I awoke in morning darkness just before the 6 AM beep beep beep and reached for the small clock radio, flicking the alarm off. My goal was to slip out without waking my wife, Sam. She had to be at work in a few hours. I slid my feet into the leggings I'd placed beside our bed the previous night and pulled one of Sam's sweaters over my head.
As I pushed open the door to my building, I was met by January rain cascading through the darkness and the swish of trucks' wet tires rolling up First Avenue. A small chant began in my head to the cadence of the rain bouncing off my umbrella. I kept rhythm as I walked: I'm doing this for the baby. I'm doing this for the baby. I'm doing this for the baby.
It was still dark out when I walked into the office 45 minutes later. The receptionist greeted me by name, "Hi, Laura. You can have a seat."
As I waited, I fidgeted with a fertility bracelet on my wrist given to me by a friend. Just hours before, Sam and I were sleeping next to a fertility Voodoo doll I'd purchased in New Orleans. I'd even pinned a strand of my hair onto the doll's torso. Sometimes I'd stare at the good-luck charms and think, Give me your baby juju.
Two years ago, both of us 29 years old, Sam and I had our eggs tested. I was shocked at my infertility diagnosis, my diminished ovarian reserve, the fact that I could not get pregnant the "usual" way without drugs or fertility treatment. This meant not only would it be difficult for me to conceive, but I would also be at high risk for a miscarriage even if I did manage to get pregnant.
I like to say that Sam has "eggs spilling out of her," but she has fertility issues of her own, including uterine fibroid tumors. Neither of us were the perfect candidate, but our fertility doctor recommended that if I ever wanted to carry, I should try to get pregnant as soon as possible. Shortly after, we picked a sperm donor we considered a fit, and purchased all six vials he had available.
Fertility patients require daily monitoring—blood work and vaginal ultrasounds that measure the progress of follicle growth—so clinics offer testing before normal office hours, meaning there's a lot of time spent in waiting rooms before the day even begins. On that rainy winter morning two months ago, I was being monitored for my third and final IUI—or Intrauterine Insemination, which is when sperm is inserted directly into the uterus to facilitate fertility. I was taking drugs to stimulate my ovaries, but the doctor had made it clear that if I didn't conceive after three IUIs we would need to take more aggressive action.
When that third IUI failed in January, I scheduled a call with a nurse from Oxford Health Insurance's Managed Infertility program to discuss IVF treatment, the next step for us if I ever wanted to get pregnant with my wife. While IUI means injecting sperm into the uterus, IVF (or In Vitro Fertilization) means the surgical removal of mature eggs from the body, which are then fertilized with sperm in a lab. The resulting embryos are then transferred into the uterus and carried like a traditional pregnancy until the baby is born or miscarried. From the initial egg testing through the third IUI, we spent €8,679 on the testing, donor sperm (one of the priciest expenses), sperm storage fees, and other affiliated costs. With IVF, our plan B, the cost can easily exceed €17,500 per attempt, plus more daily visits to the doctor for blood tests and ultrasounds. My odds of conceiving with IVF are 35-45%. They were 8-12% with IUI.
After committing to this next step, we tried to get some of the fees covered by our health insurance. Unfortunately, Oxford Health defines infertility as "the inability to achieve pregnancy after 12 months of unprotected heterosexual coitus (sexual intercourse)." Not applicable for Sam and I. We don't have premium insurance that covers IUI or IVF, but even other health care providers don't provide coverage for same-sex couples undergoing these procedures.
Unlike our friends who get pregnant after letting their birth control lapse, for us "trying" does not involve regular romps. I've mourned my inability to make a baby with my wife. I want to birth a child with Sam's green eyes. Instead, I have to lay on a table with my heels in metal stirrups as a stranger's sperm is injected into my uterus via IUI, or have my body anesthetized for a surgical IVF procedure to create a "test tube baby."
In mid-February I went to my new doctor's office for an IVF consultation, our plan B. The next day, Sam and I had to return for another appointment—a required IVF class. As I waited for the class to start, I heard someone call my name.
"You have a payment this morning," said the girl behind the desk.
The day before we had split €9,991 between two credit cards.
"I thought we paid everything up front?"
She didn't reply as she reached for a color-printed financial packet and circled the words "Frozen Embryo Transfer (FET)," which were written in bold. This meant that when I had my eggs fertilized through IVF the lab would also freeze the remaining embryos from one cycle so they could be used in the next. Tears sprung to my eyes as I read the accompanying number: €3,783. Embarrassed, I told her I needed a minute. We had spent upwards of €17,500 already and IVF wasn't a guarantee we'd get pregnant. Plus, our class hadn't started and we were just grasping these procedures ourselves. It's easy to say how much you'd be willing to spend for a baby until you have to put your money where your mouth is.
After the initial shock passed, we composed ourselves and coughed up the additional €3,783.
During the IVF class Sam and I sat with a group of other overwhelmed men and women in a hospital conference room and were taught by a video from the 90s about the fundamentals of IVF medications. The length of an IVF treatment differs for every woman, but it starts on the day you get your period, after which you have to inject various hormone medications each night in order to stimulate your ovaries into making eggs. Some of the injections would be subcutaneous—injected into our abdomens or thighs—while others would go intramuscular into the upper quadrants of our butts. "What if I hit a bone?" asked one frazzled husband. The nurse passed around needles and a dummy for practice.
When the injections begin, you have to continue making daily visits to the doctor for bloodwork and ultrasounds so they know when your body is ready for step two—a "trigger shot" that catalyzes the release of your eggs. Two days after that happens, the eggs get retrieved (if any eggs are viable) in a surgical procedure in which they're fertilized in a lab, and then the resulting embryo—aka the "test tube baby"—is implanted back into your uterus. Following that, it's two weeks of Progesterone shots to increase the likelihood of pregnancy until you either get your period or a baby is conceived.
I thought we would have time to digest the costs and get a better grasp of what exactly I would be putting into my body through IVF, but my period came the same day as the class, weeks early. I pulled out my wallet and headed home with a pamphlet offering sparse directions on how to begin hormone injections that night.
Hours later, Sam and I cleaned out a kitchen cabinet and filled it with bags of various-sized needles, a red sharps disposal container, gauze and alcohol pads, and vials of medication. My first ovary-stimulating injections involved relatively tiny needles, but Sam stuck me four times in the course of my first two shots. She'd approach, stick the needle in about an inch from my belly button, freak out when she felt it pierce my skin, then pull it out. I stood—unsexy—leaning on the kitchen counter and pinching my belly fat. "Chill the fuck out and do it," I demanded. She came at me. From there we split the nightly injections. I'd do one myself then let her do the next two. Side effects of the medicines include: Bloating, headache, drowsiness, mood swings, night sweats. (Yes, our sex life has been suffering, a wretched irony for a couple trying to conceive.)
There's a chance we might fuck up the injections out of nerves and waste the heroic sum we spent on the necessary IVF medicine. There's even a chance that we're doing everything right but this still won't work. And even if we do get pregnant through this second, more expensive process, there's still a chance of miscarriage. We haven't decided how many IVF attempts Sam and I are willing to withstand. My wife could volunteer to go through the same process as me, but it's tough to imagine us attempting a plan C when we've already spent tens of thousands of dollars pumping my body full of chemicals. Trying to remain emotionally stable through the medical bureaucracy is tough enough, but the hormones surging through my body make it especially grueling.