Women with diminished ovarian reserves, like me, are recommended to skip all the gradual building up within the tiers of fertility treatment and go right to the end–IVF. As my doctor put it, we need a “good egg”. Since eggs are screened for viability when they’re retrieved for IVF, the procedure could potentially prevent an undesired genetic diagnosis (and a possible abortion if that’s the patient’s choice) or a miscarriage or possibly even a little bean that simply doesn’t want to “stick”. I declined, opting for IUI instead.
I want to share my views on various options for having a child when the “fun way” doesn’t seem to cut it. Before and during treatment, I consistently received the same question, “Why don’t you just do IVF?” Infuriatingly, I even received this question over and over by the same people when they didn’t accept my answer the first time! When people aren’t faced with the choice themselves, they tend to act like IVF is a simple, guaranteed procedure. IVF is very extensive, and not to be taken lightly. Even after the emotional, physical, mental, spiritual, and financial strain, you are still not guaranteed pregnancy, or even guaranteed to have a full-term viable pregnancy if you become pregnant. When asked toward the end of my journey, I simply said it’s not for me instead of giving the exhaustive list of reasons I did earlier in my fertility journey, when I wasn’t as jaded. I want to share the long list of reasons here, though, just in case a woman going through something similar finds this post and needs to feel a sense of sisterhood with a woman out there that understands her. I wish I had someone who understood what I was going through the last almost-four years. I don’t want someone to feel as alone as I did.
Disclaimer: What’s right for me may not be right for you, and vice versa. This is my opinion for what I’m comfortable with in my own life, for the reasons given. Everyone has different boundaries and feelings about what they would and wouldn’t be willing to pursue to expand their families. It’s excruciatingly difficult to open up about fertility, and this is why women often choose not to at all. If you decide to comment, please be kind.
IVF – Practically
I’m very lucky I live in NY when it comes to fertility treatment. In NY, IUI and IVF are covered by health insurance, albeit limited–my insurance would only cover two rounds of IVF, and this number doesn’t reset when health insurance usually resets at the first of the year, which we didn’t find out until we used up our eight rounds of IUI. I’m not sure what goes for the other forty-nine states, as the health insurance laws are different for each one (as far as I know). Without insurance, IVF can cost $12,000 or more, not including the cost of medication, which is in the thousands per injectable pen! After breaking the bank, imagine that cycle failing. For my husband and me, specifically, our copay for one cycle of IVF was more than our copays combined for our max of eight cycles of IUI. I’ll take the extra chances for less money out of pocket, thank you very much.
Physically, IVF is stressful. With IUI, I was already cranky and uncomfortable with basic ovulation medication and my monthly trigger shot. On the day of IUI, I had much worse cramping than when I’m at the height of my typical period pain. When it comes to IVF, the medications are more intense–to get the most eggs possible for retrieval, you’re at risk of overstimulation and flipping an ovary 😳, if you don’t take life easy. After your trigger shot, you need mild surgery to retrieve the egg(s). I’m imagining embryo-transfer day is equally as uncomfortable as IUI day because it’s a similar procedure. And, I haven’t even mentioned yet all the bloodwork and ultrasounds for both IUI and IVF. Those are plenty annoying as it is, especially the further along you are with your fertility journey, and the more cycles you add to your fertility-patient-veteran status. (When I get blood drawn now, the vein in my right arm takes longer to stop bleeding than it used to from getting blood drawn 2-4 times a month for a whole year.)
This is one of the posts I had planned on posting sooner, in August of 2020, and I’m glad I didn’t until now. In September, I was on Gonal F, an injectable IVF medication, in the hope of getting more eggs for a higher chance of conceiving with IUI. My body didn’t respond at all. It was like I didn’t take the medication to begin with. I was then put on a higher dose, and we got ONE egg. Only one! My doctor wanted me to order more medication to get more eggs, but my limit for the month was already maxed out (five pens, which were $80.00 in total after insurance). I’d have to pay out of pocket for the rest, which would have been ~$7,800! I told my nurse I wasn’t doing that. I was instructed to use Cetrotide for two days, which inhibited ovulation to give the egg time to grow more, for what reason I still don’t understand because the egg was already technically large enough to be released. 🤷♀️ My nurse tried to explain it to me but I didn’t get it. 😅😂 My body hated the Cetrotide–I got puffy rashes where it was injected, and I felt “tender” where I would usually feel period cramps. I intuitively felt an aversion to the medication before and after taking it, and I knew I’d never take it again after that cycle.
