Fertility Diary: I’m Stranded An Ocean Away From My Embryos 

My husband and I have been unofficially trying to make babies since about one week after we met. We had a whirlwind romance and knew that we were going to spend the rest of our lives together. If a baby came before marriage, we were ready. I was 35 and he was 28 when we got together. 

But I had an inkling for a long time that I wouldn’t be able to get pregnant. I had never tried before but, deep down inside, I knew it wouldn’t be easy. After working to get pregnant for a year with no results, we started to officially try by tracking my ovulation cycles with a thermometer that, to be honest, I had no clue how to read. 

All of this led us to today. We’re off to our first consultation with the fertility clinic. We’re ready to rock this fertility journey. After taking happy selfies in the empty waiting room, we meet with our doctor. She asks general lifestyle questions such as how much we drink, smoke, exercise. Next we do an ultrasound. Afterwards she assures us that we were in a good place to start trying our first intrauterine insemination (IUI) cycle the following month, which is also known as the “turkey baster method.”  

Cost: $58. My insurance covers IUIs, besides a $50 co-pay, plus CVS Brand thermometer costs $8.

I go in for my HSG test. This is when they inject dye into your uterus, which flows into your fallopian tubes. They then do an X-ray to see if your tubes are blocked. I'm not going to sugarcoat it, this shit sucks. As I lie there on the hospital bed in a giant, sterile room with the extremely loud machines echoing throughout, in an inordinate amount of pain, I can’t help but cry a bit thinking about stories I’ve heard from other women about how long it can take to conceive. I hope in this moment that my path to parenthood is a short one. In the end, the pain is worth the results — my tubes are clear and the doctors tell me we’re ready to start the IUI process.

Cost: $350 co-pay. I’m paying more out of pocket than usual because of the specialized test.

I never could have imagined I’d be on a dream vacation sipping margaritas in Puerto Vallarta, Mexico, during what was going to be my first attempt at an IUI. I don't think we realized how fast the process would start or really what it entailed after our initial meeting with our doctor. We already had our trip planned and really didn’t want to cancel it, so we decided to go with a medicated cycle as opposed to full IUI. 

Leading up to the trip we’re prescribed Clomid (a pill to stimulate ovulation), and are told to have timed intercourse while on our trip. We have no problem with that and in fact, we think it might make for a great conception story. Unfortunately, we don’t get pregnant. The tale of making our baby will be longer than I’d hoped. 

Cost: $10 co-pay for Clomid. 

After a week of taking Clomid, my hormones are all over the place and hot flashes are a dime a dozen. I’m ready to have my first official IUI done. I wake up extra early feeling fresh and excited. I’d asked my nurse if I could have some wine that night before — that was a hard no. The waiting room at our clinic is bananas. It seems like there are hundreds of people here in similar boats. In a weird way, it’s comforting to know I’m not alone in this. While waiting for our names to be called, I post on my husband’s Facebook wall, “So we always remember this day.” The IUI process takes about 5 minutes max. 

Weirdly, it's very much like getting a pap smear, except instead of inserting a long q-tip, they insert the cleaned up, beautiful sperm specimens, which my husband provided about two hours earlier. They insert the sperm cocktail, and then they have me stay on the table, lying there for about five minutes. I’m not sure why, but I'm scared that if I stand up, my little swimmers will fall out of me. 

Cost: $50 co-pay. 

We’ve been trying to conceive with the help of our fertility clinic for almost seven months now. I would say IUI number four is around the time I stop believing that this is going to work. We’ve done a total of five now. I can’t say that I’m devastated, so much as exhausted. Clomid has done a number on my hormones. I’m crying all the time. I often have to suppress the Hulk inside of me anytime a co-worker or client does something irritating. And my poor husband, I'm surprised I haven’t taken him out yet. Bless him, for real. 

It’s Martin Luther King Jr. Day and we’re at home when my mother-in-law calls my husband. My father-in-law has been sick for a few months and has decided to have some tests done. Turns out he has a “scratch” on his liver that will need to be looked at immediately. They are coming to the city to stay with us so he can easily get to Sloan Kettering the next morning for more tests. We are hopeful, but very scared. We are up all night with anxiety.

