Fertility Diary: I’m In My 20s & My Partner & I Both Struggle With Fertility

Age: 27
Location: Denver, Colorado
Occupation: Insurance Underwriter
Household Income: $265K

On our wedding night, my husband and I have unprotected sex for the very first time. The next morning, awash in newlywed optimism – but also, still a bit drunk on champagne and cake – I imagine the sweet baby we could be welcoming in nine months’ time. I’ve just turned 24 and, by today’s standards, it’s young to start a family. But my husband is 37, so we both agree we want to have kids earlier than later. 

We figure we’ll conceive at some point during our honeymoon over the next two weeks. By the time we get home, I figure there should be enough human chorionic gonadotropin (hCG) in my system to be detectable by a pregnancy test. 

While my husband is unpacking, I steal away to the bathroom and unwrap the First Response test I’d pre-purchased and hidden the month before for this occasion. As the screen blinks, my anticipation builds. I can’t wait to surprise my husband. I wonder if I should start pinning cute pregnancy announcement ideas to my Pinterest board, or maybe first get on Amazon and Prime myself a copy of What to Expect When You’re Expecting. My thoughts are interrupted when I notice the blinking stop. The screen yields a cold, unmistakable result: Not Pregnant. 

Cost: $13 for the pregnancy test. Those MFers are expensive.

I feel a bit embarrassed still about my naiveté last month. Logically, I know that not every couple becomes pregnant on the first try, but still I figured we’d be one of the lucky ones. And to be fair, up to this point I’ve only ever heard about how easy it is to become pregnant. My high school health class boiled sex education down to a simple equation: Unprotected sex = baby. And shows like Teen Mom and I Didn’t Know I Was Pregnant made me believe pregnancy was something that just happened without any planning or effort.

So I reel myself back in and commit to just enjoying my marriage for a few months. “Trying,” but not stressing. My friends are quick to point out that I do seem to have time on my side. This forced zen is fairly easy to uphold in the first month but it becomes increasingly difficult to sustain as time goes on. Even when I’m trying to relax, I still can’t help but hope. And when your hope is denied enough times, it starts to take an emotional toll. 

By this point we’ve been trying for six months — a benchmark upon which many couples achieve success. I’m becoming disheartened. 

I decide it’s time to do more than just it. I order Ovulation Predictor Kits and start monitoring my temperature and cervical mucus. (Cringe. This is the exact point at which our romantic life becomes more scientific than sexy.) My husband — ever the martyr — pledges to do his part by having sex with me every single night. 

Cost: $30 for ovulation strips, a basic thermometer, and a cute notepad for charting. 

March to July 2017
What Gives?

They say the definition of insanity is repeating the same actions over and over again and expecting a different result.  

Well, by July I’m certifiably crazy. We keep doing everything right and yet, no baby. My life is now organized in an ever-repeating and emotionally exhausting loop of two-week seasons. The first half of every month is spent tracking ovulation and carefully timing intercourse, while the second half involves waiting to determine the outcome of our efforts. Insert negative pregnancy test; start cycle all over again. 

If I could record my emotions as closely as my basal body temperature (a sign of ovulation) during this time, the chart would look like a seismograph. The needle on my heart oscillates wildly, rising with every slight abdominal twinge (must be implantation pains!), then plummeting upon the arrival of my period. 

And a funny thing happens when you’re worried you may never be able to have a baby: you start to see them everywhere. At every restaurant there’s a babbling little cutie trying to play peekaboo with you from the adjacent booth. An endless parade of strollers passes through your neighborhood, and at every turn there is a radiant woman cradling her bump. Then there are the baby shower invites, celebrity ‘baby watch’ segments in your favorite magazine, and baby formula samples that show up randomly in your mailbox. This all brings about a wrenching, inescapable kind of torment. Contrary to what internet trolls would have you believe, it isn’t just sour grapes over things not working out exactly as you planned, nor is it a feeling of entitlement. It is an earnest sorrow and a sincere form of grief. 

