Infertility: An Overview

Yesterday I was chatting with some friends on Facebook about our hopes for a miracle baby (a baby born without medical intervention) and a friend recommended adoption. When I said it was too expensive, she said she had no idea the expenses and thought that with all the children needing good homes, it should not be overly expensive from a humane viewpoint. Too true! This inspired me to write a little post about dealing with infertility and the costs associated.

As I begin, let me state that I am not a medical professional. Also, these costs vary widely between states and different clinics and hospitals. Most medical insurance will cover none of the things I will be discussing, though K and I are lucky that my care is all covered to a certain point, including medications. We are truly lucky, though I have earned this care by my service to this country. Fellow veterans, be aware that the VA will cover infertility treatments, including medications, up through IUI. They will not cover IVF but may still cover some monitoring and medications.

I have done loads of research and reading and I have spent hours and hours in chats and forums trying to find out anything and everything that could possibly work. I’ve tried everything from supplements to medical interventions to crystals to acupuncture, so yes, I have some experience with this. Take it as you will. Yes, the idea of crystals may be hokum to most but my thought was, they’re pretty and can’t hurt… whether or not I believe they have an efficacy on fertility. Sometimes the game of fertility is simply keeping hope alive and feeling like you’re doing something in the interminable wait of becoming pregnant.

So, let’s start with pre-intervention assistance: testing and basic medications.

•  First thing, read Taking Control of Your Fertility and track your basal body temperature for months. Use Fertility Friend to track your findings- easiest and most supportive app I’ve found. Learn what the different results mean and don’t listen to the doctors when they tell you the results are crap. Doctors don’t know everything and I accurately self-diagnosed one of my issues even though the doctor told me I was wrong before the blood test proved me right. Trust yourself and learn everything you can about your body. Cost: Negligible- book, $17, $24.95 yearly access to FF, and BBT thermometer, $20.
• Diet: Eat organic. Eat vegetables and fruits and moderate amounts of healthy, local, organic meat. Your body needs lots of protein to create a baby, ladies. Avoid sugar. Avoid processed foods.
• Quit drinking, quit smoking, and get some exercise (if you’re overweight. Gain some weight if you are underweight). Cost: Free
• After trying to get pregnant for 1 year on your own or 6 months after age 35, ask for a referral to a reproductive endocrinologist. Cost: Depends on your insurance and provider.
• First things that will be tested: hormones- FSH, estradiol, prolactin, progesterone, estrogen, your thyroid hormones. For your male partner: semen analysis and testosterone. Cost: Depends on your insurance. Possibly a few hundred dollars.
• Next step: possible tests such as a hysterosalpingogram and endometrial biopsy. I’m not gonna lie, these hurt! I mean, seriously. If you’ve never had your cervix forcibly dilated, you’re in for a world change. The pain is fairly temporary though. You can expect some cramping and bleeding following. Also, ultrasound- painless. Cost: $800-900
• Hormone medications: If you have high prolactin and/or low progesterone, there are medications you can be put on to try to get them under control. The medications are not pleasant. Bromocriptine (for prolactin) can cause headaches and dizziness among a host of other side effects. It took a few weeks for those to stop. Progesterone can be administered in a number of ways. You can buy a topical lotion of very low dosage online. The side effects with this seem almost negligible. Suppositories are MESSY but will bring on the water works and then there’s my world: PIO (progesterone in oil) shots. Trust me, the world is weird when you must shoot yourself in the behind each night. Thankfully, this time around I’ll have my husband to help. Moodiness, tears, fatigue, and headaches are common with PIO. Cost: Depends on medication, could be hundreds.

That should cover the majority of the initial testing and the medications I know of just for dealing with hormones. Yes, there is clomid and that class of drugs for anovulation. From what I understand, there’s a mass of side effects from those- very unpleasant, and quite expensive. I can only speak from my experiences and so far, anovulation has not been my problem.