It’s been a stressful and rough few months to say the least. What we originally thought was a little “scratch” on my father-in-law’s liver ended up being a few tumors. He was diagnosed with a rare bile duct cancer called Cholangiocarcinoma. Between us going to the fertility clinic in the mornings, and the hospital to be with our family in the evenings, we’re running pretty thin. Because my father-in-law is sick, there’s added pressure to get pregnant. We really want to be able to deliver good news (and a baby!) to help lift the family's spirits.

Because of this, I’ve reached out to my doctor’s assistant to schedule an in vitro fertilization consultation. Undergoing IVF is a lot more involved, as it requires a magnitude of shots and increased monitoring visits (when they check blood levels and do ultrasounds to keep track of how things are going). Ultimately, the egg retrieval is considered a surgery. 

Unfortunately, my insurance doesn’t cover IVF and it’s going to be upwards of $30,000 out of pocket for a one-time try. Before deciding to take out loans, my doctor suggests we try IUI with injectables instead of Clomid. I am very open to this, but a little put off that we didn't try this earlier. I really, really like my doctor, but — given my age and how many times we tried Clomid — I’m worried that we waited too long. 

Costs: $0. We aren’t charged a co-pay for the consultation. 

It's day two of my cycle, which means it’s shot time. And not the fun type of you do with friends when making bad decisions at 1 a.m., but the kind you do after blood tests and an ultrasound. My doctor prescribed me Gonal-F (which helps stimulate eggs in healthy ovaries) and says it’s to be taken every night at the same time. Tonight is my first time doing it. My husband and I confidently rip open the packaging, wipe down my belly (like the whole thing, we had no clue what we were doing), and, with a lot of gusto, start to remove the cap from the Gonal pen. But we can’t get the freaking thing off! After what feels like an eternity, a lot of stress, sweating, and multiple breaks, we finally get it. After all of that, the actual shot is a breeze. When you take Gonal-F, your monitoring at the fertility clinic goes up which means we have to be there pretty much every morning. That means it's bedtime for us.

Cost: $90. There’s a $40 co-pay for Gonal-F, and a $50 co-pay for my monitoring appointment.

In comparison to Clomid, Gonal-F typically produces more eggs, which grow larger. This is great when you are having IVF done. But it’s not always so great when it’s an IUI cycle. That’s because if you have a lot of large eggs, the chances of having multiple babies increases exponentially and it’s not as safe for the person having the IUI done, nor is it safe for those potential babies. I go in for monitoring this morning without my husband for the first time ever. In a turn of events that I don’t expect, I have a lot of eggs and they’re all quite large. The doctor who did my ultrasound looks around my ovaries for a few seconds and promptly says she’s canceling the IUI and advised me not to have intercourse for two weeks. This might sound weird given how many cycles I have already been through, but it’s the first time I feel truly devastated during this process. I am fighting back tears and ready to go home. I’m not sure how much more of this I can take.

Cost: $50 co-pay for monitoring.

A few days ago, my doctor canceled my IUI (again) due to over-responding to Gonal-F (again). The silver lining is that for all intents and purposes, these results point to a great IVF cycle, the doctor says. The not-so-silver lining is the price tag. 

Then things get worse. I receive an email from my clinic letting us know that our doc is moving to an office outside of the city and we’re being assigned to someone else. We have a lot to think about.

Cost: $90. There’s a $40 co-pay for Gonal-F, and a $50 co-pay for the monitoring appointment. 

After our last cancelled IUI in May, my husband and I decided to take a break. The eight months of hormone pills and shots took a toll on me and I wanted to feel normal again. We met with our new doctor at the same clinic and discussed our options for IVF. While we liked her, and I believe I would have trusted her throughout the process, something just didn’t click for us in that moment. Outside of the hefty price tag (reminder: it’s at least $30,000 for one try), we were having communication issues with both the finance team and the coordination team. We were overwhelmed and scared. We decided to redesign the landscape of what the IVF process was going to look like for us. 

That’s why, today we’re speaking to two new fertility clinics. We’re anxiously excited. Both consultations will be over video chat because they are outside of the U.S.; one’s in Madrid, Spain, and the other is in Prague, Czech Republic. I realize it might sound crazy, and to be honest if a friend told me they were doing this two years ago, I might have thought the same thing. But these clinics are rated top in the world, they’ll cost us a third of what we’d pay in the US, and it's kind of a built-in mini-vacation. We feel as if we’re making huge strides and finally things are starting to fall into place.

