us the big needle for the trigger shot I teared up a little, and my husband grabbed my hand. It was so overwhelming getting all the info at once and seeing all the needles together. Even though they gave us fake patches of silicone skin to test doing the shots on, I couldn’t imagine mixing all the medication and doing this to myself at home. I knew I’d have to (you want that baby, this is nothing compared to that, I told myself, yet again), but it just seemed like a lot.

Cost: All of this is included in the IVF package, which totaled about $19,500

The cost of everything had me spiraling, so I did something that I thought would help me find some solid ground: I set up a meeting with a financial advisor. This is the first time I’ve ever sat down and taken a careful, honest look at my finances. My retirement savings are in several different funds, I have some investments that are doing nothing, and I really didn’t have a hold on what I had or what I needed for the future. This was one of the best meetings I had this year. I walked out feeling lighter and armed with some new knowledge and a little bit more control of my life.

Cost: There is no upfront cost for the advisor, but she’ll be taking a percentage of my investment earnings once I sign up with her for at least a year. This is a long-term investment plan.

The week leading up to the start of my period and the start of the IVF treatment, the doctor prescribed estrogen patches to prime my body for the treatment. These are like band-aids that you wear on your stomach. They even come in a box like band-aids. Except this box has a giant sticker on it that says, “May Cause Cancer.” After a panicked call to the nurse, who told me everything I’ll be taking says that and not to worry (cool), I started patching.

Cost: Box of Vivelle-Dot patches, $174

July was a hard month. Harder than my divorce. I didn’t want to socialize. It was difficult to speak to my closest of friends who have kids, including my best friend who just had two beautiful, healthy babies from her IVF treatment, and my sister who was pregnant again. When you’re dealing with infertility there’s a duality to everything. As happy as I was for my best friend and my sister, this feeling of total elation for them was matched equally by depths of jealousy and pity for myself. I was miserable. My husband was there for me — he’s incredibly loving and supportive and always checking in on me, but I was in a dark place.

During this time, there were bright spots though, and I owe them to other women. While I did distance myself socially IRL and online (muted everyone with a baby on Instagram which felt simply like… everyone on Instagram), many of the women in my orbit would not have it, and continued to reach out even when I tried to shut them out. While I was withdrawn, when someone would engage with me, I did usually share what was going on and found that those friends in both my close and outer circles were so compassionate. They were there for lunches and talks, or even a reassuring, deep text thread. My boss gave me a good luck charm. Women in the Facebook fertility group and a local online forum I joined were always ready to help each other with an insightful point of view. The latter group of women also helped each other out with sharing extra meds. And this whole process has made me a more caring, attentive person, too. I was set to start the IVF cycle in early August and with the support of other women I had just enough strength to move forward with it all.

Cost: Good friends are always free

The thyroid medication screwed with my cycle, so my previous one only lasted 24 days instead of my usual 28 days. It was now day 30 of my cycle and just a few days before my 40th birthday. I took a pregnancy test to see if I was possibly pregnant since I was late. It came back negative, but it was still early. I was sure I was pregnant this time. It was all too perfect. Here I was about to drop all the money I had and turn 40, so of course, this would happen naturally now. I replayed the fairytale of telling this story to all of our friends in a few months… hiding our big secret that we got pregnant right before IVF, telling my future child that they were the best birthday gift of all. Day 31, still no period. Day 32, period. The next day it was my 40th birthday and monitoring for my IVF cycle began. I also received a big bouquet of flowers from my husband.

Knowing that my insurance covers nothing, my doctor graciously set aside some extra medication he had at the office. A good friend who just had her baby had a few extra vials of stims (the medication that’s used in IVF to stimulate your body to produce more follicles — each of which are hopefully storing healthy eggs), which I happily accepted. Even after all this, I still had to buy a few days worth of meds. The accompanying meds for IVF would have cost me an extra $6,000, in addition to the $20,000 for the actual procedure, but all of this helped save me about $3,000.

Cost: All of this remaining medication totaled $2,900

On the first night of shots, I decided to pay for a nurse to come to our apartment to walk us through how to mix all the medication. The clinic tries to choose a nurse based on your location and the one on call for me lives just a few blocks away. She was friendly and carefully walked us through proper setup, mixing of the Menopur vials, and showing us how to administer the shots. It was so helpful.

Cost: This all cost $100, which felt steep because it lasted 15 minutes, but it also brought me great relief

My husband was not around and I panicked and texted the nurse to come back and do the shots again.

Cost: $100

My husband and I sat down to go over our options for the embryo transfer. Here’s where more acronyms start to kick in. You basically have two options: Option one is a fresh transfer, which means that after the embryo is fertilized (ICSI), it’s transferred to you at around day three — no testing. Option two is FET (frozen embryo transfer), which means if you have viable embryos on day three, you can wait a little longer for it to develop and then biopsy and test the embryo’s genetics. The geneticist will grade your embryos, and the lab will freeze the ones you choose. Then at a later month, you transfer the highest-rated embryo or embryos in the bunch for the best chance at a healthy pregnancy.

