My Tumultuous Journey To Pregnancy At Age 40

 Welcome to Refinery29’s Fertility Diaries, where people chronicle their joyous, painful, and sometimes complicated paths to parenthood.

History:  Until recently, I never thought I’d have trouble getting pregnant. Somewhat ironically, I spent the last 20 years of my single life trying to avoid it. But my husband and I are newlyweds who found each other later in life — he’s 48, and I’m 40 — and conceiving has been trickier than I anticipated. 

Age: 40
Location: San Francisco, CA
Occupation: Medical Research Administrator
Household Income: $310K

My family is extremely religious, so it’s been drilled into my head since childhood that babies come after marriage. But I buck my upbringing, and I convince (beg) my fiancé to start trying casually before the wedding. When he agrees, I go a little past “casual.” I start tracking my cycle, buy ovulation strips and pregnancy tests, and start posting cute maternity photos on my Pinterest page. 

At 48 years old, my fiancé isn’t particularly concerned with having children. He says he’s totally content for us to enjoy life as we are right now. It’s been an ongoing discussion throughout the course of our relationship, but I’ve always made it clear to him how important motherhood is to me. He promises he’s willing to try for one child. He wants to make me happy and I’m grateful for that. 

We decide to stop using the “pull-out method.”

Cost: $16 for the ovulation strips; $18 for a pack of three pregnancy tests.

My wedding day is finally here and it’s everything I hoped it would be. Although it’s a small ceremony, it feels intimate and special. I cannot wait to start a new life and family with my man.

I was supposed to have my annual gynecological exam at the end of August. But for the first time in my life, my periods have become irregular; they used to be like clockwork. After unexpectedly bleeding at work for the second time in a month, I call my OB/GYN’s office to move up my appointment. 

When I go in, I ask about the bleeding, and for advice on how to conceive as soon as possible.

I’m given a long to-do list for the coming weeks that includes extensive blood work, genetic testing, and an ultrasound to determine the cause of the bleeding. While this sounds like a lot to get done, I want to stay positive. I do my first round of blood tests on the same day. These are to determine my hormone levels, detect any vitamin deficiencies, and identify any genetic diseases I may carry. I’m not too concerned about the hormones or vitamin levels, but thinking about genetic diseases is new territory for me.

Cost: Luckily, my insurance covers the appointment, so it’s just a $20 copay. 

Today I went in for an ultrasound to figure out the cause of the irregular bleeding — they say a cyst or polyp may be the culprit. They do abdominal and vaginal ultrasounds. I’m looking forward to getting some answers. In the back of my mind, I wonder if stressing out about getting pregnant is what’s actually causing these issues.

Cost: $0. The ultrasound is covered by my insurance. 

My doctor suggests that my husband have a semen analysis to determine whether his “boys” are still decent swimmers.

I’ve been trying to deal with the baby anxiety relatively quietly, without stressing my husband out. I’m honestly not comfortable letting out all of the emotions and insecurities that I’m feeling because part of me feels grateful that he’s even willing to try for a baby. I’m a little worried he’ll freak out and change his mind, since he’s said he’d be fine without a child. I also don’t want to do or say anything that could damage my new marriage. I just had hoped this process would be easier for the both of us.

Cost: $200. This cost isn’t covered by our insurance. 

August 13, 2019 

The doctor’s office calls me with the ultrasound results. Unfortunately, they couldn’t really see what they were looking for and still can’t determine why I’ve been bleeding. I will need to come back in for something called a sonohysterogram — this involves inserting liquid into the uterus to get a better look at the inside of it. 

My doctor also reminds me that the issue could be stress-related. This isn’t such a surprise, given the year I’ve had. In addition getting engaged, planning a wedding, and getting married, my husband and I moved in together (my first time living with a man). He also got a big promotion at his job and now has to travel regularly, at least once or twice a month. Now, with all the pressure I’m feeling to get pregnant, I’m worried my body and my psyche has reached a breaking point. 