My husband and mom keep trying to reassure me that things will work out, but their words — however well-intended —  feel empty and dismissive. It’s clear neither of them feel the same sense of urgency and prescient dread that I do. I just know something has to be wrong. To try to head off my worry, I guzzle fertility tea. I even try going on the Whole30 dietary program, because a number of women in online chat boards I read have claimed going paleo helped their fertility — I figured it couldn’t hurt to try. (Spoiler: It didn’t work for me. It seemed to increase my grocery bill more than my chances of pregnancy.)

Meanwhile, friends and extended family members started asking when we were going to have kids. I would have loved an answer to that myself. 

Cost: $78 for more OPK kits, pregnancy tests, and special tea. Our grocery costs also increased by about $800 due to the Whole30 — you have to buy a lot of meat and extra ingredients. 

We’re approaching a full year of trying — the very specific, but in many ways arbitrary, cutoff in the world of reproductive medicine that will qualify us under insurance for limited diagnostic testing of fertility markers. By the end of this month, if not pregnant, we’ll begin to be considered “infertile.”

Anticipating long waitlists, I start making the calls to schedule preliminary tests for both my husband and me. Mine at a regular OB’s office, his at a reproductive endocrinologist (RE). The RE has an open slot at the end of the month. We decide to pay for a semen analysis out of pocket in order to avoid delays for insurance approval. 

My husband is an absolute trooper about it. Even though he isn’t fully convinced we have any real issues, he saddles up and does the damn thing. On the drive home, I’m almost giddy at the prospect of finally having some real insight into our situation. I subject him to a full interrogation: “What was it like in the room?” “Was there ‘entertainment’ provided?” “Was it any good?” “Did you think about me?” “Did you get it all in the cup?” You know, the real hard hitting questions. 

I’m at work a few days later when he texts to let me know he’s received his results. He types out the three numbers relayed to him by the nurse: Sperm Count 2 million, Morphology 3%, Motility 64%. I immediately input them in Google. Two million strikes me as a lot of sperm, so I’m stunned when the first hit from the Mayo Clinic reads “Low Sperm Count — Indication for IVF treatment.”  Anything from 15 million to 200 million would have been normal. Two million was critically low. 

For some reason, maybe because of the way infertility is popularly portrayed as a female-centric issue, I’d always assumed that whatever problem we were having rested with me. I’d honestly only booked my husband an appointment as a matter of procedure to rule him out. 

I text back: “Hon, let’s talk tonight”. He knows what kind of talk I mean. His reply is a single heart emoji.  

Cost: $120 for the semen analysis. 

In the months leading up to our consultation with the RE (the earliest date we could book was in November), my husband and I run through all of the different possible scenarios going forward. We don’t yet have the full picture of our reproductive health (or lack thereof), but we know enough to realize that a natural, spontaneous conception just won’t be in the cards. Our path will require work, sacrifice, and the abandonment of any and all preconceived dreams we’ve held around how our future children will come to be. 

We both very much have the heart to adopt. It doesn’t so much matter to us that our child shares our DNA. We just want the opportunity to share our love. But in researching the adoption process, we became quickly discouraged. The average cost of adopting a newborn in the US is about $43,000, and most couples can expect to spend anywhere from two to seven years on waitlists before bringing a baby home. Fostering is much cheaper, of course, but we didn’t feel prepared to parent an older child, and I wasn’t sure I could handle the heartbreak of having to say goodbye to someone I’d come to love (in the likely event they were reunited with their biological family). Plus, in both cases there would be a lengthy pre-approval stage involving applications, home studies, background checks and more. Now 38, my husband is far from being ‘over the hill’, but his age is still a major consideration in all of this. We unfortunately don’t feel we can afford to gamble with what could wind up being years of time.  

In vitro fertilization, as unappealing as it sounded, was shaping up to be the most feasible course of action for us. My employer’s insurance has an infertility benefit that would significantly cut our costs (we’d be looking at around $20,000 out of pocket), and the average timeline for a single cycle is generally under a year. So long as the doctor felt we had a reasonable chance at success, we were ready to go all in.  