To make matters worse, I had an extremely scary experience in the shower on Gonal F–my husband and I were enjoying each other’s company naked 😉 and I was cleared for sex beforehand by my doctor, so I should have been fine. I spontaneously got this horrendous pain reminiscent of my traumatic HSG pain. In my mind’s eye I could see my entire reproductive system and I was so aware of it, like an in-body experience instead of an out-of-body experience. Even typing this and thinking about it after so much time makes me incredibly uncomfortable. I quickly finished showering and immediately called my nurse, who spoke to one of the doctors since mine wasn’t available at the time, and basically said there was no need for concern. It could have been the medication “kicking in”. The pain took a few hours to go away (while I suffered rolling panic attacks), but still felt “tender” for about a day. No, thank you. Needless to say, the risk wasn’t worth it, considering the worst side effects I had on Letrozole was crankiness and hot flashes, and every other cycle, I had two eggs instead of only one, AND I responded every time to the medication. So, long story short, even if I wanted to, IVF probably isn’t even an option for me.
There is a huge, HUGE! misconception that when you undergo IVF treatment, you are guaranteed a baby. This couldn’t be further from the truth. The odds for conceiving with IVF your first cycle are extraordinarily all over the place… I can’t seem to find a unifying number. But basically, your odds of conceiving the first cycle are 20-something to 40-something percent (if you’re younger than thirty-five–the odds plummet each year after), and the percentage doesn’t include full-term, live-birth pregnancies–it only represents the initial conception. These odds also don’t take into account the cause of the fertility struggle to begin with–the particular diagnoses (which are, in my opinion, practically infinite, especially when a woman has “unexplained infertility”) further skew the percentages. With IUI, my percentages were 10% for the first cycle, 20% for the second, 30% for the third, and so on. Considering by the second cycle, I was already at or near the percentage of conceiving with one IVF cycle, I preferred the odds of IUI, especially when I only had a max of two IVF cycles with my insurance, as opposed to eight IUI cycles.
IVF – Spiritually
Spiritually speaking, I’m not comfortable with the conception of my baby occurring outside of my body–and growing for a little bit before being put into my body!–nor am I comfortable with my eggs and my husband’s sperm getting frozen and/or my embryos getting frozen. I personally believe some of the “magic” is lacking and the miraculous life-force isn’t the same. It’s less special, less perfect, and too forced, too desperate, too man-made. It’s hard to explain. There’s something off and creepy about it for me that makes me shy away intuitively. That’s really all there is to it.
Eggs are usually the focus of IVF, but let’s forget them for a second. There’s only a small, very finite amount of eggs you’re working with when they’re retrieved, compared to the millions of sperm when ejaculated. The eggs are divinely chosen by your body and God to begin with, and then every single one is checked for viability before fertilization. But the sperm… Out of millions and millions of those little spermies swimming around, a sperm-tech picks which one! ONE person chooses for you! OUT OF MILLIONS! WHAT!? Does anyone else ever truly sit down and think about that? That’s outright playing God, and I’m not okay with it. A random person I don’t know is not choosing one-half of my child’s DNA. That’s between my husband’s sperm and God, and that’s final.
I need to carry my own child. Plain and simple. I’m an “all or nothing” type of person, and I need the whole journey, from start to finish. I need that bond of my baby growing inside me, to feel those kicks, to be a birth shaman, a living, breathing goddess of fertility, a spiritual conduit between this world and the next. Some women get heightened psychic gifts during pregnancy since they have one foot in this world and one foot in the next–I want to experience that. I want to experience all of it. And then see my baby on the other side of the journey and be like, “We did that, kid.”