My recent lab work included a follicle stimulating hormone test (FSH). The results are in and they reveal that my egg reserve is low, something I’ve been silently dreading. “It’s not the lowest I’ve ever seen,” my doctor says — but it’s definitely low. Basically, I have fewer eggs than I should have at my age, and there really isn’t anything I can do about it. I automatically feel panicked, guilty, and helpless, all at the same time. Based on the results, she suggests that I see a fertility specialist as soon as possible.

The FSH results have made all my deep-seated fears about not being able to have a baby come to the surface. I know that seeing a specialist will be stressful and expensive. Up to this point, I’ve tried to keep a brave face, hoping things would happen naturally. 

I’ve also been trying to be mindful about the fact that parenthood is more my dream than my partner’s. My hubby is out of town and I don’t want to talk to him about all of this until I know what I feel about it. I frantically search the web for helpful information about fertility, and read up on IVF. There are plenty of articles, but most assume that both partners want to start a family with equal urgency. Is there nobody out there in my situation?

I make a number of teary calls to my insurance company to figure out how to be seen by a specialist. I’m able to get a referral authorization for one visit with a specialist and one ultrasound. The authorization ensures that the services will be covered. Any subsequent visits with the specialist will require their own authorizations and will be covered at 50%. IVF is not covered at all, and I’ve read it can cost up to $20,000 a pop.

This all also sounds so expensive. We have a fair amount of savings, but we were hoping to use the money for a down-payment on a house. Plus, I still have student loans from grad school hanging over my head. I don’t want to add more debt to this situation. 

Tears of frustration start to flow and they don’t stop for hours. Maybe it’s a good thing that my husband is traveling and I have our apartment to myself for a while. I don’t sleep well tonight. 

Cost: $0 — for now. 

This morning, my OB/GYN is supposed to do an imaging study of my uterus, which is called a sonohysterogram. 

As soon as I check in for the appointment, the receptionist hands me a clipboard with a payment request for over a thousand bucks, since it’s a “fertility-related” procedure. My jaw — and spirit — just drop. 

I’m really not comfortable paying that amount without any notice (and without knowing that the procedure is absolutely necessary). I hand back the clipboard and walk out of the office. On my way home, I feel embarrassed and angry. I call my husband and completely fall apart on the phone. I can tell he’s caught off guard as he has no clue how difficult the last 24 hours have been for me. But I decide to let it all out. He says that we can pay the $1,200, no problem. I remind him of the real issue and source of my distress: This bill could just be the tip of the iceberg. The first in a slew of big expenses that will come our way if we move forward with fertility treatments. He tries his best to comfort me, saying that we should take the situation one day at a time. But it’s hard for me to see it that way. I tearfully tell him about what it could cost in the long run — tens of thousands of dollars, based on my research. With no guarantee of success.

Even after hearing what all of this might cost, my husband seems focused on my wellbeing. I can tell in his voice that he is really worried about my emotional state. When he finally gets home that night after a long flight delay, he crawls in bed with me and holds me tight.

Finally some good news — my husband’s semen analysis results are in and he has “normal and healthy” levels. We both feel some relief about this and it gives us incentive to keep trying. Also, now that he’s clued in to everything that’s been happening with me, we’re able to talk about the fertility stuff much more easily. 

I do some research and find an acupuncturist with great reviews who accepts my insurance. I’ll be coming in once a week. Maybe a little Eastern medicine can make the difference in fertility? It’s worth a try. 

The first appointment goes very smoothly with minimal discomfort. The needles are tiny and most of the treatment is painless. It’s a bonus that the acupuncturist says she has worked with many women who have struggled with conceiving, but who eventually got pregnant. I leave with renewed peace of mind. I’m feeling happy and hopeful. 

Cost: $20 copay. 

First meeting with my fertility specialist 

I head to a fertility specialist for an ultrasound, where he looks at my ovaries. Then the doctor lays out a plan of action with the precision of a military sergeant. I totally dig this vibe.

