Pregnancy: Fertility + IVF
I struggled with my decision to post this. I am feeling out of my element being vulnerable. But my desire to remain in my safe space pales in comparison to what I aim to accomplish through my blog. I want to demystify and destigmatize a lot of issues in our community, specifically the African community. I don’t want to live a life where I’m ashamed of who I am and of the decisions I make. I hope reading this makes you more informed and kinder to others. And whatever your struggles are, I hope this entry resonates with and acknowledges them. If you’re going to be mean and rude, this blog is not for you. Move along. Now to my story…
My journey to motherhood starts with a story worth telling—let’s go back to where it all began.
Before we got married, my husband and I knew that fertility treatments would play an important role in our journey to parenthood. This life-changing journey that would change our lives, for the better, started shortly after we got married.
To level set, In Vitro Fertilization (IVF) - our treatment - is a type of fertility treatment where a woman’s egg is combined with the man’s sperm in a lab. IVF could be used to treat infertility and could also be used to prevent passing a known genetic condition to a child.
Now let’s proceed.
I approached the IVF process with a naive optimism on the outcomes. I am a planner, so I envisioned it would take about 6 to 8 months from consultation to conception, based on all my research. HILARIOUS! Life had other plans—God and my own body threw challenges my way, stretching the process to over 2 years. I’ll break down the physical aspect of the process into 5 phases below:
Phase 1 - Consultation & Testing
Our journey began with an hour-long conversation with our doctor, discussing why IVF, medical history, an overview of the process and next steps. We started out with numerous tests—genetic screenings, blood work, semen analysis, uterine scans—and insurance. Insurance coverage in the US for IVF really depends on what your employer offers and we were blessed to have jobs that mostly covered our procedures.
We worked closely with our clinic to obtain prior authorization for the IVF process from our insurance; without it, insurance wouldn’t cover any tests or procedures. We got approved within a couple of weeks. I quickly learned that while fertility treatments may be covered, there’s a limit (mine at the time was a lifetime limit of $35,000 USD). Taking our nurse's advice, we decided to pay for medications out-of-pocket for our first & second retrieval (total cost of ~$1,200 USD), which allowed us to use the remaining insurance funds toward other required procedures. If insurance had covered our medications, we would have used up ~$15,000 of the $35,000 lifetime limit just on the medications. Insanity!
Phase 1 took over 9 months to complete due to my medical history (to be discussed in a future post). Additionally, I had to be on birth control for 2 months prior to the start of Phase 2 to keep my hormones at a baseline level ready to go when my Doctors gave me the green light.
Phase 2 - Ovarian Stimulation
With the tests and insurance complete, we were ready to move on to the arduous part of the process, ovarian stimulation. This is probably what most people think about when they hear IVF. Over an 11 day period, I was injected with a series of medications aimed to help develop more than one egg, mature the eggs and delay ovulation until Phase 3 (see below). My protocol was pretty mild and included daily injections of Gonal F and Menopur (ugh I could say a lot about how painful this one was) for the first 6 days. These medications stimulate my ovaries to produce as many eggs as possible, simultaneously. On day 7, another injection of Ganirelix—which prevents my eggs from releasing prematurely—was added to the mix. I continued these 3 injections from day 7 - day 10. That’s 24 injections by day 10, for those counting. On day 11, I took my final Ganirelix injection in the morning and then at night, at exactly 8pm (they were so precise), the HCG trigger injection (to prepare my body to release the eggs).
In addition to the injections, I had bloodwork and a uterine scan every 2-3 days to monitor how my body was responding; my hormone levels (mainly Estrogen & Progestin) and the number of follicles (where each egg is stored) developing and their size. On day 12, I had only bloodwork done to ensure that the HCG was fully in my system (they’re looking for a number >50 and mine was 217, which was great!) In total, I had a 8 bloodwork draws (add this to the # of total pokes) and 5 ultrasounds.
Phase 3 - Egg retrieval & Sperm Collection
On day 13, I had my egg retrieval procedure under anesthesia and my husband had his sperm collected. If you have ever been under anesthesia, you know how freaky it is to wake up with no memory of what just happened after taking the best nap ever! After the procedure, we went home and I stayed in bed the rest of the day dealing with cramps. Nothing that good ol’ tylenol could not handle though.
Phase 4 - Fertilization & Testing
The next day after retrieval, our clinic called to inform us they’d retrieved 10 eggs and of those 6 fertilized. Then we waited another 5 days and found out that all 6 became embryos that were sampled and frozen. I’ll be honest and say that these numbers were very disappointing to me. I had anchored my expectation on experiences I had seen online where women were retrieving 30+ eggs and fertilizing 15+. But my doctors eased my anxiety a bit by telling me between 10 - 15 eggs retrieved is the normal range and anything above that could put a woman at risk for a serious condition called Ovarian hyperstimulation syndrome. This was somewhat helpful but I couldn't help feeling disappointed and worried about our chances.
We chose to test our embryos due to our combined medical history. The results from the test will determine if we move on to Phase 5 or have to start all over again. This was the longest 3 weeks of my life. I distracted myself with movies, work, study, and travel.
Phase 5 - Transfer
After testing, we only had one healthy embryo. After speaking to our doctors, we decided to move forward with transferring our embryo. We were grateful. “All it takes is one”, I told myself. The transfer protocol is super mild compared to the stimulation protocol. For this, I took one injection of Lupron to release any eggs on day 1 and then progesterone vaginal suppository twice a day starting on day 3 and then on day 8, we drove through a snowstorm, to get our embryo placed in my uterus. Then we wait for 2 weeks (the dreaded wait) for a pregnancy test.
