One of the main reasons for starting this blog is to share my story of the long and winding (and very slow-going) journey toward getting pregnant and starting a family later in life – I had my first child at the age of 40.
There were so many unexpected delays, twists, turns, and setbacks; so many unavoidable delays I had no idea would be part of the process. It all added up to a whole lot of frustration and heartache, all of which I wish someone could have told me about beforehand. Had I had a mentor, someone who had been down this path before, it would have made all the difference. I hope to be that “someone” for somebody out there who might be just starting out on this road. I hope to equip you with the knowledge you need in order to:
- Speed up the process
- Improve the outcome
- Be spared some of the headaches and heartaches I experienced
Skip the story and go straight to the stuff you need to know before starting IVF
I come from a very fertile line of women. My mother got married at the age of 18 and conceived two months later. Her and my dad went on to have six kids in total, her last one at the age of 35. My grandmother had seven children. My sisters all got pregnant within a few months of trying, and never had any issues. So I was sure that, even though I ended up getting married later at the age of 30, I would have zero issues in the “baby making” department. My husband and I decided to wait a few years after getting married to start trying for a baby; I figured as long as we started trying around age 34 or 35, we would be just fine; all the experts say a woman’s fertility is good to go until age 35 and then it drops off a cliff right after that. I thought, ok, so we will start trying a few months before my 35th birthday, give it about 3 months to “take” and bingo…baby! I assumed I could even push it out to age 36 or 37 because of my awesome “fertility genes” giving me a major bonus.
When the time drew near, around age 34, there was only one housekeeping item that needed attending to…my husband had had a vasectomy done in his previous marriage. We went to one of the top-rated doctors in the country and got it reversed. The doctor reported that all had gone well; we just needed to wait 2 weeks to let things heal and then we could get down to baby-making business!
Life’s Unexpected Detours and Delays
As life has a way of doing funny things, during the 2 week waiting period after his vasectomy reversal, I got an unsolicited job offer that I simply couldn’t refuse. We decided to delay trying for babies for another year so I could save my paychecks toward paying down the cost of the reversal and some other debt. “No problem,” I thought. “I still have time.” After all, I was sure I’d get pregnant within a few months of trying.
A year went by, and it was finally time. I got off birth control, started a million new Pinterest boards for all things baby, and baby-making officially commenced. And then…cue the crickets. Nothing. Nada. Negative after negative pregnancy test. We decided to go get a semen analysis on my husband to make sure the reversal worked as it should. A quick drop-off to the lab, and a same-day call back from the doctor telling him his sample looked “just fine…lots of sperm present. Good to go.” So then, the logical conclusion was that the “problem” was with me. I went to the local women’s clinic with many hours of research in hand. I got every hormonal and fertility test done that they offered. I had them check my FSH and follicle count (more on that later!), thyroid, estrogen, progesterone, and tons more. They put a probe up my you-know-what and did some imaging to see if my fallopian tubes were blocked in any way. They checked for scar tissue, fibroids, irregular uterine shape, we checked EVERYTHING. And everything came back just fine. In fact, more than fine…I was told, based on my workup, my fertility age is very young, younger than my actual age. So what gives???
We figured since both our testing checked out ok, all we needed was more time. So we continued trying, using every trick in the book…sex on the day of ovulation; sex two days before ovulation. Taking Mucinex before sex to help the sperm get to the goal. Certain positions. Supplements, vitamins and minerals. ALL THE THINGS. We tried them all. And yet, months and then years passed with no luck. Not a single positive pregnancy test (except for a few false positives, which I wouldn’t wish on anyone.) During all of this, we had my hubby’s sperm sample analyzed on several different occasions just to be sure. Each time, the report came back saying his numbers were good.
Finally Getting Some Answers
At the point of desperation, we decided to have my hubby’s semen analyzed again but this time by a different doctor and lab; the same that we had used for his reversal, in a much bigger town several hours away. This time, we got bad news…yes, he had plenty of sperm, but THEY WEREN’T MOVING. Apparently, there must have been some seminal fluid that had leaked into his bloodstream either during or after the vasectomy reversal, resulting in his immune system identifying his semen as a pathogen and attacking it. This was causing his healthy sperm to be “weighted down” so to speak, by white blood cells and rendered immobile. Our doctor explained it as “having a perfectly healthy olympian runner forced to wear a 500lb backpack full of lead.” It didn’t matter how healthy or plentiful his sperm were; they simply could not get to where they needed to go.
