I’m 33 & Have ‘Unexplained Infertility,’ But I’m Still Trying To Get Pregnant

History: My husband and I met when we were 19 years old and got married at 27. We started trying to conceive a few years later. But our journey had more twists and turns than we’d initially hoped. 

Age: 33
Location: Sunnyvale, CA
Occupation: Librarian
Household income: $270,000

On New Year’s Eve this year, after a few glasses of Champagne, I boldly announced that my resolution was to get pregnant in 2020. Even so, my husband, J, and I hadn’t really started to try for one reason or another. But now, a few months later, J’s dad passes away after years of fighting stage-four cancer — just as the West coast is beginning to feel the impacts of COVID-19. In the midst of all this sadness and confusion, J and I officially come to the conclusion that there’s no reason to wait to conceive. Life is short and nothing is promised.

Cost: $0

After nearly a year of tracking my ovulation and hoping for a positive pregnancy test every month, J scheduled a consultation for us with a Reproductive Endocrinologist (RE). On Zoom, the RE goes over our health histories and quickly talks through all the diagnostic tests she recommends. She emphasizes the importance of both egg quantity, something that can be measured through blood work and an ultrasound, and egg quality, something that is more difficult to determine. She tells me to start taking the supplement CoQ10 immediately to help improve my egg quality. 

Cost: $3,864.71 total. The consultation appointment is $695.86, and the high cost confuses me, but I figure it must be because it’s the beginning of the year and we have not met our in-network deductibles yet. J has a special supplemental insurance plan, and I talk to him about making sure we know how to use it. We also pay $3,168.85 for diagnostic blood work, an ultrasound, semen analysis, and genetic testing over the next month. Genetic testing is by far the most expensive test because the lab is out of network.

I’m really nervous about this test, which involves injecting iodine fluid through my cervix to detect blockages — like cysts or polyps — in the fallopian tubes. I’ve read online that some women experience a lot of pain and discomfort. I dealt with vaginismus in the past, and had to go to a special pelvic floor physical therapist for eight months when I was in my early twenties to treat the painful disorder. I’m anxious that any negative or painful experience might trigger my vaginismus to come back. 

While I wait for the nurse, I try to breathe deeply to calm down. Seeing my tattoo on my ankle, which I got after recovering from the vaginismus, gives me a sense of strength and purpose. It’s a delicate iris; I hope to name my future daughter after the flower. I think of it as a promise to myself to choose hope. When I was dealing with vaginismus, I worried I would never be able to have children because it was so difficult to have sex. Working through the physical and emotional aspects of the condition taught me how to be vulnerable and grow through discomfort.

Ultimately, the HSG is uncomfortable but not painful, and luckily it’s over quickly.

Cost: $231.87 for the procedure. I’m relieved by this number because, on the day of the procedure, the radiology office makes me sign a form that says I might be liable for up to $1,500, depending on insurance coverage.

We just road-tripped to Portland to celebrate J’s birthday. We take a doctor’s appointment via Zoom in our parked car. Whenever we talk to the doctor, I get the sense she is overworked and just trying to get through the day; today, she’s racing through our test results. 

Everything looks mostly normal, but the results from my HSG last month are a bit inconclusive, so the doctor wants me to have a hysteroscopy, a surgical procedure to see inside my uterus and remove any polyps. J, meanwhile, is ecstatic to learn that his semen analysis is well above average. He leads with this when we tell our families about the appointment. 

Ultimately, we are diagnosed with “unexplained infertility.” I’m puzzled that this is an actual medical term. Our doctor enthusiastically recommends trying three to four cycles of intrauterine insemination (IUI), then moving on to in vitro fertilization (IVF) if that doesn’t work. She seems confident that she can help us conceive, so we end the call full of hope.

Cost: $36.83 for the appointment. Luckily our insurance is covering most of the costs of the appointments now.

A nurse practitioner friend asks if I’m doing acupuncture to help with fertility. I do a little research and I figure it’s worth a try. I book an appointment with an acupuncturist nearby. It’s a lot of needles in my head, ears, hands, and feet. I’m relieved that it’s relatively painless. Most of the appointment involves laying in a dark room with a heat lamp on my legs, and “getting some rest” as my acupuncturist says.