On the morning of day 22, I went to get my blood drawn for a pregnancy test. I did nothing all day until I saw my doctor's office number pop up. I was so nervous. And from the nurse’s tone I knew it. “I’m so sorry, Ore, you are not pregnant. We look for an HCG level of >50 but yours came back 11 indicating you had a chemical pregnancy.” Bruh! This was so hard to hear. The hardest part about IVF is not knowing what the outcome will be. Everything can go well and you can end up with nothing and this was the case for us. I have not really healed or unpacked what happened that day. But if you are going through this, I feel for you.
I ended up completing 4 retrieval cycles (Phase 2 & 3) in total, with each retrieval cycle bringing its own version of disappointment and gratitude. After retrieval #4, we decided to move forward with transferring a normal embryo that resulted in our handsome son, Rayo. I am forever grateful for the opportunity that science and God has granted to us.
Debunking Common Misconceptions about IVF
#1 - IVF results in genetically perfect “ aka Designer” babies - False - IVF is not a tool to select specific genetic traits you want your children to have. It’s not a customizable menu where you select preferred traits. Rather, IVF can include preimplantation genetic testing-monogenic (PGT-M) to screen for certain single gene disorders, such as sickle cell anemia and cystic fibrosis, to reduce the risk (~99% risk reduction rate) of passing on a known genetic condition to a child. And even after this is done, the clinic advises on the best quality embryo based on a grading system. Some US states allow you to choose the gender but that’s the extent of the choosing you get to do.
#2 - IVF is only for female infertility - False - IVF can address both male and female infertility issues. It’s also used in cases where both partners face challenges or for single individuals seeking to conceive or preserve their fertility. Fertility preservation is a common reason for seeking IVF for women either going through cancer treatments or women who are delaying having children, either by choice or circumstance. You have the option of either freezing your eggs or freezing an embryo with a donor sperm or a partner. Whatever choice you make, don’t be ashamed and talk to your doctor. Cleo Abram, Video Journalist, has a really good video documenting her egg freezing journey, if you’d like more information on this.
#3 - IVF depletes a woman’s egg supply - False - IVF uses eggs that would naturally be discarded during a woman’s menstrual cycle, so think of it as actually saving your eggs from being lost monthly. #win.
#4 - IVF pregnancies are automatically high-risk - Inconclusive - IVF pregnancies are not inherently high-risk, however, certain factors associated with IVF can increase risks compared to natural conception. For example, IVF pregnancies may have a slightly higher chance of complications like multiple pregnancies (twins or more), preterm birth, low birth weight, and preeclampsia.
#5 - IVF is not affordable for most people - True - IVF is a very expensive process to pay for out-of-pocket. However, a lot of clinics offer financing options and certain organizations and individuals offer grants to cover some costs. Additionally, for the medications, as mentioned above, buying them with your clinic at their out-of-pocket discounted price could help lower the cost.
Reflections
IVF was an isolating experience for me. Part of the reason you are reading this is because I don’t want it to be that way for others. The fear of it not working was enough for me to keep it to myself, including keeping it from my family. I just did not want to discuss it.
In the trenches of IVF, I would occasionally find myself at an event where someone found it super important to tell me “don’t wait too long”, “I know somebody that [insert long story about how said person went through IVF to have children]”, “you are older now, what are you waiting for?”, “wait till you have kids”, “this time next year prayers”, “You will not be barren prayers”. Urgh I could go on! All in all, I know their intentions were somewhat good (some were just being nosy), however, that only increased the pressure and added to my anxiety with each retrieval cycle. If you’re ever been tempted to ask someone about having children, don’t! Unless they come to you for advice or a listening ear, just be quiet.
I also missed out on events and had to plan my life and work around these procedures. Wedding, baby shower, birthday, happy hour; the list goes on. To navigate work, I scheduled all my appointments for the mornings and on days for retrieval and transfer, I took a day off. I count my blessings that I worked from home during this time as it made it easier to tackle this part of my life. Missing events always reminded me of this herculean task before me and at times I had FOMO and other times, I carried on like it didn’t bother me. It did but the end goal was more important to me.
The baby showers and pregnancy announcements were particularly triggering and filled with mixed feelings. Not that I wasn’t happy but it was particularly triggering when someone would say “omg we weren’t even trying.” Lol congrats, I guess. I’m not saying hide your pregnancies or don’t be proud of the blessing you have. I’m saying be sensitive when breaking the news.
One thing I found helpful during this time was Facebook groups (Meta has a bad reputation but this product is one I would recommend). I joined an IVF Facebook group and learned from the stories and experiences of women going through the process. Women who could relate to the struggles and feelings I’ve described above and suddenly I didn’t feel so alone. Also, these groups equipped me with information to better advocate for myself and also introduce beneficial natural remedies like acupuncture, CoQ10, prenatal vitamins and herbal tea.
A special shoutout to my husband for his support and for giving me the injections. This experience was mentally tasking for him as well and I am grateful to have had him in my corner. Also, shout out to our employers for providing fertility benefits.
If you are in the trenches of IVF, I see you. You’re not broken. There’s a whole world out there with many women like me and you and we can lean on each other to get through this phase of our lives.
tldr: IVF is an incredibly demanding process—physically, mentally and financially. If you can, research fertility benefits covered by insurance when applying for a job. Join a support group. Lean on a support system. The outcome may not be what you envision but you will come out on the other side changed, dare I say for better, forever!
Disclaimer: None of the information disclosed above is medical advice. This is based on my experience and my learnings. Please consult with your Doctor before you make any decisions about your fertility and your health.