Emotionally, I don’t even have reserves to handle the jealousy anymore. I’ve already seen women have two, and sometimes three, babies in the time it’s taken me to try to have one. That jealousy has been hard enough. I’m already bitter, I’m already sad. I don’t need more of that while watching another woman carry my baby. Hell no. I’d rather just not have a baby. 🤷♀️ To each their own.
And the financial cost… Holy shit, is surrogacy expensive (with good reason)! You pay the gestational carrier a salary to carry your child. I’m personally not going to blow ~$40,000 for someone to carry my kid, plus all the IVF costs (when the transfer might not even work!), plus pregnancy healthcare costs, plus delivery fees, when I need that money to take care of my baby when it’s here. And my husband and me, because we matter too, damn it!
The amount of times I’ve heard, “Just adopt.” 😒 Nothing gets me more riled up than someone telling me that. It’s not that easy. You can’t “just adopt”. There’s mountains and mountains of research, finding the right child–which could take forever–lawyers, required parenting classes, home visits… the list goes on and on and it fucking disgusts me. There are “unfit” parents who give birth to children every day who never had to go through a parenting course, and then you have parents who would do anything for a child, and they need to take a course and be constantly watched? The principle alone drives me up the wall. Also, I don’t like people telling me what to do 🤪 And the LEGAL FEES. The amount of money it takes to adopt is insane, to the point you’re basically BUYING a baby. It’s unethical to me. I can’t, and won’t, do it.
Even after all that, it can take years for the adoption process to be finalized, and in the meantime, your baby can get taken away by the courts for whatever reason. I can’t bond with a child after going through years of miserable fertility, to then get that child taken away. My heart can’t handle it.
Most importantly, everything else aside, I need my own child, my genetics, to leave a piece of me in this world when I’m gone. And in total honesty, I believe I won’t love another child enough. There are many parents out there who will love a child in need as their own blood. I’m too honest with myself to ever call another person’s child mine.
This section makes more sense last because all my arguments against the options above apply to donor eggs as well. Often, depending on how advanced a woman’s diminished ovarian reserve is, donor eggs are recommended for a successful pregnancy. Not for me. I need my own genetic child, I’m not buying half of a baby (I say “buying” loosely–technically it’s a donor reimbursement “fee”. Let’s cut the crap, shall we? You’re buying the eggs.), and I won’t do IVF, which is obviously necessary for donor eggs. And if the situation was reversed, and my husband’s sperm quality was the hurdle we were trying to jump instead of my eggs, I would never ask him to use donor sperm. He has the exact same feelings as I do, and he doesn’t believe he could love the child as his own either.
I didn’t want to do IUI, but I felt like it was a fair compromise between spirituality and science, and it felt right intuitively. It made me feel like I was doing something, like I had some sort of control (even though I still didn’t 😅), like I had a better chance with it than without it. It was a crutch because I knew what was going on with my body each month. Every time I felt hormonally weird or uncomfortable (my body’s favorites are boob pain, any time for any reason–I have no idea why–and random uterine twinges, which are equally as baffling!), I knew I wasn’t pregnant because medication was forcing my cycles to behave and I knew what day of the cycle I was in. And after each IUI, I knew a blood test was coming if I didn’t get my period. It was a tether for my sanity.
Now I don’t have that structure, that emotional, mental crutch. I’m hoping my periods will stick around consistently for a while before getting farther and farther apart, then stopping altogether again–I imagine they will since they did after my miscarriage. Even with them continuing, though, I’m not using ovulation test strips. I want to have sex with my husband for fun and in celebration of love, not worrying about what the act could create. “Trying” kills your sex drive and the joy of love making, especially the longer and longer you’ve been at it, even with structured fertility treatment–actually, especially due to fertility treatment because you don’t want to waste the opportunity you’re paying for! I want to live my life to the fullest, and the constant “what if I’m pregnant” thoughts with every weird hormonal feeling isn’t doing that, especially when I’m at risk of pre-menopausal-esque feelings with my diminished ovarian reserve (which was what I was experiencing on and off before fertility treatment, when I kept thinking I was pregnant as the symptoms are frustratingly, devastatingly the same). I know too much now, and I just want life to happily surprise me.
To happy surprises. 🥂