Infertility Part 1: Treatments, IVF, and More

As with most of my baby-related posts, this will be a lengthy one and quite possibly entirely irrelevant to you. (Feel free to skip – I won’t be offended!) When I was experiencing infertility in real time, I didn’t have the emotional capacity to help others or seek help for myself. It was too real, too difficult. But now that I can see the other side, I’m ready to talk. Every situation is different and I’m not a doctor, but I can at least share my case in the hopes that it offers comfort and clarity. So here I am, gettin all vulnerable. I hope it helps someone out there.

This will be a two-parter. This post will cover the most common questions surrounding infertility treatments as well as the nitty gritty of the process. I’ll be writing a second post to cover the more nuanced side of infertility – aka, the many complicated feelings. That post might be particularly helpful if you’re seeking ways to support a friend who’s struggling with infertility.

Not even all the medications. Our kitchen looked like an urgent care center.
So let’s get into it…

There’s a lot of confusion revolving around infertility. Interestingly, the people who don’t seem to be confused are the ones who actually know NOTHING. It’s the ones with zero medical background, or who got pregnant easily, or who haven’t even begun trying but “totally know someone who had trouble” who have alllll the answers. Or is that just me? It’s straight up dangerous to your emotional health to listen to those voices if you want to know about infertility. Maybe you’re having troubles yourself or maybe you want to know how to best help a friend. Step one: doctors – specifically fertility doctors – know best. Start there. Step two: if you want less clinical advice or anecdotal support don’t talk to someone who has a friend of a friend who did IVF. There’s a whole community of people currently going through it and that’s who you should talk to.

Note: I’m basing this all off my personal experience and EVERY experience is different. I went through this process with a partner but know many women do this alone if they’re looking to be a single parent or if they need to proactively freeze their eggs to test for known genetic factors, like the BRCA mutation. I talk about my partner’s support here, but I want to recognize that many women are doing this solo and, frankly, deserve the most massive round of applause. I also mention that I’m ready to talk because “I can see the other side.” It’s important to mention that the other side for some will be pregnancy, while for others it may simply be the peace of mind that carrying a child will not happen for them. Most roads will look different, and there isn’t a “right” way for this to go.