Cost: $108 per weekly visit (which comes out to be approximately $2,000 for my visits from April to September). My insurance covers acupuncture for certain conditions but not for fertility issues. I briefly considered asking my acupuncturist to bill insurance with a different code, but that feels unethical.

It’s J’s dad’s birthday, a hard day ever since he passed away. We’d talked about celebrating by reminiscing about him and listening to all his favourite music. Unfortunately, today is also my hysteroscopy. J takes me to the clinic in the morning but has to wait in the car during the procedure, because of the clinic's COVID protocols. 

I never get to meet the doctor doing the procedure, only the resident that will be assisting and the anesthesiologist. It seems weird to never talk to someone who is going to see inside me. 

I wake up feeling groggy with really intense cramps. The resident stops by to say they removed a polyp, but I’m too out of it to ask any questions. Back at home, I curl up on the couch with a heating pad and my dog for the rest of the day. We do get to spend some time in the evening watching Neil Young videos on YouTube and crying in remembrance of J’s dad.

Cost: $1,031.29 total. I’m shocked when I see that this procedure would have cost $15,511 without insurance.

Our wedding anniversary is tomorrow, and I’m feeling sentimental about the timing of this IUI. We started our fertility journey so long ago, and I’m excited that it’s finally time to move on from diagnostic tests and procedures and do something that could actually result in pregnancy. The past few weeks were tough; I had more side effects than I expected from letrozole, the drug I was taking to stimulate egg development, including really bad headaches and insomnia. 

In the exam room, I hold a vial of J’s washed sperm (sperm washing is a procedure that separates healthy sperm from the rest of the semen) to “keep it warm” while I wait for the doctor. I do a quick meditation sending all my positive energy to the sperm to do their job. The procedure is quick and painless. I watch the sperm flood into my uterus over ultrasound and feel a flood of emotion, too. I wish J could be in the room. Now all I can do is wait and try to not Google early pregnancy symptoms for the millionth time.

Cost: $193.16 for IUI in total. $117.22 for the procedure and monitoring appointments, $45 for the trigger shot to make sure I ovulate, $1.70 for letrozole, and $29.24 for sperm washing. Everything was covered by our fertility insurance at 90%.

The first IUI didn’t work. When I saw the negative test results, I started bawling and ran to my bed. J tried to comfort me, but I felt like such a failure. 

The second IUI feels easier because I know what to expect. My doctor rushes and almost injects the sperm before the nurse has the ultrasound in place. I leave feeling ambivalent about my chances of getting pregnant.

Cost:$166.13 total for the IUI. $90.19 for the procedure and monitoring appointments, $45 for the trigger shot, $1.70 for letrozole, and $29.24 for sperm washing.

The second IUI didn’t work either. I’m starting to doubt that they ever will. IUIs only have about a 10% chance of working each try, and I wonder if my chance is lower because we don’t know what is causing my infertility. Ultimately, we decide to switch to a smaller clinic with better online reviews. At the old place, everything felt very cold and impersonal, and I want to know my doctor better. This feels like the best choice, especially since I know our fertility insurance only covers three cycles of IVF.

Cost: $0

After a consultation with our new doctor, we’re starting IVF. The hardest part so far has been getting all the insurance preauthorizations. J is so supportive and took on the majority of the work coordinating with our insurance rep and clinic. 

I head to the new clinic in the morning for bloodwork and a baseline ultrasound. Everyone is really friendly, the mood is a lot brighter, and I get to meet my doctor in person. 

In the afternoon, I get the go-ahead to begin my medications tonight. It takes an hour for J to watch the educational video and prepare all the shots and meds. He is a bit of a perfectionist, but I appreciate his dedication to detail. I’m squeamish about the whole process, so it’s easier to look away from the needles. Menopur, one of the medications, really burns when it’s injected, but overall the shots are bearable. I can’t believe this will be our nightly ritual for at least 10 more days.

Cost: $182.26 copay for all medications.

It’s the day before my 33 birthday, and it's finally time for my egg retrieval. I feel so bloated and fed up with shots and needles. My stomach is sore and so bruised that it’s hard for J to find places to inject the needles now. Two nights ago was the grand finale of injections. I had to take the trigger shot exactly at 10 p.m. along with my other medications. I’m thrilled to be done with the shots and thankful the egg retrieval is not on my birthday.

