Fertility Diary: I’ve Spent $4,000 Trying To Get Pregnant During COVID-19

Age: 38
Location: Brooklyn, NY
Occupation: Research Project Manager
Household income: $150,000

We’ve been talking about having another baby since our son turned 1 last year. When our little guy was 18 months, I was certain it was time to attempt to get pregnant again in good faith, but my husband wasn’t quite ready yet. Finally, our toddler (!) turned 2 this fall, and my partner and I were on the same page. I make an appointment to get my IUD taken out in December. 

I want to have a second child because parenting my son has been such a joy so far — he’s an incredible source of love and sunshine. I also want to give him a sibling, because my sister has always been my best friend. 

Cost: $0. There’s no copay for removing my IUD, because it was removed at my annual wellness visit. 

I’ve been trying to get pregnant for months now with no results. After my concerns about fertility were blown off by my old OB/GYN (who delivered my first son), I decide to try a new clinic. I end up going in for bloodwork and ultrasounds today. I also do a Hysterosalpingography (HSG), which involves an X-ray test so doctors can see the shape of the uterus and figure out whether the fallopian tubes are blocked. My husband does a semen analysis. Everything comes back normal, and then we’re off to meet with our new reproductive endocrinologist (RE). 

Based on my inconclusive results and age, they recommend I try three attempts at intrauterine insemination (IUI), which many people call the “turkey baster method.” If that doesn’t work, we’ll try in-vitro fertilization (IVF), which is more expensive and involves more medical procedures. I just started my menstrual cycle, so my doctor opts to do “Day three bloodwork”, which confirms my cycle has started and I’m not pregnant. My doctor decides to start me right away on a drug called Clomid, which stimulates ovulation. I’m nervous and excited. 

Cost: $50 copay for the office visit, as my insurance covers the testing. 

I have my first “monitoring" appointment on September 27. This involves bloodwork and a vaginal ultrasound. They’re official monitoring where you’re at in your menstrual cycle by checking your levels of estrogen and Human Chorionic Gonadotropin (hCG), which many people call the pregnancy hormone. They also measure my uterine lining because it gets thicker when you approach ovulation, and look at my follicles, or the sacs in which eggs develop. I do an Ovidrel trigger shot, which tells my body it’s time to ovulate. I’m nervous about the injection but it's relatively painless. 

The next day, my husband has to go to work, so I drop off his sperm sample at the clinic myself (I can’t even begin to explain how inherently awkward it was to hand a virtual stranger a cup of my husband’s swimmers). I go have a solo breakfast and wait until the doctors are ready for me. It’s weird getting inseminated by a male physician without my husband there — I wish he could be by my side for all of this. They instruct us to have sex that evening and again every 24 hours for the next two days to increase the chances of pregnancy. It’s odd to be prescribed sex, but, hey, whatever you say, doc.

Cost: $242.86 for the medication and the co-pays, for my IUI and monitoring doctor’s office visits. 

The IUI didn’t work. I’m upset — I wanted to be the person who nailed it on the first try. But no dice. It hits me how real this is, how it isn’t going to be easy or a short ride. My son just turned three, and I was sure I’d be pregnant again by the time he was this age. I’m grieving for that vision that I had for my family. 

I go in for more bloodwork in mid-October and start taking my Clomid again. We head out of town to California for the week. I have a work conference and we turn it into a vacation. It’s the break I needed from life and all the fertility talk. We fly back on October 25 and I go in for bloodwork, ultrasound, and my trigger shot the next day. I didn’t account for how exhausted I’d be after traveling with a toddler. Because my body was under the stress of traveling and I’m so tired, my RE suggests transitioning this to a medicated cycle, which means we skip the actual insemination, and just have sex instead. 

Cost: $92.86 for the monitoring appointment copays and prescription costs.

I’m feeling more and more defeated as the months go by. But I’m not ready to give up yet, although the appointments are getting more difficult. It’s my busy season at work, and I’m officially on the clock seven days a week until the end of the year. I’m feeling extra grateful to my husband, parents, and my son’s preschool. In mid-November, I go in for bloodwork and start Clomid yet again. A week and a half later, I drop my son off at school while my husband drops off his sperm sample. I meet him at the clinic afterward, and we go for our second IUI (but our third medicated cycle). 

And now we wait. Again. 

Cost: $242.86 for monitoring co-pays, the IUI visit, and prescription costs.

Starting on January 1, the New York State fertility mandate will compel large group insurance providers to cover up to three cycles of IVF for folks who’ve received a medically diagnosis of “infertility.” We’re hoping to benefit from this new rule, but we decide to sneak in one last round of IUI first. 

Maybe this will be the one! We start the process and the Clomid again in early December. My husband drops off a sample to be frozen and thawed for the upcoming procedure — thank God I don’t have to do it this time! On December 2, I go in by myself for what I hope is my last IUI.

Unfortunately, the procedure doesn’t result in pregnancy.

Cost: $532.86 total for monitoring co-pays, our IUI visit, prescription costs, semen cryopreservation, and bloodwork.