He says that once my next cycle passes, I can come in for an HSG, which he also calls the “ink test.” As he explains it, they take X-ray images while pushing colored ink through my fallopian tubes and into my uterus to spot any blockages that may be preventing fertilization. The test doesn’t sound fun at all. In fact, it sounds terrible, but I don’t have much choice. If the results come back the way I hope they do, we’ll try some IUIs (the turkey baster method) — up to three rounds, before exploring IVF, which is much more costly and complicated. 

At this point it’s surreal to think that I could be pregnant in a matter of months. Just the thought makes me incredibly happy.

Cost: $0. I’m able to get this visit and ultrasound covered by my insurance. I asked the doctor about the potential bills, and he assures me that their administrative coordinator will thoroughly review all of the prospective treatments and associated costs with me beforehand. This is good news, but I’m still uneasy about it.

My fertility specialist gets some of my test results back, and they’re not as great as he’d like them to be. My AMH (Anti-Müllerian hormone, another test to assess my ovarian reserve) is a bit low, which is no surprise based on my previous FSH test. It’s further confirmation that I likely don’t have a ton of eggs left. He says this means we need to “move quickly” and schedule the HSG as soon as my next cycle passes.

Cost: $0

Hysterosalpingography (HSG)

I wish I could say otherwise, but the HSG is an extremely painful experience. As I lie on the exam table, my doctor is definitely trying to make me feel comfortable, playing upbeat music (even Taylor Swift bops!), and making some small talk. At a certain point though, his tone starts to change. I can tell it’s not going well when he says, “Hmmm, I don’t see anything coming out.” He keeps going but I know that’s bad, because it means the ink is not moving through my fallopian tubes, which is the whole point of the test. Afterwards, he explains that my tubes appear to be blocked and even with the increased pressure he used trying to push the ink through (ouch!), they would not open up enough for it to pass through to my uterus. This most likely explains why I’ve had no luck getting pregnant so far. I ask him what this means. “It means we’ll have to do IVF,” he answers. Great. 

I feel a combination of shock, sadness, and disappointment. The doctor can clearly see that I’m upset. Tears start streaming down my face. It’s the last thing I wanted to hear today. IVF is an intimidating prospect for me. I was hoping it would be a last resort that I never had to deal with.

I call my husband on my way home from the doctor and tell him the news. I can hear on the phone that he’s genuinely concerned about me. He offers to leave work and take me home, but I decline. I just need some time to myself to reflect on this news.

Cost: $0. With a pre-authorization from my insurance company, it’s covered.  

Today my husband and I visit the specialist who performed my HSG to further discuss IVF. We’re good candidates for the process because I’m generally healthy, my uterus is in good shape, and my hubby’s sperm looks good. But there’s still a lot to consider. The doctor can’t determine how healthy my eggs are (or aren’t) until the retrieval part of the IVF process. The success rate for women my age is only 20% to 30%. The cost depends on a number of factors but he says we should expect to spend $17,000 to $22,000 per cycle for the procedure and medications.

This is a lot of information to take in, so my hubby and I decide to think about it for a few days. We’ve already confirmed that neither of our insurance plans will cover any of it so cost is definitely a consideration. For me, the most daunting part is the fact that there is no guarantee this will work. I absolutely want a baby and I always have. But with IVF, the cost seems so high — and we’re only buying a slim chance of making it happen. What if it doesn’t work and I’m left with nothing? At the same time, I’m terrified that I’ll have regrets if I don’t do it. Right now I don’t know what the right answer is.

Cost: $0. This is an IVF consultation and it’s free of charge.

I do some research on adoption and discover that costs for private domestic adoption rivals that of IVF. Sometimes, they’re more. I’m surprised and a little disappointed, but in many ways this reconfirms my commitment to try having a child with my own genetics. After much discussion, my husband and I decide to do IVF, but agree that we’ll only do one cycle. It’s the best compromise for our relationship. We still want to buy a house in the next year, and don’t want to take any money out of our savings. So we’ll put $10,000 down, and finance the rest with a loan.