We were in a state of shock after getting this news since for so long we had been told everything was fine, but at least now we had answers and could begin looking for solutions. The silver lining in all of this was that the problem was with him rather than with me (many times female fertility challenges are harder to overcome than male factor infertility.) After many, many days spent researching, and consulting with the local women’s clinic, we decided to try a few rounds of IUI (intra-uterine insemination). By now, my clock was ticking. I was fastly approaching age 39. We tried 3 sessions of IUI with no luck. Time to bring out the big guns. We decided that since time was no longer a luxury, we needed to pursue IVF treatment (In Vitro Fertilization.)
And So the IVF Journey Begins
First, we consulted with two separate clinics in the same town where he had his vasectomy reversal; they were both rated as some of the best in the country. As we deliberated on the drive back home, we both agreed that we just didn’t feel good about either clinic…their credentials were exceptional, but something about each one didn’t sit well with us. Then, almost as if an angel whispered in my ear, I suddenly remembered that a smaller town on the way home also had a clinic…and luckily, we were about 30 seconds away from the exit! Had we already passed it, I don’t think we would’ve bothered ever checking it out. But as fate would have it, we took a sharp turn in the nick of time and paid an unscheduled visit to the clinic. It was smaller, homier, and we both instantly knew this was the one. The receptionist handed us a packet of info, and by the time we arrived home, we had already sent an email requesting a consultation. A few weeks later, we met with the doctor, gave him the details of our situation, and were placed on their calendar to begin the IVF process.
The doctor was cautiously optimistic that we could have good results since the trouble lie with my hubby’s sperm, but my “wiring” was all good. He prescribed me a course of medications to get my body to grow all the eggs in my ovaries at once that month, rather than just one as is typical in a normal (unmedicated) cycle. (I’ll post the deets on these meds in a later post, but OMG they are $$$$$!!!). The plan was to extract all the mature eggs and see how many would fertilize and turn into little baby embryos that survive 5-days in the lab…the ones that make it this far would then be genetically tested (PGS tested – more on that later). The ones that tested as viable would be transferred. It never crossed my mind that I wouldn’t have enough viable embryos from the first round; I figured we would just get through this process one time and be done with it. The reason for this rash and ill-informed assumption on my part was that I was told I have plenty of follicles (in other words, lots and lots of eggs still left) and my AMH hormone (anti-mullerian hormone) was great. This typically indicates an excellent ovarian reserve. It turns out that this can ALSO indicate Polycystic Overarian Syndrome – yep, surprise, surprise, the clinics and labs back home somehow missed that one. So I had tons of eggs – too many in fact; but not many of them were any good, capable of turning into viable embryos.
Pull That Trigger
After a month of injecting my belly with syringes full of costly meds that made me feel absolutely awful, the time had come to inject what is affectionately called the “trigger shot”…an injection of a hormone that forces your body to “ripen” all the eggs simultaneously 12 hours before the scheduled extraction. It must be administered at a very precise day and time…within a 10-minute window, the day before. The goal is to retrieve the eggs just before they are released by the ovaries. I was staying in my sister’s guest bedroom along with my husband since the clinic was 2 1/2 hours away from our home. (There are countless appointments involved, so having a friend or family to stay with is a godsend if one must do this process out of town). My hubby helped me prepare the syringe, we double-triple checked the instruction sheet, we held hands and said a prayer, then did the jab and hoped against hope that tomorrow would yield joy and not sorrow.
We went to the clinic late morning the next day, my husband provided the “sample” (his physical investment in this process was quite minimal, LOL!) and I got all gowned up for the procedure. They wheeled me into the operating room and put me under. The egg extraction process entails the doctor navigating a needle up into the vagina and piercing through the vaginal wall where the ovaries are located next to. The needle “suctions out” the eggs from each individual follicle. The needle has to make a new puncture for each egg. The process is pretty quick, but the recovery, as I discovered, can be quite painful for the unlucky few who develop something called “Ovarian Hyperstimulation Syndrome”. Look it up. It sucks. Ask me how I know. Anyway, the procedure itself went great, except that I always throw up after using anesthesia. When I came to, the smiling doctor announced they were able to retrieve 31 eggs…a HUGE number! (Yes, that means I got stabbed with the needle 31 times.) I was feeling so hopeful on the drive back home (in spite of having to pull over multiple times so I could throw up on the side of the road from the anesthesia).