This meeting with my doctor is really emotional. I just got back in town after my mother-in-law’s funeral. My husband is still with his dad, so I’m solo parenting for the next few weeks while also starting the IVF process for the first time. At least my RE has been kind, compassionate, and supportive. My doc breaks down what will happen next as we embark on our IVF journey, step by step, and explains the statistics of success based on my age and other factors. Next, I meet with my nurse, an IVF coordinator, and a finance advisor.

Even though IVF will be covered for me because of the NYS mandate, I find out that my insurance still requires six medicated cycles or attempts at IUI before they’ll pay for IVF. I’ve only done four, so this will push our progress back at least two months. I’m frustrated that this was never mentioned and that I have no control over the situation. Additionally, I can’t proceed with IUI until my husband is back to give another sperm sample. I don’t know when that will be. 

Still, we decide to do two additional IUI rounds. It would have taken at least two months to appeal the insurance company’s decision, and I don’t have any time or resources to waste. We considered doing IVF out of pocket, but it just makes more sense financially to take advantage of the New York guidelines and take advantage of the mandate in our state. 

One thing getting me through this time has been the support groups I’ve joined, such as the Modern Fertility Community and other ones on Facebook. At first, it could feel like I was all alone in this. I had no idea how helpful it would be to have open dialogue with other women. It calms my nerves even in times of extreme stress.

Cost: $50 for my office visit copay.

On Valentine’s Day morning, my husband goes to drop off his sample, while I drop our kiddo off at pre-school. Next, we met at a diner which has become our fertility breakfast spot for a very romantic (ha) Valentine’s brunch before my IUI. Then we head up to the office and I get inseminated.

Cost: $242.86 for monitoring co-pays, my IUI procedure, and prescription costs.

The IUI doesn't work, which isn’t a surprise. At this point, these appointments just feel like a means to an end in order to get insurance to cover our IVF. 

At the same time, my husband and I are glued to the news, like the rest of the world, and trying to figure out what we’re going to do as the coronavirus begins to really spread in the U.S. Should we pull our son from school? Do I start working from home? Early in the morning of March 13, I decide to work remotely and determine our son won’t be going to school anymore until it seems like COVID-19 is under control. We also decide to skip the IUI. Luckily, this will still be considered a “medicated cycle,” since I took Clomid and got the trigger shot and has sex. The good news is, that means I’ve checked the box for our sixth medicated cycle and insurance will cover IVF. 

The bad news: We’re preparing for a lockdown and I won’t be able to start any procedures right away because of the outbreak. I’m disappointed by this, but I don’t disagree with the fact that everyone should be sheltering in place right now. I honestly wouldn’t have been comfortable going to the doctor’s office with a little one at home. The health and safety of my family is more important to me than this medical timeline I’m on. 

Cost: $92.86 for my monitoring appointment copay, and the prescription costs.

I get the word from my fertility clinic, that they are slowly restarting IVF cycles and they put me in the group allowed to start because of my age. I have a telehealth visit with my RE during which we talk about the risks of coming in for procedures during this time, particularly when we truly don’t know exactly how COVID-19 affects pregnant women or fetuses. However, I’m really optimistic after talking to her. She’s so supportive and takes the time to answer all of my questions. We decide to go for it and start as soon as I get my period.

Cost: $0. There’s no charge for telehealth visit.

Here we go! I go in for my first monitoring appointment on May 18. All my meds arrive and it’s overwhelming but exciting. I place some of them into the fridge. For example, the Gonal-F, a hormone used to stimulate follicles so they develop, and the Cetrotide, which blocks the hormone that causes eggs to be released from ovaries, and is used to prevent premature ovulation. I put the drugs Menopur, Lupron, hCG, Clomid, Doxycycline and all supplies in their own box in the kitchen. 

There are so many appointments and medicines next that it’s dizzying. I have a monitoring appointment on May 21, and a nurse calls later that day and gives me the green light to start injections. Gonal-F in the mornings and Menopur in the evenings. Clomid for 5 days. On May 25, 27, and 29, I have even more monitoring appointments. On May 27, they increased my Menopur dosage and added Cetrotide to my evening routine. On May 30, I take my Gonal-F and go in for monitoring. They instruct me to inject hCG and my Lupron trigger shots at exactly 11 p.m. — this is so the drugs that tell my body to ovulate are taken exactly 36 hours before my egg retrieval. On May 31, I have my last appointment to have bloodwork done to ensure my body absorbed the trigger. Finally, I get a night off from injections and get ready for the egg retrieval the next day.

Cost: $216 for medications and copay

Today is the day, and it’s truly surreal. My parents come over to babysit for the first time since the COVID-19 pandemic began. I don’t have to take a COVID-19 test before I go in, but they do check my temperature, and ask me if I’ve had any symptoms or been around anyone sick. 