We have the incredible fortune of living in a state with two top ranked fertility clinics. I’ve heard high profile celebrities are known to fly in from LA to seek treatment here, and the doctor we are about to see is known for high live birth rates (the gold standard for measuring IVF success). At the office, the doctor  tells us that based on my husband’s sperm count alone there is virtually no way we will ever be able to conceive without medical intervention. We would have had better odds at winning the Powerball, he says. Then he goes on to promise that he will be able to get us pregnant. His overconfidence makes me skeptical, and the way he rattles off his stats and awards makes me feel like we are sitting through a timeshare pitch. Embryo transfers at this clinic have a 65% chance of resulting in a healthy, full term baby. Relative to the roughly 40% average success rate for other practices in the country, this sounds great, but I can’t help but think about the other 35% of couples for whom IVF didn’t work. I bet he gave them this same spiel. Plus, after so many months of failure, it’s hard to believe that our luck will ever change. 

My husband is nodding enthusiastically though. He’s excited, which is sweet, but I’m annoyed watching him succumb to this doctor’s charms. 

We wrap up the meeting, and the doctor escorts us to the next room over. There, a coordinator runs through the logistics of our treatment plan. We would start that very day with blood draws to check for nutrient deficiencies, thyroid abnormalities, and hormone imbalances. My husband would immediately begin taking supplements to enhance his sperm quality. Then, over the following weeks, I’d undergo several procedures to assess the health of my reproductive tract. If all of that checked out, we would be assigned a nurse and move on to officially start an IVF stimulation cycle. 

Cost: $550 for the consultation, blood work, and male fertility supplements. 

It feels like we just can’t catch a break. Every routine test seems to uncover some new problem that will further complicate our treatment. Blood tests established that I have hypothyroidism and I’m vitamin D deficient. That’s a problem because these issues have been found to negatively affect fetal development. 

Then, an hSG (dye test) shows that one of my fallopian tubes is blocked. A hysteroscopy (analysis of the womb via catheterized scope) reveals a uterine lining riddled with polyps. My doctor says this could make embryo implantation difficult. Then, the coup de grace: Ultrasound evaluations of my ovaries determine that I have Polycystic Ovarian Syndrome (commonly referred to as PCOS), which can cause issues with ovulation. 

What we thought was a relatively vanilla case of insufficient sperm turned out to be so, so much more complicated. My husband and I were just a shitstorm of fertility issues. 

I spend the holiday months on various medications in an effort to correct my underlying conditions before starting the stimulation cycle (also called a stim cycle),  designed to stimulate the ovaries to produce an abundance of mature eggs. 

I take prescription-dosage vitamin D, Levothyroxine (a synthetic thyroid hormone), and Metformin (a diabetes drug that is used off-label to improve symptoms of PCOS). I also take every one of the six different herbal supplements our doctor suggested to improve egg health, because, at this point, why not? My body has already become a giant science fair project. So I start popping supps such as CoQ10 and Acai Berry. 

Cost: $1,600 for diagnostic procedures, medications, supplements, and monitoring. 

It’s the first of the month and I’m sitting on the couch half-watching The Office while listening for the doorbell. I’ve taken PTO so that I can be home to sign for the delivery of stim meds being overnighted from a specialty pharmacy in New Jersey. (Fun fact: IVF meds are so specialized and controlled that they are only available from a select few locations – you can’t just pull into the Walgreens drive thru and order them up.) When the delivery man finally arrives, I open the door and am taken aback by the size of the box being hoisted into my arms. 

I’m strangely excited. It’s a complicated, butterfly-in-stomach, Christmas-present-under-the-tree feeling that I hesitate to admit because I don’t want anyone thinking any part of this process is fun — it’s not. This box contains $3,200 worth of needles and scary medications I never wanted (certainly, I can think of a million more enjoyable ways to drop this amount of cash – Bahamas vacation, anyone?). But it also contains promise. Even if the contents of this box don’t ultimately bring us a baby, they represent a first big concrete step toward that goal. And even though I’ve already been taking a slew of medications and supplements, something about this giant prescription pinata sitting in front of me makes it all real.

Our cycle starts the very next morning. My husband is our self-appointed ‘shot-meister’ and is taking the role very seriously. He clears a ‘workspace’, wipes it down with a Clorox wipe (so extra) and organizes all of the meds, syringes, and needles in neat rows. Before we can begin mixing up the first medication, he insists on watching another YouTube instructional video. We have already seen several of these, not to mention that we also attended a multi-hour course at our clinic on how to prepare and administer shots. But he’s adorably nervous and doesn’t want to mess up his big job. So I humor him and watch the video once more for good measure. 