I documented every single doctor’s appointment (aka outfit), including retrieval day.
Common Questions and Answers
  • What fertility treatments did you do? I started with IUI and then moved on to IVF. Because of my particular issue, we had no reason to believe IUI wouldn’t work. I did 5 total IUIs (most with the assistance of Letrozole, which is now preferred to Clomid) and began the IVF process when the IUIs didn’t work, completing two IVF transfers.
  • Do you wish you started trying earlier? Truthfully, this isn’t a question I’ve been asked, but it gets to the crux of a *statement* I heard all. the. time. That statement is “so and so is having trouble because she’s in her 30s.” This has been said around me enough that I know many – many – of my friends will believe I had to do IVF because I didn’t start trying til I was older. SPOILER ALERT: my infertility has nothing to do with age and is entirely anatomical. My ovarian reserve looked fab (!), but my organs are not shaped the way they’re supposed to be, making it impossible to get pregnant naturally. Whether I started trying at 23 or 33, the result would have been the same: no baby. That means IUI/IVF was always in the cards for me. Sadly, I’m pretty sure nobody would believe me (like they see the girl who fixed a “deviated septum” but everyone’s silently judging her for getting a nose job). And that’s a big reason why I didn’t tell people I was going through this process.
  • How uncomfortable is it? Some people aren’t bothered by needles. This girl? Very bothered. They’re my biggest fear. Beyond the fear, I find the specific sensation from a needle different than other forms of pain. I could get punched in the gut, tattooed, and waxed over every centimeter of my body and wouldn’t flinch. Girl, I could get a full Brazilian while sitting in a zoom meeting and you’d never know…but needles are a different story. So to be totally honest, this process was awful. Every single person I spoke with told me “the injections won’t even bother you by the end” and “it’s all mental.” That was not the case. It never got easier. I cried most nights. I had to have Albert give me every single injection because I couldn’t bear to do it myself. And guess what: THAT’S OK. It’s fine if this is really difficult for you. Maybe they were trying to keep me calm, but not one person told me the injections were tough on them. Everyone said that was the least of it so I started to feel like a crazy person when I was having such a difficult time with all the shots. Beyond the pain of the injections, you just feel downright gross. Everyone experiences this part differently, but I had severe bloating. By the third evening my stomach was so distended that I truly looked 4 months pregnant. (In fact, I was bigger than I would later be when I actually was 4 months pregnant.) Bottom line: highly uncomfortable. Just keeping it real.
  • Is it really an emotional roller coaster? Oh lordy, the ‘mones! You are pumping yourself up with so many different hormones that you’re bound to feel some type of way. In fact, you’ll probably feel all the types of ways. Beyond that, you’re dealing with something major every single month. Every month that a procedure is unsuccessful feels like a loss. It’s also very difficult not to feel like something is “wrong” with you. Because we know the issue is on my end, I felt like I wasn’t upholding my end of the deal. This is something that women are literally supposed to be designed to do and my body came off the assembly line defective. There is also a fine line between staying positive and getting your hopes so high that you’re crushed when it doesn’t work. Being realistic but not negative, hopeful but not delusional…balance is hard.
  • How expensive is it? Very. Thankfully, many insurances (mine included) cover many of the costs. My first 4 IUIs were covered in full. The 5th I paid for out of pocket ($750). IVF is mostly expensive because of the meds. I would estimate about $6,000 for those. For the retrieval, I had to pay for the anesthesia ($750) and then we opted to do PGT genetic testing on all the embryos ($2,000). There’s also an annual storage cost of $500 for embryos (first year free). And since I was not taking public transportation (COVID) I Ubered to every appointment – and there are a lot of appointments. At an average of $25/ride, that was just over $2,000 in Ubers.
  • Did you change your diet/lifestyle? During the IUI process I lived life normally until the IUI procedure itself, at which point I cut out alcohol. My thinking was that people get pregnant all the time when they’re drunk so it shouldn’t effect anything. Before IVF I dug into research since we had more skin in the game…and learned that alcohol consumption can impact fertility. Two weeks prior to retrieval, both Albert and myself cut out all alcohol. After his part was done he started drinking again while I continued to abstain. After the first transfer I cut coffee consumption down to 8 oz and after the second I cut it out entirely. Is that what made transfer number 2 successful? Meh, probably not. I think it was the increased levels of progesterone and an additional dilation procedure the doctor performed. That said, I don’t think it hurt.
  • What else was difficult? Making a baby should be the sexiest time of your life, but this was the least sexy process. While prepping for retrieval, I felt awful so sexy time was the last thing on my mind. Additionally you’re actually not allowed to have sex for some time after the retrieval and transfer. I found it kind of funny that you’re trying to make a baby but not doing the one thing proven to make babies. The weight gain was incredibly difficult for me. I very quickly went up a jean size and a half. The major bloating went down after the retrieval, but the combination of hormones and lack of exercise (similar to sex, working out is a no no) had me packing on the pounds. Losing this weight feels like an insurmountable mountain and I don’t want to go through life not feeling my best/healthiest.
We went through four sharps containers throughout this process
The Treatments
  • Testing: Before starting anything, the doc will get a lay of the land by performing an exam (similar to your annual gyno appointment). Your mans will also get his junk tested to see size, shape, and speed of his lil guys. They may also have you do an HSG test, which takes place in a radiology department. There, they shoot dye up in ya to detect any polyps blocking your tubes. (NOTE: After many attempts, they were unable to perform this test on me, which is how we knew something was wrong.)