Don’t Count Your Eggs ‘Til They Hatch
Out of 31 eggs retrieved, surely I was guaranteed at least a few good embryos, more than enough to grow our happy little family, right? RIGHT?? The next day we got a call that out of those 31, 16 of the eggs successfully fertilized. By day 5, the surviving number of embryos was 8. A few weeks later, PGS testing revealed that only 1 out of the 8 “final contestants” was viable. The other 7 had zero possibility of survival. Out of all 31 eggs, we had only one viable embryo, a little boy. Viable embryo doesn’t mean guaranteed…it just means there aren’t any chromosomal abnormalities that preclude the possibility of life. We were told our viable embryo had about a 60% chance of resulting in a live birth.
We were now faced with a hard choice…proceed with the transfer of the embryo to my uterus straight away, and take the gamble that the little bean sticks…or freeze our little bean and repeat the process. I was in a race against my ticking biological clock and hoped to get more viable embryos to improve our chances. I had just turned 39. I couldn’t risk it. We decided to keep our little guy on ice while we went through another round. A few months later, we were able to retrieve 22 more eggs, 12 of which made it to day 5, and 3 of them tested viable. All girls! We put them on ice along with the first batch to let my body recover from ovarian hyper-stimulation.
A chilly February morning, a few short months away from my 40th birthday, we walked into the clinic for the big day. In just a few hours, I was either gonna be a mama, or I wasn’t. We opted to transfer two tested embryos at the same time, the one from the first round and one from the second, and planned to return for the other two later. The transfer went smoothly; it was surprisingly short and painless (way better than the egg retrieval!) Afterward, my husband and I went and stayed at a hotel on the coast to connect, have a breather from the tension of the past few months, and help pass the time since I wouldn’t be able take a pregnancy test for almost 2 weeks.
A Happy Ending
I took a test around 10 days post-transfer, and it was positive! The first time in 6 years of trying! Unfortunately, I ended up miscarrying the baby girl in the first couple of weeks, but we had our perfect and beautiful baby son, Ethan, that August (10 weeks early.) He is now 17 months old and the light of our life!
As I write this, I’m waiting to hear back from the clinic about our other two “little frosties”…our two remaining baby girl embryos on ice, awaiting transfer. My husband and I are so excited to take the final step in completing our little family, and we have peace regardless of the final outcome of this next transfer.
I hope reading about our story helps shed some light on what to expect when you decide to pursue IVF.
Stuff To Know When Starting the IVF Journey
When you bring up wanting to pursue IVF to your doctor, you will most likely be directed to get some testing done first. This will include a semen analysis on his part and a fertility workup on her part. Many times they will try to piecemeal this out one test at a time and only do the bare minimum (I don’t know why, but this happened to me and all my IVF buddies as well.) I knew what I wanted, I stuck to my guns, I demanded to get as many tests done same-day as possible, and I made it clear I was willing to pay out of pocket for anything insurance didn’t cover. Have a list of exactly what you want tested. If they say they don’t do that kind of test, find out who does. As for the following info, a little disclaimer: I am BY NO MEANS a doctor or any kind of expert whatsoever…my research all came from Dr. Google and the interwebs. Please consult your doctor and obviously, their word trumps mine on any of this stuff. Don’t take this as actual medical advice! I’m just saying these tests were very useful for me.
The list of tests I requested to have done include:
- Cycle Day 3 estrogen and progesterone levels,
- Thyroid,
- Follicle Stimulating Hormone (bloodwork),
- Anti-Mullerian Hormone (bloodwork),
- Antral Follical Count (Vaginal Ultrasound),
- Check for any ovarian tube blockage or scar tissue (imaging), fibroids, cysts
- Polycystic Ovarian Syndrome.