IVF during a pandemic is a whole different ball game than what I was planning for. It’s nerve-wracking but so exhilarating. My husband isn’t allowed in the building with me, so he drops me off and goes to park the car and wait for his sperm sample appointment. I go upstairs, fill out the forms, get changed, and meet with the nurse and anesthesiologist. I feel a little alone without my partner but, funnily enough, just before they come in to start my IV, I see a runner pass by my room with a sample cup that I know is my husband’s. It provides some levity in a strange moment. I lay on the table and the next thing I know, I’m waking up in recovery. They tell me they were able to retrieve five mature eggs. I’m honestly a little bummed it wasn’t more, but I’m also not surprised based on my age and follicle count. 

Cost: Since this procedure was so recent, I’m still waiting on my insurance to tell me how much I’ll have to pay. I really don't have an estimate for how much it will be, but I’m sure it’ll be at least $150 out of pocket — likely more because of anesthesia. Without insurance, the retrieval alone would cost $8,431.

My nurse calls the next afternoon to let me know that all five eggs were fertilized. I’m finally feeling optimistic. 

But, on June 9th, she rings me again and shares that only one embryo made it to blastocyst (or an implantable embryo that’s developed enough to have hundreds of cells). I am really upset and bummed about this. We are sending our one hope in for genetic testing and will wait for those results to come back before we know our next step. 

Cost: $2,150 for genetic testing.

After the genetic testing comes back, my RE lets me know that the results came back abnormal. I am upset and disappointed. I can’t believe all of that hard work was essentially for nothing. Next, we prepare to jump right back into another retrieval next week, with a modified protocol.

At this point, things are moving really fast. I finally get my period in mid-June and go to the clinic for bloodwork and a baseline ultrasound. All my meds arrive. Again. My nurse confirms I’m ready to start this next round of IVF. I’m doing a “microflare protocol” this time, which involves taking different, specific medications in the hopes of yielding more eggs than last time. I unpack the drugs Gonal-F, microdose Lupron, and Ovidrel into the fridge. I’ll also need to inject more Menopur. I start “stims” tonight. 

Cost: $121.83 for the medications. The telehealth appointment cost nothing. 

Three full days of stims and I’m already heading back for monitoring. This round has been a lot harder on my body. I’m really uncomfortable and bloated. My skin is so sensitive and bruised. I can’t wear anything that touches my stomach. My RE also wants me to have a saline sonogram to make sure there is nothing in my uterus that will prevent an embryo from implanting. 

This is the first time I’ve seen her in person since January, and I feel so emotional I want to cry. We talk about how I’m feeling, and about some ways to manage the discomfort. She sees some progress from the stims and my saline sonogram shows my uterus is fine.

Cost: $50 copay.

I’m really surprised at today's visit. At my ultrasound, the doctor says she thinks I’ll trigger ovulation as soon as tomorrow. It’s so early, only seven days in, and I only have three follicles that are even close to mature size. I’m flustered and frustrated — this retrieval already feels like it wasn’t even worth it. I get an email from my RE later in the day and she says we’ll reassess tomorrow. Yes, it’s not as many follicles as I’d hoped, but if we wait to0 long, we miss out completely.

Cost:  $50 copay.

I’m back in the office for bloodwork and my ultrasound. The tech confirms that there are three follicles ready, another two small ones and, another few extremely tiny ones that will not likely yield any eggs. She estimates they will be able to retrieve three eggs total. I can’t help but think that this was all pointless. All the injections, discomfort, money, pain — just for three little eggs. The odds are not in my favor. They’re actually worse than last time.

I have a call with my RE when my labs came back. She agrees with me that this is not the cycle we wanted. My results aren’t great. After two phone calls over several hours, lots of discussion, we’ve decided to convert this cycle to an in-uterine insemination (IUI) instead of doing the retrieval — a less expensive and painful route. I feel so much better about this now. My husband and I will go to the clinic in two mornings for insemination. We’ll strategize after and will be prepared to start again in early July when my next cycle begins. The one piece of decent news is that my doctor “prescribes” that we have sex again tonight. So, I guess that turns the week around.

Cost: $50 copay for appointment.

This was definitely not the plan, but here we are. My husband arrives to produce his sample, and then I go up for my appointment. It’s so easy and painless, it’s a wonder to me. Now we’ll wait two weeks to see if it actually works. Fingers crossed.

Cost: $150 copay. 

Total Cost: $4,334.99

Reflection: The hardest part of all of this has been the guilt I feel for already having one healthy child. There are so many women fighting so hard for their first child. For a long time, I hesitated to talk about this because I felt I should just be thankful for the son I already have. I’m still working through this, but feel more comfortable being open and honest about it. 

In addition, I worry about how going through this fertility journey has affected my son. There are days when I am so distracted that I know I am not being present enough for him. I missed a lot of mornings getting him ready for school, which was always our special time.

One pleasant surprise that’s come out of the pandemic is that I get to see more of my son, even when I have appointments several times a week. Since the shelter in place in our city began, we have had family dinner every single night — something we were never able to do before. My son and husband sit with me while I do my shots in the evening. My husband, a photographer, has been documenting every step of the way. My family gives me hope. They have offered me the love and support I need as we try as hard as we can to have a second baby. Even if it doesn't work out, I know they will all be there for me, no matter what I need. For this I’m incredibly appreciative and blessed.