When I inform my doctor that we want to move forward with this, he recommends a lender that works exclusively with IVF patients. We fill out a loan application based on our financial history, and get pre-approved to finance the remaining balance for the procedure. I’m now on the schedule to start IVF in early November. Since It has to coincide with my menstrual cycle, the doctor can’t give me a specific start date, but it will definitely be next month. I can’t believe I could be pregnant by the end of the year! The anticipation is so exciting.

Cost: $75 application fee for financing.

This evening, I attend a training at my fertility doctor’s office on how to administer IVF medications. If I didn’t realize it before, I definitely know it now — IVF is a serious commitment. The amount of medication, shots, and doctor visits is mind-boggling. I’m not really afraid of the pain of getting the shots, but some of the side effects sound really unpleasant. It’s basically like PMS on steroids. I have a new appreciation for how strong women are. 

Cost: $0

Now that my IVF is scheduled and I’m done with all the testing, I’ve been in a different headspace. My constant worrying is finally starting to subside. 

Then, oddly, my period is late. I’ve loved rolling on the “no worries” wave, but this makes me concerned that I’m still stressing out too much and it’s affecting my cycle. Although it’s strange that I’m late, at first I feel no urgency to take a pregnancy test. It makes me sad just thinking about seeing another negative result, and I want to stay positive. 

On the other hand, even though I know it’s totally unlikely, I feel a spark of hope inside. So ultimately I pick up a single pregnancy test while I’m out running errands. I put off using it for a while after I get home. Eventually, of course, I decide to pee on the stick. In the past, I used to look away and try to keep myself busy for the two to three minutes it takes to get the results. Today though, I stare intently at the test the whole time. I just want to get it over with so I can get on with my day. I’m laser focused on the test, and I begin to see a faint second line start to appear in a matter of seconds. I squeeze shut my eyes to say a prayer. I hope I’m not seeing things. When I look again, the second line is still there. And it’s much darker this time. There’s no mistake — that means I’m PREGNANT. I immediately tear up, get on my knees, and start saying a “thank you” prayer. I’m overcome with joy and gratitude. This is one of the sweetest moments of my life.

Cost: $15 for pregnancy test

The next 72 hours are a mix of happiness, hugs, and doctor’s appointments to confirm that it is actually happening. It is! I’m definitely expecting, and my doctor is just as shocked as I am. Maybe even more so. He proposes that maybe the HSG somehow unblocked my tubes temporarily. In my heart, I truly believe it’s more than that. I think it’s a combination of my faith, prayers, and positive thinking that made this happen. I’m overjoyed. 

Cost: $0. The fertility doctor didn't charge me to come in and confirm the pregnancy, or for a subsequent visit to check that my hormone levels were properly rising. I don’t know if he billed my insurance for these visits or not, but I’m so grateful for his generosity.

Total Cost: $484, including weekly acupuncture co-pays. The single greatest expense was the semen analysis. I was able to get authorizations for all of my fertility specialist visits and procedures. Doing so required some pre-planning with my insurance provider, but was well worth it. Of course, bypassing the sonohysterogram made a big difference in the overall costs incurred but not having to do IVF was by far the most tremendous financial relief. While I would have happily paid for the chance to carry a child, part of me still wonders how it would have felt if the IVF didn’t work. Would I have regret for spending so much and not getting the result that I wanted? Would I regret it more if I didn’t even try? I don’t think there is a right answer. But I know my decision would have been much easier if my insurance had covered any part of the IVF costs.

Reflection: Now, I’m a few months along in my pregnancy. When I look back on my fertility journey, I still feel so many emotions. My struggle to conceive lasted less than a year, which is a tiny drop in the bucket compared to what many other women go through. Nevertheless, it was significant and I learned a lot about myself and my relationship — mostly that anything is possible and you should never, ever give up. I also wish I gave my husband more credit instead of trying to shield him from the stress I was feeling. Although parenthood was more my desire than his, when I needed him, he was always there to support me. We are stronger for having gone through this together.

Recently, I’ve met a number of women who are struggling with some kind of fertility issue and I always tell them: If you want it, keep trying, keep praying, and keep making plans to become the mother you want to be. I believe that God is listening and I’m proof that miracles definitely do happen.