I see my doctor before the procedure, so that's reassuring, after my experiences at my last clinic. While I’m under anesthesia I dream of J’s dad. He’s helping me look through archival drawers to find the best quality eggs. I wake up feeling refreshed and hopeful.

After the procedure, the doctor comes to the bed holding a plain piece of white paper with a larger circled number. Eleven, that’s how many eggs he retrieved. My heart rises with hope — earlier, my doctor said I could expect between 10 to 12 eggs given my age and stimulation protocol. 

We head home and wait for news. In the afternoon we find out that nine of my eleven eggs are mature, and on my birthday, we get the excellent news that eight are fertilized. Our doctor is impressed, and J is taking all the credit with his above-average sperm. Ultimately, four embryos mature and pass the genetic testing. A wave of calm rushes over me. I didn’t realize how worried I was about all the shots and procedures not working until we got to this point. I’m overwhelmed by hope and anticipation for the transfer.

Cost: $1,565 total with insurance. This is all for the egg retrieval, as our insurance covers PGT (though only for specific labs). 

It feels like I’ve reached what I hope will be the final lap of a marathon. J is able to be in the exam room for the transfer and he holds my hand through the whole procedure. My bladder is so full (it’s recommended for the transfer) and J keeps making me laugh. I tell him to stop because I don’t want to pee all over the floor, but I appreciate the levity. I told J about a study that found that laughter may help improve implantation rates, so I’m proud he’s doing what he can to help.

The embryologist gives us a printed picture of our embryo. When we get home, I put the picture on our refrigerator. J says his heart warms every time he sees it. Somehow everything feels more real now and my heart feels full of hope. We need to wait nine days before my first blood test to see if I’m pregnant. Waiting is the hardest part of all the treatments.

Cost: $0. We reached our out-of-pocket maximums for insurance, so now everything in-network is covered at 100%. I feel so privileged that J works for a company with a supplemental fertility insurance plan.

I get my blood taken to see if the transfer was successful. We’re both on edge all day waiting for the results. In the afternoon, our doctor calls and my heart sinks as he says, “I wish I had better news to share.” 

I fight to hold back tears as our doctor runs through our options, which include trying again, trying more diagnostic tests, or taking some time off from trying. I spend the rest of the day yo-yoing between overwhelming crying fits and feeling emotionally numb. J carries on with his afternoon meetings while trying to console me during his breaks. I take a sick day; I’m too distraught to work.

I can’t let go of the idea that there has to be a reason the transfer failed. I know pregnancy is not guaranteed after IVF, but it’s hard for me to accept that this was by chance. I feel like there’s something wrong with me. I go down rabbit holes online and end up buying Jun0 Bio, an at-home vaginal microbiome test, Garden of Life Women’s probiotics, and the book Spirit Babies: How to Communicate with the Child You’re Meant to Have.  

I spend the rest of the day trying to grieve — I do yoga and even build an altar to my fertility journey (which I do based on advice I read about on RESOLVE). I also get a last-minute appointment with J’s therapist, who guides me through a check-in exercise. This helps me realize that I still have hope buried under my grief. We still have three embryos, and I have faith that we can have at least one biological child with a little good luck. I end the day knowing I want to do another transfer cycle soon, but for now, I just need to be with my feelings and wait for my period to come.

Cost: $246 total. $160 for the Juno Bio test, $36 for probiotics, $15 for the Spirit Babies book, and $35 for an online Yoga class. The therapy session is covered by insurance.

Total Cost: 9,517.25 

I’m proud of all we have done to try and I’m grateful for all I’ve learned along the way. I want to be a better advocate for fertility research. There is so much we still need to learn about conception, pregnancy, and fertility. I also feel extremely lucky to have health insurance that covers fertility treatments. 

Going through this fertility journey is a strangely validating process. I always knew I wanted children, but now I know how much time, energy, and money I’m willing to give just to get to the starting line. J and I are ready to be parents and we have so much love to give our future family. I hope I have the emotional strength to continue with treatment. Dealing with the pain of each passing month is the most challenging part of my fertility journey. We are going to continue with IVF for now, but I know there are other ways to make a family if getting pregnant proves to be too much of a struggle.