Sunday, August 16, 2020

There's More Than One Way To Make A Baby

"Is this a sign or a test?" I asked my husband as I brushed five inches of snow off the top of his car with a broom. Overnight, an April blizzard had battered its way across Minnesota. A cement-like layer of snow covered our driveway. "Is God saying, 'Stop!' or is He saying, 'How bad do you want it?'"

“I don’t think it necessarily has to be either. And I don’t think it’s worth trying to figure out,” my husband said before firing up the snowblower.

I was constantly trying to discern God’s will – a fruitless and frustrating endeavor – as it concerned our baby-making options. “Would it be that hard for You to be a little bit clearer?” I often thought. “I mean, come on! You’re God. You can do anything!”

Ah, but He’d left us silly humans to decide for ourselves. And this morning, we had an appointment with a Minneapolis IVF clinic – and we weren’t going to cancel.

We somehow managed to slog into the clinic’s parking ramp on time. Despite the weather, the clinic was bustling – phone lines trilled, couples filled out paperwork, and delivery drivers dropped off packages. John Mayer’s voice singing “Fathers, take care of your daughters” echoed through the waiting room. It seemed like an insensitive song to play at an infertility clinic.

It was strange to be there knowing that everyone had the same goal as us and couldn't achieve it on their own. I sized each couple up, trying to figure out how old they were, how long they’d been trying, and how the hell they could afford this. The consultation alone was over $400; they didn’t even let you sit down until it was paid.

Our doctor appeared and called our names. He looked like the Gerber baby all grown up – pale, blonde, probably genetically perfect. His corner office was dominated by a huge oak desk, his walls lined with bookshelves that were too empty for my taste.

I’d sent the clinic every imaginable medical record I could find regarding our fertility, which Dr. Gerber said he’d reviewed. He agreed with Dr. Baby-Maker that my (appallingly low) AMH was not predictive of my ability to get pregnant.

“But I am concerned about your FSH levels,” he said.

FSH (Follicle Stimulating Hormone) is what tells oocytes (premature eggs), to start growing. As the eggs mature, FSH levels decrease – as in, “My job is done here!” Low FSH levels were good.

A normal FSH level in a woman my age was under 7.9.

My FSH level was 17.7.

“The FSH is yelling at your ovaries and they’re responding in a whisper,” Dr. Gerber said.

I momentarily imagined my reproductive organs arguing. It was not funny.

Dr. Gerber laid out several laminated diagrams of the IVF process. First, there were medications to shut down my natural cycle. Then there were medications to artificially induce ovulation. Rather than one egg per cycle, I would (ideally) produce eggs in the double digits. When the eggs were mature, I would be put under general anesthesia and the doctor would insert a needle through my vaginal wall and into my ovaries to aspirate the eggs out. The eggs would be fertilized with my husband’s sperm, either traditionally (one egg in a petri dish with a bunch of sperm, may the best sperm win) or by injecting a single sperm into each egg (if my husband’s sperm weren’t up to the task). The embryos would be cultured for several days; if any survived and were healthy, they would either be transferred back into my uterus or we would freeze them for a future transfer.

It was all very complicated.

 Dr. Gerber laid out our options:
- A vasectomy reversal, followed by six months of attempting to conceive naturally
- A vasectomy reversal, followed by IUI (Intrauterine Insemination) if my husband’s sperm count was low
- A vasectomy reversal, followed by traditional IVF
- Skip the vasectomy reversal and do IVF with TESE (Testicular Sperm Extraction, basically sucking the sperm out of my husband’s testicles with a needle) and ICSI (Intracytoplasmic Sperm Injection, aka injecting the healthiest sperm into one of my eggs) right away instead

The success rates of all of these options differed, of course, as did the costs. Like buying a car, there were endless add-ons to the IVF process. Given our ages, Dr. Gerber recommended PGS (Pre-implantation Genetic Screening, which identifies chromosomal abnormalities) and PGD (Pre-implantation Genetic Diagnosis, which identifies genetic defects that would prevent implantation, cause a miscarriage, or pass various diseases onto the baby).

The down payment for IVF was $12K. A cycle with ICSI would be around $18K. Add TESE and we were up to $20K or more. PGS and PGD? Close to $30K. Our health insurance covered nothing. Some states have mandates that insurers must cover infertility treatment, but Minnesota is not one of them. (This pisses me off to no end, as infertility is very much a medical problem, but that’s a rant for another post.)

“I don’t have any problem with you two trying to conceive naturally,” Dr. Gerber said, as if he were some sort of reproductive warden. “But we could just go straight to IVF with your eggs. Don’t wait more than a year to do that, though. I’d start you on high doses of hormones and would be pleased if we got two embryos per cycle.”

I didn’t know much about IVF, but I knew that two embryos per cycle wasn’t much – and not all embryos are created equal. Even if we could get two, if they were abnormal, or subpar, we wouldn’t be able to transfer them. Then we’d have to start a whole other cycle from scratch. Even if the embryos were OK, what if we transferred them and they didn’t implant? What if they did and I miscarried? It seemed like a lot of trauma to my body and a lot of unknowns for so much money.

“What about donor eggs?” I asked, even though I knew we couldn’t afford them. The egg donor cycles started at $30K and went as high as $47K. “Aren’t we at the point where that would make more sense?”

“Egg donor treatment is one of the most successful assisted reproductive techniques available,” Dr. Gerber conceded. “But I don’t think you’re there yet. I’d want to try a couple cycles of IVF with your own eggs first.”

(Of course he would. He wasn’t paying for it.)

“If you decide you want donor eggs, know that there is a waiting list,” Dr. Gerber added. “And it’s a more involved process.”

First, we’d have to do a consult with a reproductive counselor. Then we’d have to meet with the egg donor program coordinator and a financial coordinator. That would be followed by a medical workup. Then we’d presented with one egg donor at a time. Once we chose an egg donor, the IVF process would start.

Realistically, I knew an egg donor wasn’t an option for us, mainly because of the cost. My husband and I had already argued about how much was too much to spend on chasing the baby dream. His limit was any figure that would force us to go into debt. Thirty grand was definitely in that range.

“If cost is your main concern, you could just go ahead with the vasectomy reversal and try to conceive on your own,” Dr. Gerber said. “Because if we tried IVF first and didn’t retrieve enough eggs or have any quality embryos to transfer, I’d probably recommend a vasectomy reversal and natural conception anyway.”

We sat in silence for a moment and tried to absorb the massive amount of information he’d lobbed at us in under an hour.

“Clear as mud?” he finally said.

I did feel clear, at the time. IVF seemed too extreme. Infertility for our age group was defined as six months of timed intercourse that failed to result in pregnancy. By that measurement, we weren't infertile; I was just impatient. So my husband and I decided we’d go ahead with the vasectomy reversal, try to conceive for six months, and if nothing happened, we’d go back for IVF.

On the car ride home, I breathed a sigh a relief. The matter was settled. Later that day, however, Dr. Gerber called.

“Have you had an HSG?” he asked.

Yet another acronym I was unfamiliar with. He explained it was a procedure where dye was injected into the fallopian tubes and an X-ray was taken to see if the dye (a dummy substitute for sperm) flowed freely through the tubes.

“If your tubes were closed for some reason, the vasectomy reversal would be a waste,” he said. “Seriously consider having it done.”

Ugh. It felt like every time we cleared a fertility hurdle, 10 more appeared in its place. God was definitely asking, “How bad do you want it?” My answer: A baby was the only thing I wanted anymore. Giving up was not an option. We were all in.

So I scheduled the HSG for the day prior to my husband’s vasectomy reversal. His and hers fertility procedures. How (un)romantic...

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