After he decides he feels confident enough to proceed, he pokes the needle through the rubber membrane of the vial and draws up my first dose. “Let’s make a baby” I tell him, pinching my stomach and gesturing for him to start. “Wait” he says, “Kiss first!” He gives me an excited peck and holds the needle over my belly. He wavers for a second, then pushes into the little pooch of skin I’m holding between my fingers. It isn’t nearly as painful as I was expecting, but then again maybe I’m just high on anticipation and nervous energy. Still, though, it’s an intense and strange experience. My husband and I look at each other in bewilderment, then fumble a high-five that ends in a deep hug. We did it. Well, not all of it — not even close — but the first shot is always the hardest, right? 

Over the next 21 days, my life becomes completely consumed by IVF. Six days a week, for three weeks in a row, I report dutifully to the clinic for ‘monitoring’ appointments, which involve transvaginal ultrasounds to track follicle growth and blood draws to check hormone levels. Yep, more needles! Joy.

Everywhere I go, I keep my phone glued to me, ringer on, waiting for my nurse to call with instructions for the next day’s dosages (it can, and often does, change day-to-day depending on your body’s response). I’m constantly thinking about how to time my day to accommodate for all the shots, pills, and patches that must be taken at different, specific times. Yet I’m also trying to remain competent in my full-time job, be sociable with my friends, and stay somewhat mentally well. It’s an impossible juggle, and one that I’m performing mostly solo, which is starting to really weigh on me. My husband, for as wonderfully supportive as he is, does not have to experience this in the same way. His body isn’t bloating with hormones, and he doesn’t have to check his modesty at the clinic door while stripping down naked in front of an ultrasound tech every morning. His privates get to stay private. And his work life gets to continue uninterrupted. 

While there are plenty of sweet moments where I truly feel we are in this together — when we sneak away from a dinner party to inject a clandestine shot in the bathroom, for example, or when we squeeze each others’ hands while anxiously awaiting the day’s test results — I’m frustrated by the overall inequity of the whole thing. 

By day 20 of the stimulation cycle, I’m emotionally depleted but cautiously optimistic. My body has responded ideally to the medications, and in each of my ovaries there are 15 to 25 follicles of sufficient size to yield mature eggs (which are necessary for the development of embryos). Everything seems to be in check, so the doctor orders us to administer a ‘trigger shot’ at exactly 10 p.m. in preparation for egg retrieval the next day. We are told this is extremely time sensitive, as a premature shot will cause the ovaries to release the eggs, making it impossible for them to be collected. Too late, and the eggs won’t be matured in time. We have to be precise down to the minute. No pressure or anything… 

At 9:30 we turn off the TV and go to prepare the shot, only to realize that we don’t have the proper syringe for it. This is the only shot that is to be given intramuscularly, so the other needles we have on hand won’t be long enough to substitute. We run around panicked for 25 minutes and still can’t find it, so we decide to use a mixing needle since it is roughly the same length and we are running out of time. This turns out to be a very painful mistake. While the mixing needle is the same length as a regular intramuscular needle, it is about three times as thick. The thing looks like a Halloween prop! Even my husband, who now fancies himself a needle expert, is sweating at the sight of it. But if there’s anything I’ve learned at this point in our IVF journey, it’s that I can (and often have to) do hard things in the name of our family. I buck up, pull my PJ pants down, and lie on top of our dog’s bed with my full moon hanging out. My husband’s phone alarm goes off, signaling that it is ‘time’. He hovers over me and makes a couple false starts before declaring ‘ok, I’m really going to do it this time!’ I can see in the reflection of our fireplace glass that he is closing his eyes while stabbing at me. My whole body clenches while he pushes the medication through. Ouch. Remember how I said the first shot is the hardest? Yeah, I take that back. 

Cost: $3,200 for medications, $7,800 for our first payment to the clinic. 

It’s retrieval day. My ovaries are now the size of grapefruits (for reference, a normal woman’s ovaries are about as big as almonds), and I’m ready for them to be deflated. 