Your Antral Follicle Count (how many eggs your ovaries had in the last batch – a total of 12 – 15 or more total (both sides included in count) indicates a good supply of eggs still in “reserves.” Read more about Antral Follicle Count Here.
A low Follicle Stimulating Hormone number is good as it indicates the same thing; a higher number means your body is having to push harder on the “gas pedal” just to bring an egg to maturity to ovulate, which can indicate there aren’t too many “good eggs” left. Read more about Follicle Stimulating Hormone here.
Anti-Mullerian Hormone is a substance that each egg in your body gives off at all times; therefore a high number indicates lots of eggs still left. Taking all this info together gives you a clue as to what chance of success you might have with IVF and helps shape realistic expectations. Read more about AMH hormone here.
Just keep in mind, Polycystic Ovarian Syndrome can make these numbers look better than what they really are.
Next, your local clinic will likely want you to try any number of “first line interventions” before IVF, such as losing weight, trying Clomid, doing a bunch of IUI attempts, etc. That’s all well and good, but just remember…the clock’s ticking and YOU are in the driver’s seat. You don’t have to follow their recommended protocol, and you don’t have to explain yourself. Make that phone call to the IVF clinic when you feel the time is right for you; you DON’T need a doctor’s recommendation (unless you are one of the lucky ones whose insurance covers IVF and your insurance requires it.) They are losing a paying customer so keep that in mind when you face resistance. If they tell you you don’t need a certain test, tell them you want it anyway and be prepared to pay out of pocket, if it’s important to you.
Fertility and Pregnancy Charts and Statistics by Age – General Info
Hurry Up and Wait
Be prepared for a SHOCKINGLY long waitlist at the IVF clinic, even just for a consultation. All the more reason to get started sooner than you think.
Understand that it’s not just a one-time procedure…there are a TON of appointments you must make, to monitor your hormone levels throughout the month, to discuss meds, to do the egg retrieval, then rinse and repeat for the scheduled month of the transfer. Be prepared to use up all of your vacation time, ditto for your spouse/partner if they plan to come to all appointments with you. So, several months on the waitlist and several more for the egg retrieval and transfer. Even more if you have to redo the egg retrieval process if you got disappointing numbers the first time. Pick a clinic near home or family & friends to cut costs on meals, lodging, and gas as well as getting an extra boost of emotional support.
Whatever price quote the clinic gives you, even if it says all-inclusive, almost surely does NOT include the cost of meds (approx. $2000 to $6000 per IVF CYCLE) or PGS embryo genetic testing (optional but recommended: $2000+ per IVF cycle).
How much does IVF cost? Read about costs involved with IVF here.
Understand the risks and symptoms of Ovarian Hyper-stimulation Syndrome, and be prepared to take time off work or have a plan in case this happens to you. You’ll possibly have to be on pain meds and it can last several weeks until your cycle begins again. Also, be aware that if it does happen, you will NOT be able to do a Fresh Embryo Transfer (most likely), because of the associated risks…chances are you’ll be required to freeze your embryos and transfer once your body is out of the danger zone.
Needles, Needles, and more Needles (and a Case of the Crazies)
Mentally prepare to face giving yourself daily injections with needles both large and small…if you have a phobia of needles (hand raised) this is a real problem. This can be a deal breaker for many. Consider how badly you want this, and whether you are able to face this challenge daily for many months. I can tell you though, it DOES get easier with time and it feels amazing to face and overcome a lifelong fear of needles, speaking from my own experience. You can have someone else do it for you, but I found that I preferred being the one in control of the needle. Doing it myself just worked better for me. Find what works for you. The tiny needles that go in the tummy are a cakewalk after a week of practice; the infamous Progesterone in Oil, a big needle with syrup-like fluid that goes in your upper hip/backside region is as awful as it sounds. If I can do it though, ANYONE can.
Prepare yourself, your spouse/partner and those close to you for the emotionally unstable person they’re about to be living with. The meds make you feel barely human, much less a woman. Just research Lupron for IVF side effects. No, you’re not just an over-emotional weenie. This stuff is hardcore.
Get Some Zen
Let the little things go during this process. Hire house-help or accept the mess. Sleep more. Eat the chocolate.
Thats all for now, I will update this list as more things come to mind. I hope and pray this somehow helps you on your journey. Thanks for reading!