Cost: $750, in the form of a surprise bill from the previous fertility clinic for co-pays that weren’t billed at the time of monitoring or procedure. The two video consultations are free. 

Today, we did it. After many, many discussions with the clinic and mulling it over late into the night, we decide that Madrid is the place where we want to make our babies. I take my husband there for his 30th birthday, so we are familiar with the area. We really fall in love with the city. We’re elated. We send them our payment, which includes literally everything, from visits to retrieval to genetic testing to transfer to freezing for up to one year. The only thing that it does not include is the medicine, which we will buy from the pharmacies when we are there. We’ll be taking the red eye from New York City on December 31 (Happy New Year in the air!), and our first appointment will be on January 2. I feel like I have fireworks going off inside of me. It’s finally happening. 

Cost: $11,328.49. This includes $9,165 up front for a year of clinic costs, all out of pocket with no insurance assistance; $1,548.59 for the Airbnb; And $614.90 for the two roundtrip flights. 

It’s New Years Eve and we aren’t on our flight to Madrid. My father-in-law wasn’t doing great before, but he took a turn for the worse a few weeks ago. We’ve basically been living in the hospital with my mother-in-law, sister-in-law, and a few other family members. The doctors told us today that he only has a few days left and we should be with him as much as possible. He has been fighting so hard and we’re all crushed. We aren’t ready to say goodbye to him, but we don’t want to see him struggle, in pain, any longer. 

I email the fertility clinic and let them know that we have to reschedule our cycle. I also call the airline and cancel our flights. Surprisingly, they were very empathetic and allowed us to cancel without fee and have flight credits that cover the full cost of what we spent. We lost our Airbnb payment. As I deal with these logistics, I’m sitting alone in the hospital’s rec center with tears spilling down my face. The impending loss of my father-in-law is weighing heavy on my heart, and the setback to starting our future family together opens the floodgates.

At 8 p.m., the hospital community center is having a balloon drop with sparkling cider and finger foods. Everyone in the hospital that can be is there ready to “celebrate” 2020.

“Happy” New Year, I guess. 

Today, my father in law passed away. The past few nights we’ve been staying at a hotel by the hospital so we could be close when it happened. Last night, we decided to come home to sleep, which means we weren’t there. There were so many people around him at the hospital for so long but when he went, he was alone. We like to believe that going that way was easier for him. We love him and we will miss him every day. He is the smartest person I know. So warm, loving, and so, so excited for us throughout our fertility journey. I wish I could have delivered for him, but I know he will continue to be with us throughout our journey. 

At the urging of my mother-in-law, we rebooked our trip to Madrid after a few very tough weeks at home. We arrived on January 29, but in true WTF fashion, my period was late for the first time... really ever… so we are only starting the cycle now. Today is my day two of my cycle. Time for testing. The office is beautiful and modern, yet somehow has a cozy feeling. We’ve met with our doctor twice since arriving, once just to meet our doctor and her team, which is a nice change. (At our previous clinic, you barely saw the actual doctor unless we were scheduled for a procedure). We’re handed a prescription and they tell us to go up the street to the pharmacy to fill it. 

This is so different from what I experienced in the U.S. Anytime I had to get meds at home, it was done via phone and then delivered to my house with a signature required. Health insurance always had to approve it beforehand. Now here is the kicker: In New York City, our medications were estimated to cost $10,000 (yes, you read that right). In Madrid, without health insurance coverage, we’re spending $900 on the same exact medicine. We left the pharmacy feeling as if we robbed the place. We could have skipped back to our Airbnb, we were so excited.

My doctor instructs me to take 75 intravenous units of Menopur (a follicle-stimulating hormone)  and 225 IU of Gonal-F every night around 10 p.m. After a day of testing, sightseeing, and a delicious dinner, we return to our Airbnb ready to get our shot on. Or so we think. The Menopur is a challenge. We thought we’d listened carefully to our nurse’s instructions, but alas… When it comes time to pop open the little glass vial of liquid to mix with the medicine, we fail. Three times in fact. With each fail we create new, tiny, bloody cuts on my husband's fingers due to breaking the fragile top of the bottle. We frantically email our fertility nurse, but by the time she gets back to us, we’ve finally figured it out. That means we’ve successfully started IVF. 