But today is also my husband’s time to shine. While I’m under sedation having my eggs surgically removed, he is performing his own sort of, ahem, extraction. Because our eggs and sperm need to be brought together as quickly as possible to ensure successful fertilization, he must make another trip to the ‘fun room’ to provide a fresh batch of swimmers. Apparently he was very efficient in this task, as he later told me that my mom (who came with us for support) commented “that was fast” when he returned to the main waiting room. I’d like to believe it was because he was thinking of me, but something tells me the doctor-ordered month of abstinence had more to do with it. 

When I wake up, the nurse cheerfully tells me they retrieved 44 eggs. This sounds like a lot, and it is, but IVF is a total numbers game. Eggs do not equal embryos, and there are myriad factors complicating fertilization rates. From the 44 eggs retrieved, only 26 turned out to be mature, and of those, 18 fertilized normally. On day five post-retrieval, our embryos are frozen. 

Cost: $800 for Anesthesia. $5,600 for remaining balance with the clinic. This balance is for the transfer cycle. 

March – April 2018
"Healing"

Our clinic does not do ‘fresh transfers’ (transfers of non-frozen embryos the week after egg retrieval), and I am now grateful for that fact. My belly is somehow even more swollen than before the retrieval, and I look a solid six months pregnant — an unfortunate and ironic circumstance I try desperately to hide under flowy tunics while at work the following week. I’m clearly still physically reeling from the stim meds, and can’t imagine I’d be in an optimal place to nurture a growing life inside me at this point. As much as it sucks to wait even longer, I get it. I need the time to heal. The doctor places me on birth control pills to regulate my hormones for a couple months before we start a transfer cycle. 

I tell myself I’m going to use the next couple months to pursue joy in other non-baby-making aspects of my life. I’ll heal my soul alongside my body. So I do all the things I haven’t let myself do while focusing on our fertility, plus a few things I’ve always wanted to do just for the heck of it. I go on late nights out with my husband. I go on incredible hikes. I take pole dancing lessons. I drink all the beer. 

This all feels restorative and nice. But to be honest, I don’t know that anything can quite shake the anxiety wrought by infertility. It’s always hanging out in your periphery, and even as you try to cast your sights forward you can’t help but be distracted by it. 

Cost: $300 for ongoing medications. 

We receive another giant box of meds, along with a busy-looking cycle calendar with dosing instructions, times and appointments. For this cycle there are just eight appointments, and an average two shots a day (verus up to four or five daily during the stim cycle). It seems comparatively manageable. 

The three weeks pass so quickly and otherwise uneventfully that we are almost surprised to finally arrive at the day of transfer. 

It is a momentous day, but it begins without fanfare. I wake up, and, for the first time in almost a month, don’t have to worry about shots. I type up a few emails, set my out-of-office message for work, and pull on my go-to leggings. Then I fill a Nalgene with exactly 32 ounces of water (your bladder must be full in order for the uterus to be tilted in the correct position for catheter insertion) and prepare all our documents. 

On the drive to the clinic, the gravity of what we’re doing hits us and my husband and I both erupt in smiles. I turn the radio up and blast cheesy ‘90s pop. We jam and shout the lyrics while I chug down my water. This is one of the best moments of my life. I look at my husband, grinning and jumping in his seat, and think how much I appreciate him for taking this wild ride for me. Ours is an unorthodox love story, and I hope we make a baby today so that I can one day tell them about it.   

At the clinic we are led back to the same room where I underwent my egg retrieval a few months before. But this time a nurse hands us a photo of the embryo we are transferring, which is wild. Sure we had to spend ourselves broke for the privilege, but how cool is it that we get a picture of our baby when they’re just five days old? I clutch it to my chest while the doctor guides me into the stirrups. He quickly goes over the procedure and then directs us to look at a large television monitor above his head. There, our embryo comes into focus. What looks like a giant tube enters stage right and sucks the embryo up and out of view. The embryologist emerges from the next room with the catheter (a giant tube) in hand, and slowly transfers it to the doctor’s hands. He expertly inserts it, then tells us to look at the ultrasound monitor by my side. My husband grabs my hand. “Three, Two…” and on “One” we watch a bubble shoot across the screen. It’s instant waterworks. My husband chokes he’s crying so hard, which makes me laugh and pee and cry even harder. The doctor and nurse wish us luck and leave the room. We continue laying there for ten more minutes, smiling through tears with such love for that little embryo.  