Ideally, I would like to be able to test, but if we don’t get a lot of viable embryos, I might just take my chances and do a fresh transfer. The reason for this is, let’s say I only have one healthy embryo. I’d rather take the chance of transferring it back right away to its natural home in my body and see what happens, than have that one embryo go through the stress of a biopsy (some don’t make it through this), possibly finding out it’s a middle grade, then needing to decide if I want to freeze it, dealing with a small chance of issues with the thaw, and then putting it back in.

Cost: Included in the whole IVF package

By now I know what a Saturday morning at the clinic is like, so I leave at 6:30 a.m. to beat the crowds. During my ultrasound the attending doctor shares that my left follicles are growing but the right have not. She said that it’s still early in the cycle and they should start to develop. Later that day I get a call to add Ganirelix (a drug that stops the eggs from releasing prematurely) to my regimen for at least the next two nights. So starting tonight I’ll now be giving myself at least three shots.

Cost: Included in the whole IVF package

I’ve weirdly been looking forward to my stomach shots because I get on a little high when they’re done. They really aren’t so bad now that I’ve got the hang of it, and I feel accomplished when it’s complete. Plus I eat dinner and let myself relax and watch TV after so it feels like I get a reward. Tonight the Menopur and Gonal F drugs go quicker than ever, but I clumsily dropped the Ganirelix on the floor. I quickly picked it up and did some recon on my offending syringe. The needle was bent with a crack and the liquid was filled with bubbles. I texted a photo to the nurse who told me not to use it. Great. Why not light $100 bills on fire while I’m at it. My husband told me not to stress because there was nothing I could do, but I was pissed. And the damn thing had a slightly thicker gauge needle than the Menapur and Gonal F medication, so when I went to inject myself using a new, non-broken syringe, it didn’t slide in with ease like the other meds. I angrily jabbed myself and did the deed.

Cost: $92 for an additional Ganirelix syringe

Last night I put the word out to a few friends and the local online group asking if anyone had an extra injection pen (minus the needles, of course). My doctor had given me a cartridge of medication for free but it didn’t come with the injection pen applicator and my pharmacy didn’t sell them alone. The medication given to me cost $900, so I needed that pen. People who have insurance that covers everything often get sent extra meds and applicators that they don’t end up using so there’s a healthy gray market of sharing unused, unopened, unexpired medication for free. I received a text from someone who got my message. She had an extra pen and was happy to help.

Cost: Free

When I arrived at the clinic for monitoring this morning, I was presented with the bill. The big bill — the one for the whole shebang. So, right there in a packed waiting room, I handed over my Delta Amex (go points!) and paid up. Then I casually walked back to a seat to wait to be monitored. I texted my husband and told him we were going somewhere fun and far away for a long weekend whether this worked or not.

During the ultrasound monitoring, the on-call doctor made a comment that my right side was looking “sleepy.” Here’s an acronym you’re likely familiar with: WTF. What the fuck is that supposed to mean?!

Cost: $18,500.00 This includes the retrieval procedure, anesthesia, testing for up to four embryos (more than that will be an additional cost if I am so lucky to have more), and the transfer. There will be an additional hospital utility fee of $1000 on the day I’m admitted for the retrieval procedure

Today I requested an appointment with my doctor for monitoring since I was worried about the development of the follicles. Since I go to a group practice, I don’t necessarily see my doctor for monitoring and I found out that, unfortunately, he may not be the one doing my retrieval either. She took a look at the follicles and confirmed that my left ovary had at least six growing follicles (looking great!, she said), while the right ovary had one tiny follicle and was busy taking an insanely expensive nap this month. I asked her if I should stop and try again next month, but she assured me that the left was in a great place and to keep it going.

After I left monitoring (in tears, despite my doctor’s positive affirmation, worrying about my under-developed right ovary), I went to meet the woman who offered up her injection pen. It was only a one-minute meeting, but when she handed me the bag and said, “good luck,” I looked at her and nearly cried — again. But this time out of appreciation and comradeship.

My friend reached out and asked if I wanted to join her at the beach this weekend. I told her that my retrieval was likely going to be scheduled any day now and I wasn’t sure I’d be up for a beach day. She suggested trying out a meditation class together at Chill instead Friday night. What an awesome pal I have.

Cost: $22 for a session

I just left monitoring and am waiting for the call to let me know if the trigger shot will be tonight for a Sunday retrieval or Saturday night for a Monday retrieval. I’m really hoping for tonight because I’m out of some of the meds and I don’t want to buy more. I’m also ready to get some relief from my insane bloat. Despite righty o’ doing the least, all systems seem to be a go with the left ovary in command.

Reflection: The fertility journey sucks ass and I can’t wait for it to be behind me. That’s the honest truth. But — and this is a big, big BUT — I feel that I’ve become stronger from this whole thing. My relationship with my husband is solid, I’m grateful for my friends, and feel so incredibly cared for. I have also found that I’m comfortable sharing the process and my emotions openly, which is not something I’ve always been secure with in the past. Plus, I’ve been successfully stabbing my tummy for two weeks with not a tear in my eye. I know I have the biggest challenges ahead of me still, but I can say that I am tougher now than I was at the start.