Cost: $2,272.85. That’s $900 for medication, and $1,372.85 for the new Airbnb booking. 

The last six days have been filled with shots, clinic visits, and work (we’re able to do our jobs remotely throughout all of this, luckily. But we’re on U.S. hours, from 2 p.m. to 11 p.m. Madrid time — yikes). Now, it's finally the weekend. We’ve decided to treat ourselves to a quick trip to Mallorca, a tiny island about an hour flight from Madrid. I have to take my shots with me, though. I inject them overlooking the orange groves growing outside of our dreamy, castle-like room. This makes me feel warm and hopeful.

Our flight home is booked for this Saturday, February 15. Our doctor predicts an egg retrieval for Valentines Day. Those plans change a bit today after our ultrasound. Turns out, my follicles are moving slowly and need a little more time. I’m instructed to take Ovitrelle 25o Micrograms (aka the “trigger shot” that releases your eggs) and 0.1 Milligrams of Decapeptyl (which lessens the chance of premature ovulation) on Friday. My retrieval is on Saturday. We have to push our flights to Sunday and extend our Airbnb one night, but I could care less. Soon — fingers crossed — we will have embryos!

Cost: $421.85. There was no additional charge for the monitoring appointments, as they were included in the upfront payment.  It was $99.23 for the extra night in the Airbnb, and the airline change fee was $322.62. 

It's our final ultrasound before our retrieval and everything is looking up. We have 14 total follicles, which release eggs. The most promising follicle size is over 16mm, and we have five in that range. Eight to 15 follicles is an acceptable amount for IVF, so we are in a good place. Next up, retrieval day.

Cost: $0, since we paid everything up front. 

All of the emotions of the past year and a half seem to come to a head today. Since we started trying, I’ve been cautiously optimistic. Today, this will all change, I know it. I am so ready for this – put me under, doc! I’m wheeled into the retrieval room. The anesthesiologist is hilarious. Right before he injects the anesthesia, he tells a joke about going under being like having a few too many drinks at the pub. I smile. The next thing I know I am waking up to my husband's voice in the recovery room. We did it. Our international liaison has held my hand throughout this journey, and she comes in to deliver the good news. They retrieved 11 eggs, which are currently being fertilized to become embryos. We decide to have our embryos checked for genetic issues. This is to help prevent miscarriage and impantation failure. These tests happen at stage five of embryo growth, when they become “blastocysts.” Basically, we are now doing a waiting game to see if our embryos will survive the next few days.

Cost: $0. We had already paid an extra $400 up front for EmbryoScope monitoring. This is a new type of incubator that allows the embryologist to monitor cell divisions while the embryos are still in the incubator.

We have been home for a few weeks, and man, have we been wrought with a mix of anticipation, anxiety, elation, fear, and joy. So, yeah — literally every emotion. Our clinic has been emailing us pretty much daily with updates on our embryos. By days five and six five embryos are blastocysts, meaning they’re ready to be tested. 

We receive an update from our international liaison at our clinic and she informs us that the genetic test results have come back. Out of our five embryos tested, two are ready for our IVF transfer. I’m not sure how to explain in words the emotions that we are feeling, but you know how when you give a dog a treat and they start twirling and jumping all over the place? That’s how we felt inside. 

In the last few weeks, everything went to shit. An unknown virus, COVID-19, has spread throughout the world and has been devastating to hundreds of thousands of people. Today is my birthday (39, woo-hoo, womp). It’s also the day our clinic in Madrid let us know that we would be putting our transfer on pause. They’re hoping we can fly back abroad in May or June. 

The hope is that the coronavirus will have cleared up, and that we’ll be able to resume our planning. But here in New York, things are looking dim. We have been in quarantine since early March, and I don't think we’ll be coming out for a while. I feel guilty for feeling distraught about my transfer when people are losing family members and friends due to COVID-19 left and right. But we got so close to finally reaching this milestone, having our baby, and now we are an ocean away from our embryos. It seems the chance of a family is slipping through my fingers. In addition to that, I’m terrified that someone in my family is going to catch this virus. The unknown of the future is an inexplicable feeling. All of this makes me question what the world will look like for a baby in the future. 