Cost: $1,740 for medications. 

That tiny bubble on the ultrasound screen became an amazing, vivacious baby girl. She is a naughty little ham and the absolute joy of our life. And we are endlessly grateful to have had success in our first IVF cycle as we realize that not all couples are so fortunate. 

We are now midway through another transfer cycle in the hopes of giving our daughter a sibling to complete our family. 

It’s surreal and strange to be going through this all again, especially now. 

In many ways, this round feels familiar. The medications and procedures are the same, and the gracious clinic staff are all happy to see us back. 

But it also feels decidedly different. For one, I’m coming into it with a full heart. Thanks to my daughter, I’m not gripped by the same essential fears I felt before. I already have a family, and if I can grow it with the love of another child, all the better, but I’m genuinely so grateful for our little girl that it’s hard to ask for much more. I know I’m lucky. 

And then, of course, there is COVID-19. This pandemic has not only caused deaths and job loss, but interrupted virtually everything for everyone, and fertility clinics – not to mention patients – are no exception. Our cycle was postponed by several months while all centers for reproductive medicine (deemed nonessential) were mandated to close. Now that we have resumed, there are several cautionary measures in place that considerably alter the day-to-day experience of fertility treatment: Face masks, temperature screenings, and magazine-free waiting rooms are minor, yet eerie reminders of our changed situation. More significant is the fact that all appointments must be attended alone. This makes an already lonely experience even more isolating. I worry that all of the small, special, redemptive moments I shared with my husband the first round just won’t be possible this time. As it has with so many other things, Covid-19 is threatening to strip this process of its potential beauties.

Cost: We have paid almost $9,000 for this cycle. We’ve already maxed out our IVF benefit through my company, so this one is entirely out of pocket. Luckily, though, the transfer cycle is much more affordable without insurance coverage. The breakdown: $1,750 for medications; $2,050 for standard procedures conducted prior to cycle  such as a trial embryo transfer, a sonohysterogram to check that my C-section scar has healed internally, another polyp removal procedure, and a doppler ultrasound to test blood flow to uterine lining; and $5,100 to the clinic for the actual transfer. 

Reflection: For a long while, I was worried that I would become irreparably scarred by my experience with infertility. I had watched my best qualities — optimism, drive — erode, involuntarily, over the course of two years. I spent so much time, too much, at emotional odds with those closest to me. And I became bitter, something I’d never been before and had hoped never to be because it’s so toxic. Often upon confiding in friends and family, my feelings would be swatted aside with ‘at least’ and ‘it could be worse’ statements. And on a societal scale, people undergoing fertility treatments are also frequently painted as ‘desperate’ or ‘selfish’, while IVF is characterized as an elective, elite procedure. The net effect of all of this brought an overwhelming sense of loneliness and emotional disenfranchisement, which really did a number on me.

But, admittedly, this painful process also bore some unique, beautiful rewards. For one, my husband and I became even more deeply resolved in our love and commitment to one another, children or no children. Our marriage was tested, then proven, in a way many others are not. I’ve also emerged from this with more compassion. That adage we’ve all heard is now my personal creed. “Everyone you meet is fighting a battle you know nothing about. Be kind.”

And then, of course, there is our beautiful daughter who is the biggest reward of all (and hopefully her brother soon to be on the way). It’s only because of her that I’ve finally been able to openly reflect on our fertility journey. It was too painful when we were in the thick of it, then too scary once I became pregnant. But her presence has brought so much healing, and the emotional scar I thought would mark me forever is fading. It’s so light that I’ve barely even felt it during this IVF cycle. I have been mercifully unburdened by (most of) the fears that plagued me during our first round of treatment, even if I now face a new set of challenges brought on by COVID-19. Right now, like the rest of America, I’m just trying my best to appreciate and hold on to the things that matter most to me. The pandemic has shown the world just how much is out of our control, but that is a lesson infertility taught me long before COVID-19. I realize that while parenting does not look the way I thought it would this year, neither did my path to becoming a parent in the first place.