Baby Deux, Part 5: Fertility Consult Lowdown

Dear Santa: all I want for Christmas are gift cards to the fertility clinic.

What I mean to say is: we had our first fertility consultation, today. It lasted nearly two hours. So, I don’t even know where to begin. I guess I’ll just start at the beginning.

This fertility doctor has come highly recommended by a ton of other lesbian couples in Chicago–and by the practitioner who did our last two rounds of IUI at the LGBTQ clinic. We always said that we would give unmedicated, unassisted IUIs a few months and, if they didn’t take, we’d move on to a fertility specialist to–hopefully–get the job done.

Part of that decision was motivated by the fact that, when they did labs at the LGBTQ clinic, Sona’s AMH (anti-mullerian hormone) levels came back “low.” The AMH level indicates how many eggs you’ve got left in your little ovarian bank. The older you get, the lower the number. Sona’s is 4.1, and we were told that was on the low end of normal, which worried us a bit. Of course, we consulted Google, and we found many (barely credible) sources that seemed to indicate the same thing: 4.1 is low for a 36 year old woman. Turns out, that’s wrong. (More on that in a bit.)

We’ve had today’s appointment for over a month, and we figured that if we happened to get preggo during this last cycle, we’d just cancel it. That didn’t happen.

So, today, we both left work early and met at the clinic, which happened to be right across the street from one of our favorite coffee shops (shout out: Wormhole) and next door to some of our favorite sushi burritos. That has to be good juju, right?!

The space is uber posh, but I guess when you are making thousands of dollars per client, you can afford some swanky furniture and a couple of potted orchids.

To their credit, I’ll say that they make a great first impression. Every single staff member greeted us warmly–and by name. They were exceedingly prompt and professional. We never felt rushed. It was an organized and well-orchestrated appointment, complete with a choreography of insurance experts and nurses and, finally, the doctor. And they had free snacks! (We might have stolen pretzels and a granola bar for daycare pick-up.)

The insurance expert was the opening act, and while they would probably argue that they want the financial aspect of the exchange to be transparent from the get-go, I would argue that they want to get the biggest blow out of the way quickly, allowing you plenty of time to faint, cry, or leave before they bother going through the rest of their performance.

We’d asked around, and we’d heard that most folks had gotten the majority of their IUI treatments mostly covered by their plans. Since I have BCBS PPO, I thought it wouldn’t be an issue, and we were modestly hopeful that we’d have a lot of the process covered. WRONG.

Turns out, employers get to decide how much fertility coverage they want to offer their employees, and my employer has elected to only cover “the diagnosis of infertility.” Basically, today’s consult and bloodwork SHOULD be covered in full. From here on out, every single thing will be paid for out of pocket.

It was not the best way to begin the consult, and Sona and I were panicking a little inside.

After that, we met with the nurse practitioner, who led most of the consult. We walked through everything: Sona’s labwork from a couple of months ago, our attempts to get pregnant this time, how we got pregnant with Finn, our goals for conception, etc. The NP was a great listener, and she helped us understand a lot of medically-relevant stuff that no one had bothered to explain before. It was the first time we felt like someone knew more about getting pregnant than we did.

For starters, they are THRILLED with Sona’s AMH level, which they actually classify as high for her age. Girl has eggs for days. Remember, she has a 4.1, and they ideally want clients trying to conceive to have a 1-3. So, when held to their standard, Sona is super fertile.

She also explained a lot of possible reasons why we may not have gotten pregnant so far: Sona may have a polyp or a fibroid that’s blocking the egg, there may be scar tissue from her previous pregnancy, her progesterone levels may be a tad low–and the list goes on. While there aren’t any glaring concerns right now, we are going to do what they call a water ultrasound to check and make sure the pipes are running clean. We’re also going to do another series of ultrasounds to see how many viable eggs she’s working with each cycle.

The biggest thing we have to decide is whether or not we want to do a medicated or unmedicated cycle to begin. Do we try to go au naturel, using bloodwork and ultrasounds to better time insemination? Or do we just say “Screw it! Let’s go all in.” and immediately begin using medication to better control timing?

There are three medications we could use:

1. Progesterone: The NP said that progesterone is the hormone that makes the uterus lining fuller and more sticky. “It’s like a fluffy pillow covered in honey,” she said. The stickiness makes it a little more likely that the embryo will, well, stick. It makes the uterine environment more desirable.
2. Clomid: This is a follicle stimulant. It would increase the chance of pregnancy by 10-15%, as Clomid better preps healthy eggs for ovulation. Of course, it could over-stimulate, and that might result in multiples (KILL ME NOW). Also, while it increases fertility for the first three months of use, research indicates that it begins decreasing fertility after that. So, it is not without side effects, including some crazy mood swings.
3. HCG: This is the pregnancy hormone, often called a “trigger shot.” Using it makes it much easier to time when ovulation is going to happen, as the shot actually triggers you to ovulate.

We can choose to use one, none, or any combination of the above drugs. Again, it’s important to note that, as of now, we aren’t actually “struggling with fertility.” Sona isn’t infertile; she’s overly fertile. We’re pretty sure that timing is the problem, as I’ve discussed at length in previous posts.

The other issue is, of course, cost. These things all cost money, and insurance won’t be helping out. An unmedicated IUI cycle, complete with ultrasounds and bloodwork, will run us $800 plus sperm. Either way, we’re likely going to do two vials of sperm each time, giving us better odds. That’s another $1800 a month.

A medicated cycle will cost around $1200. So, that’s really only a difference of $400.

$2600 for an unmedicated cycle or $3000 for a medicated one. PER MONTH. Either way, we’re looking at a 10-20% chance of pregnancy per cycle. (Either way, we are going to be broke as a joke.)

So, yeah. It’s going to be a tough haul financially, but we’re just crossing our fingers that it happens quickly, and we won’t have to do multiple months. Because truly, I don’t know how long we could do this for–financially, emotionally, or otherwise.

What I do realize, though, is that we are privileged that this is even an option we can entertain. And I wish that this were an option that insurance companies made available to a wider range of couples.

Still, we left feeling rejuvenated. I’m an academic and Sona is science-minded. To both of us, knowledge is power; we feel much more empowered, now.

Next steps: two appointments for ultrasounds and bloodwork next week!

(Our pre-appointment selfie.)