Cost: $500.65, the cost of medication I was supposed to take to prep for the embryo transfer, which I’d ordered from Tel Aviv — a loss. Luckily, we hadn’t already booked the flight for our transfer before COVID-19 hit.

We received some very welcome, amazing news a few weeks ago regarding my health insurance. Turns out, at the beginning of this year, New York mandated IVF coverage (for three cycles) for businesses located in the state and I qualify. Holy shit. It doesn’t look like we will make it to Madrid anytime soon, so we decide to start the whole shebang over again. After researching a few clinics here, we make our decision and are ready to rock IVF (again...). 

Today is day two of my cycle and I’m at my new clinic. I’m doing a blood test; the doctors are looking at my hormone levels to see if I’m ovulating, and trying to get an idea of my ovarian reserve. I also do an ultrasound at my new clinic. We won’t be starting IVF until June. During the ultrasound, the technician sees what looks like a small bump on my uterine lining. She doesn’t seem overly concerned, but mentions removing it prior to my transfer. This would delay me for a month. I’m okay with this, as long as it means we have a successful pregnancy.

Cost: $50, a co-pay for the monitoring appointment. The initial consultation with the clinic is free.

May consisted of a lot of testing, webinars, and Zoom meetings to meet my new IVF team. Today is day two of my cycle again, and I’m back for bloodwork and another ultrasound. I won’t receive my blood test results until later in the day, however, my ovaries look great. I have 16 very small eggs waiting in the wings, ready to start growing.

Then, this afternoon, a nurse calls me. My FSH (follicle stimulating hormone) levels are too high, and so my doctor is canceling this cycle. The maximum cutoff number is 15, and my levels are just just above that. High numbers typically mean that your body is working very hard to produce eggs. Higher numbers typically come with higher ages. Needless to say, I’m devastated. I’m lying in my bed crying. I can hear my husband on a conference in the other room and I’m praying it’ll be over soon. If we hadn’t had so many previous setbacks, I don't think my reaction would be this strong. But at this point I feel hopeless. 

Cost: $50 co-pay for monitoring.

One good thing that came from my high FSH levels in June is that I now have the time to remove the fibroid chilling in my uterine lining. Before the surgery, I have to take a coronavirus test. It’s much scarier than I expect it to be. Thankfully, my results come back negative. 

Today is surgery day. For this procedure I’ll be under anesthesia (my anesthesiologist is very nice, but not nearly as funny as the one I had in Madrid). I couldn’t have asked for an easier or more pain-free experience. I’m thankful to have one less hurdle to jump on my journey.

Cost: $0, as this was covered by insurance. 

Today is day two of my current cycle again, and I’m in for my blood tests. As things start to look better in New York regarding the coronavirus, the waiting room starts to fill up a bit more than it had over the past few months. Still, I’m called in at exactly my appointment time and I’m out of there within 20 minutes. My ultrasound looks great, and when I get the call from my nurse later in that day, I ‘m told my FSH is 13. It's still on the higher side, but my doctor gave the approval to move forward. I’m so happy. *Insert “prayer hands” emoji.*

We start our injections tonight, 150 IU of Menopur and 225 of Gonal-F. We injected them this time without a hitch. Go us.

Cost: $4,820. That includes a $4,600 prepayment for genetic testing (this is a baseline charge for testing 10 eggs, but if they test fewer than 10, they’ll reimburse us later, $460 per egg) and a $120 co-pay for all the medication. 

Today is my third day of “stims” (injection of fertility drugs), and, man, are we proud of how well we are doing. Sike. We were instructed to take Gonal in the morning and Menopur in the evening, and yet somehow we heard the reverse. After injecting the Menopur this morning, I happen to look at our medication chart and realize that we had been doing this backwards. After a few minutes of extreme panic (okay, maybe my eyes filled with tears, but I’m on hormones!), we talk to a nurse and she lets us know that we are all good. Our next appointment is on Tuesday, July 28, for an ultrasound and blood work. I’m so excited to see how everything is growing and moving in my body. It really is such a miracle what we produce inside of us. I have a good feeling about all of this. I really do.

Cost: $0 — for now. Due to the coronavirus, they bill after the fact and not in office.

Total Cost: 20,891.84