You’ve been trying for what feels like forever for a baby.
Deep breaths. You’re not alone. More than 1 in 10 women in the US have a hard time getting or staying pregnant. There are plenty of reasons for that. For women, most of them involve the body parts in charge of ovulation. Think: reproductive organs like the ovaries, fallopian tubes, and uterus. If you’re under 35 and want a baby with a male partner, many medical professionals recommend giving yourself about a year of having frequent sex — particularly when you’re most fertile, aka during your ovulation window — before talking to a doc about fertility treatment. Older than that, think about seeking help after about six months.
And how do fertility treatments help?
Think of them like reinforcements to help your body conceive. They can do things like help you produce more eggs and shorten the sperm’s path to an egg. The Society for Assisted Reproductive Technology estimates that more than 74,000 babies were born with some type of fertility assistance in 2018. But there were many more attempts than that: about 280,000 cycles, aka rounds of fertility treatment. So seeking fertility help doesn’t necessarily guarantee pregnancy.
What else should I know before seeking treatment?
You’ve heard it before...But age is hugely important. That’s because the younger you are, the healthier and more plentiful your eggs. SART data shows that in 2017, nearly 70% of women under 35 using IVF successfully delivered babies. For women older than 37, rates dropped to well below 50%. It’s also important to maintain a healthy diet and lifestyle, and pay attention to your periods. If they’re irregular or painful, consider getting tested for a condition like PCOS (which affects approximately one in 10 women of childbearing age and can interfere with ovulation) and/or endometriosis (which affects about the same number of people and might cause blocks in the fallopian tubes). And as with all major health decisions, you should consult a doctor before you undertake any fertility treatment.
Where do I get treatment?
Pick a fertility clinic that’s approved by the Joint Commission on Accreditation of Healthcare Organizations, College of American Pathologists, or is a member of the Society for Assisted Reproductive Technology. When you get there, you’ll probably have your AMH (anti-mullerian hormone) level checked, which gives you an idea of how many eggs you have. A doc might count your follicles that contain eggs (called an antral follicle count), and look at your uterus and fallopian tubes. Your partner’s semen can also go under the microscope. About one-third of infertility cases stem from an issue with the woman, one-third from an issue in the man, and the last third from a problem with both partners or no specific cause found. That’s sometimes called “unexplained infertility.”
It’s a legit diagnosis. That’s when standard fertility tests aren’t picking up anything wrong. You seem to have healthy eggs, you’re ovulating, his sperm seems normal, your tubes are open, and your uterus looks A-OK. But you’re still not getting pregnant. (This Skimm’r was diagnosed with unexplained infertility but found success with IUI.)
Got it. How can science help me get pregnant?
Pills and injections…When you just need to kickstart egg production. Some names to know: Clomid pills and gonadotropin shots. With pills or injections, you’ll still have sex to try for a baby, hopefully with more eggs, aka chances for fertilization. But beware: Those hormones can take a toll on the body. In rare cases with injections, women experience Ovarian Hyperstimulation Syndrome (OHSS) — when your ovaries produce excess fluids that can cause kidney failure and blood clots.
Artificial insemination or IUI…When you want to give sperm a shortcut. IUI, aka intrauterine insemination, is what you think it is: semen going straight into the uterus. And it could be an option for you if your partner’s sperm is low in number or doesn’t swim so well, you’re using donor sperm, you have a semen allergy, or there’s something blocking sperm from meeting the egg, like thick cervical mucus or extra tissue. It can be done during natural ovulation, or with fertility meds to force the release of an egg. Risk of serious complications from IUI is low, but there is a chance of infection and cramping. The process is less invasive — and much less expensive — than IVF. But it’s also considerably less effective.
IVF…The one you’ve probably heard of, when the egg and sperm meet outside of the body. With IVF, you take injections like you might with IUI to stimulate your ovaries to produce more eggs. Then, a doc retrieves your eggs, which should take about 20 minutes. Once out, the eggs are mixed with sperm and fertilized “in glass” (that’s what “in vitro” means) in a lab. Then a new embryo is transferred directly into the uterus with a catheter. If the embryo successfully implants in the lining of the uterus, score, you’re pregnant. That whole IVF cycle can take about three weeks or longer. And although IVF is an expensive and time-consuming treatment, it could be your best chance at pregnancy. Reminder: According to SART, the success rate is as high as 70% for women 35 and under, when you include pregnancies that require multiple IVF cycles. The CDC has a digital tool to give you an idea of whether IVF is a good option for you.
Gestational surrogacy…When someone else agrees to carry your baby. If you don’t have a uterus, don’t have success with IVF, or have repeated pregnancy loss, you might consider it. And it's an option for same-sex couples. A gestational carrier is someone who gets pregnant with your embryo through IVF, and isn’t genetically related to your baby. Gestational surrogates are used in 2% of IVF cycles, according to the Journal of Reproduction & Infertility. But “traditional surrogacy” — which is much rarer than gestational surrogacy — is when a surrogate’s own egg is used. Keep in mind: Surrogacy is illegal in some European countries and a couple of US states (New York just started allowing gestational surrogates this year).
What will this cost me?
The further you go down the list, the more expensive family planning becomes. Fertility medications (including those pills and injections) can cost a couple thousand dollars per cycle to cover consultations, ultrasounds, blood tests, and monitoring. IUI is probably an additional several hundred dollars per cycle. And IVF can be as much as $20k a pop. But you’ll likely need more than one cycle. If you need a donor egg, tack on tens of thousands of dollars per cycle. Sperm costs about $400 to $1k a vial. And if you work with a surrogate who isn’t a volunteering friend, it could cost more than $100k if you account for IVF and legal fees. As for whether insurance can help, that all depends on your policy and where you live. Check out Fertility IQ for a detailed price breakdown by treatment. As of 2019, 16 U.S. states required insurance providers to cover or at least offer infertility coverage. And just some companies offer benefits.
This is exhausting.
Amen. Dealing with infertility can be hard on your physical and mental health, your relationship, and your wallet. And even getting to the point where you’re being properly cared for can be challenging. Studies show that married Black women, who may be twice as likely to experience infertility compared to married white women, are 50% less likely to seek care. That’s likely because Black women consistently report feeling less comfortable under the care of doctors than white women (systemic racism in health care is still a huge issue), and a recent study published in the Journal of the American Medical Association shows that they’re less likely to be referred to specialists (including fertility specialists) than white women.
I could use some help.
Some places to look for support and information: On the social media pages of OB-GYN and reproductive endocrinologists like Dr. Temeka Zore and Dr. Natalie Crawford (both were consulted for this guide) and on advocacy blogs like Fab Fertility and The Broken Brown Egg. Consider joining a support group (you can find one near you on the Resolve: National Infertility Association website) or trying teletherapy (we have a guide for that), because talking it out can help. And if you know a friend who’s struggling to conceive, be there for her. If it makes sense, offer to drive her to appointments and call to hear about how her cycle — or cycles — went.
People often call conception a fertility “journey” because it can have many highs and lows, and lead you somewhere you may not have expected. An important thing to remember: You’re not alone in this journey, and there are a number of resources to help map the right route for you.
Skimm'd by Carly Mallenbaum, Becky Murray, and Jane Ackermann
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