Non-medical supplements

Let’s talk a moment about non-medical things you can do. I won’t list costs for these, as they vary but are fairly negligible ($10-20) and can be purchased on Amazon or Vitacost. This is not an exhaustive list; just what I know best.

• Vitex: All around awesome hormone stabilizer. Takes some time to work (4-6 weeks) but it does work. How well is individual. Some people cannot take it; I’ve taken it with no issues. Please note: Vitex CANNOT be taken with bromocriptine.
• Evening primrose oil (EPO): Should be taken from menstruation to ovulation to help with cervical mucus (CM). A lack of CM can hinder the travel of the sperm. The best CM that indicates ovulation and is best for sperm resembles egg whites. No joke. Just like it.
• Flax seed oil: Taken from ovulation to menstruation (or end with confirmed pregnancy).
• Vitamins: In general, loading up on Vitamin B is great and good for progesterone. Zinc is also good for progesterone. Vitamin C is excellent for simple immunity but beware how much you take, it can cause bowel issues. Vitamin D assists with proper absorption of calcium in the bones and helps with mood disorders. Vitamin D should not be taken in excess, as it is one of the only vitamins that can cause a toxic reaction. 2000iu daily should be enough, though listen to your doctor’s advice on this one. Vitamin E for progesterone and excellent for men’s sperm.
• CoQ10: Good for the heart but also good for egg production and a man’s sperm.
• Another non-medical supplement I like is a Fertility Tea. I drink 2 cups 5 days a week. There is a brand sold online called Fertilitea but in Nashville, we thankfully have High Garden Tea, and they sell a Fertility Tea blend that tastes lovely and has basically the same ingredients at a fraction of the cost.

On the note of supplements, teas, etc, please note that you are in a vulnerable state of mind when dealing with infertility. There are plenty of companies out there that will try to take advantage of you by selling you a “baby guaranteed” diet, supplement pack, food, etc. Don’t fall for it. Nothing is certain. Nothing is a magic food or “superfood”. What worked for your friend may not work for you. These are medical conditions we are discussing and like cancers, they are varied in location, origination, and effect on the body. Thus, their treatments are individual and differentiated.

Now for the big stuff.

Medical treatments:

• Intrauterine Insemination (IUI): The least expensive and least invasive of the treatments. When the woman is ovulating (this may be naturally or triggered), the man will give a sperm sample. This will then be centrifuged and cleaned and put into a syringe. The woman will then lay back and a very thin catheter will enter the cervix and the man’s semen will be administered. That’s it. Takes 5 minutes and is completely painless. Cost: $500-1000 (without medication)
• In Vitro Fertilization (IVF): IVF has a number of different options. With fresh or frozen transfer, 5 day blastocyst transfer, Intra-cytoplasmic sperm injection (ICSI), GIFT, ZIFT, and I am sure there are others. The best I can say is, do the research and learn what will be best for you and your partner based on your conditions. ICSI is recommended for low sperm count and/ or poor morphology as a healthy sperm is chosen to be inserted into the egg. Expect around $5,000 in medication costs alone, from what I remember in my research, though some medication regiments cost less. There’s the cost of monitoring, harvesting of the egg, and implantation plus medications. Some clinics are now offering shared cost/risk IVF. A lump sum paid for 3-6 IVFs and if you do not become pregnant, you get anywhere from 75%-100% of your money back. If you get pregnant, you get nothing back. Obviously, these cost more than the average single round. Do your research though. From what I understand, these are generally not sound financially for the individual couple. Cost: $11,000-$30,000

Other ways to grow a family:

Lots of people say, “Why don’t you just adopt?” If you haven’t done the research, perhaps you don’t know that the average cost of adoption is $20,000 to $40,000 and the wait time is, on average, 5 years. This is for adopting an infant or very young child internationally or domestically. This depends on private or non-profit agency route and where you live. If adopting internationally, the wait time is still about 2-3 years and still costs quite a bit, since you must make trips internationally and stay in country for amounts of time plus pay for all the agency requirements. Home studies, medical costs, and legal fees all play in here.

Surrogacy runs approximately $50,000 to $120,000. This depends on whether there is any need for a donor egg, the agency, legal fees, and medical fees for the surrogate. Don’t forget that you are also then including a stranger who will undergo great attachment to the fetus due to biological processes over which she has no control and relying on her not to smoke or drink, do drugs, eat properly, and follow the advice of doctors.

Foster-adoption is the most financially viable option for many people but this typically results in an older child and can be unpredictable. The cost is, on average, $3,500. My personal fear with foster-adoption would be getting attached to a child and then having them reclaimed by the birth parents.

Those are the most common means of building a family and their associated costs, from what I know based on my research. Feel free to add any information you may have. Please understand though that these are emotional decisions each couple must tackle. At this time, my husband wants a biological child of his own. So, we are not considering adoption… yet. However, we have not yet begun our journey together, other than trying the good old fashioned way. We have levels to go of medical interventions before we consider trying adoption and a bit of time before we try those. We also are working on our health- diet and exercise are key for fertility, though obviously even those can’t always help. Anovulation, endometriosis, PCOS, hormone imbalances, low sperm motility or poor morphology, and stenotic cervix are just a few conditions men and women have that contribute to infertility. Please remember that it is fairly split between men and women as to who is the “cause” of the infertility and often, the infertility is medically unexplained (1/3 to each category). Just because a man or woman already has a child does not mean they are not currently suffering from a condition pertaining to infertility. This is known as secondary infertility.

Things NOT to say to your friends suffering from infertility:

• “Just relax and it will happen.” Remember, these are medical conditions like arthritis, cancer, and depression. Left untreated, they will not miraculously heal themselves.
• “You’re trying too hard.” Sorry, but like the above, if couples do not try hard to overcome these medical conditions, pregnancy is unlikely to occur.
• “Don’t get stressed. Stress is the cause.” Infertility is stressful. There’s nothing anyone can do about that, though exercise and acupuncture can help with the emotional burden. Stress is not the cause. Medical conditions are the cause.
• “Just be glad you don’t have kids (yet) so you can be free to sleep, go out, etc…” Those things that stress out parents are the things infertile couples are dying for. They’d love to be exhausted and covered in poop from their little darling offspring. They’d love to have the hassle of toys and clothes everywhere and a messy house.
• “Whose fault is it?” It isn’t about fault or blame but the couple together grieve the medical conditions, endure the side effects of treatments, and grieve each miscarriage TOGETHER. Just like cancer isn’t one person’s fault and a family endures it, so goes infertility.
• “It must not be meant to be.” Or “God has a different plan for you.” No. Just don’t. You’re saying that child abusers and drug addicts have some universal destiny to their children but upstanding, clean, healthy, well-adjusted couples don’t? Please, just don’t go there.
• “You have plenty of time.” Fertility greatly declines and the chance of Down syndrome greatly increases when a woman is 35. Hey, I’m 35! Also, chances of autism increase with a man’s age. Thankfully my husband is a young’un. No, there isn’t plenty of time before fertility decreases further and we keep aging as time passes. Most couple would agree they would like to have their first before they are 40 so they aren’t on Social Security when their child graduates high school.

Be gentle with those hoping to start a family and having difficulty doing so. For me, I LOVE seeing my friends’ baby pictures and hearing their joys of becoming pregnant, even if it hurts at times that it isn’t my time. Some couples are far more sensitive to these things. Many couples also remember acutely the days of each miscarriage and mourn each life that ended, no matter how far along they were or why they miscarried. They remember how old their child could have been, had they lived. They know just what they will give up to pay for the costs to create a child that is part them and part their partner. Reproducing is what animals are supposed to be able to do and it is heart wrenching when the body doesn’t work like it should, particularly at this most basic level.

For those looking for more resources for support, whether those affected by infertility or wanting to support loved ones dealing with it, please check out www.Resolve.org.