  • IUI: This is the turkey baster or head start method. Basically, your guy’s swimmers are loaded into a little tube that’s inserted up your lady parts. It gets them closer to your egg if they have trouble reaching it on their own. On the day of an IUI, your partner goes into the office and jerks off into a cup. They “wash” his stuff so the best guys remain and you go an hour and a half later to have that good good stuck up in you. After they do it, you sit on the table with your legs up for 15 minutes. It’s entirely painless (I found pap smears to be less comfortable). NOTE: Many people go straight to IVF because they hear “IUI never works.” I am not a doctor so I can’t speak to that. I think it all depends on why you’re experiencing infertility. If it’s a male factor sitch, IUI is probs not for you…but many people experience infertility for other reasons. In our case, there were good ovarian reserves and strong swimmers so IUI “should” have worked. Since it was free and easy, it felt like low hanging fruit. In the end, it didn’t work, but it seemed very worth the try.
  • Letrozole: This is an oral medication that stimulates ovulation. More/bigger eggs means a bigger target for those spermies. Taking Letrozole is a treatment on its own – me taking it and doing IUI was like doubling down. NOTE: A drug like this is what could potentially cause multiples. Everyone used to think IVF resulted in twins. Not the case. Sure, it does if you transfer multiple embryos, but most doctors refuse to do that nowadays because it’s higher risk. IUI doesn’t inherently cause multiples either. The issue is that many people do IUI in conjunction with Clomid or Letrozol, which means you’re giving those sperm a head start and you’re siccing them on more eggs than normal. If you were just taking Clomid/Letrozol and having sex (not doing the IUI) you’re still at higher risk of multiples – it’s the drug, not the procedure, that increases those chances.
  • IVF: Think of IVF as two parts: the retrieval and the transfer. First, you prep your bod and gets tons of eggs ready for harvesting. This is the part with all the shots. Those eggs are then removed (the retrieval) and while the doc is doing that, your partner is providing his sample. You go home and that day they try to fertilize those eggs with his stuff. Then you wait for them to turn into full fledged embryos before, timed to your cycle, they inject an embryo straight in your uterus (the transfer). An IVF cycle has one retrieval but could have multiple transfers.
I had a nurse outline the area where we needed to do the progesterone shots with a Sharpie. Albert eventually started drawing funny faces in the circles since we had to stare at them for months – might as well have fun with it!
The IVF Process
  1. Training: Our clinic had us watch training modules to know what we’re getting into. IVF is an emotional, physical, financial, and time investment so you need to be prepared.
  2. Birth control: I took bc for a couple weeks to get my bod on the right schedule. With IVF, timing is everything.
  3. Azythromycin: Both you and your partner will take a single dose of a z-pack before certain procedures to get your bodies fully cleaned out.
  4. Pre-Retrieval Injections: These can last 9-14 days. I did injections for 10 days. A mix of Follistim, Menopur, Ganirelix, hCg, and Lupron. The first five days were two injections/day; next five days were three injections/day. Some injections require mixing; some are pre-loaded into a pen. It’s a bit confusing and I felt like we were in Breaking Bad. Honestly, there’s a reason I didn’t go to nursing or med school. I am not trained for this and it’s WILD that they’re just letting all sorts of people with marketing degrees stick themselves with potentially deadly needles but whatevs. These injections are all subcutaneous which means they’re just going into fatty skin. As a service, our clinic will send a nurse to your home to administer the injections for a fee. Because I’m sooo not a needle person, we took advantage of this the first two nights and then felt fully comfortable rocking it on our own. (By “we” I mean Albert. He administered every single injection because doing it myself was a big heck no.) We also had a nurse over FaceTime for the trigger shot because it has to be timed perfectly and includes some extra mixing. There’s a lot riding on this injection so we wanted another set of eyes.
  5. Retrieval: This is technically surgery, which is something I did not realize. No contacts, jewelry, makeup, or fragrances. Apparently eggs are SUPER sensitive to fragrances. You’re fully under anesthesia so you blink and it’s done. While you’re under they’re using a tiny needle to extract as many eggs as possible. While you’re on the table, your partner is making his contribution and they’ll mix it all together in a petri dish. Afterwards you hang in the recovery room for a bit and eat graham crackers. I took videos while I was high on propophol and have zero recollection. It was great.
  6. News: When you leave the retrieval, they’ll tell you how many eggs they got. The next day, they’ll call to let you know how many were mature and then how many of the mature ones were fertilized. Then you wait about a week to see how many make it to blastocyst stage (aka 5- or 6-day-old embryo). Many people choose to transfer at this point. We opted to go one step further and perform PGT testing on our blastocysts to improve our chances. The thinking is: we want to put our best foot forward and transfer the healthiest embryos so they have the strongest chance of surviving in my belly.
  7. PGT Testing: An embryologist biopsies the embryos and tests for chromosomal abnormalities that could cause things like down syndrome and cystic fibrosis. They also determine the gender at this point. This testing takes 2 weeks. So, yes, you can know the sex of your potential babies before you’re even pregnant. Who needs Miss Cleo?
  8. Ranking: All embryos get a macro-level morphology grade based on size and shape. Because we did PGT (which is more of a micro analysis), we only did this macro analysis on those blastocysts that had the healthiest insides. Basically, if you don’t do PGT you’ll have more embryos to work with/rank. After PGT, you’re likely working with less (assuming some are abnormal) but they’re [hopefully] only your highest quality babes.
  9. Decisions: Since they’ll only transfer one embryo at a time, you have to decide your transfer schedule. We opted to go with the embryologist’s ranking, regardless of gender. If I’m being totally honest, I had a [slight] gender preference so I didn’t want to learn in advance in case it would sway me to change up the order and that kinda felt like playing god. We wanted to go with the best embryo, periodt. (Because in the end, we’d love any child, gender shmender.) We also had to decide what to do with unsuitable embryos. After PGT testing if something comes back as mosaic, it means they’ve got a mix of abnormal cells in there. My doctor will not transfer a mosaic embryo but since this is something that could turn into a life, you have to decide to discard, freeze, or have it transferred by another doctor. We also had to decide what would happen to any embryos if we divorced or if we were done having children but have embryos remaining. I’m not going to share what any of our decisions were, but I think it’s important to know that these are things that WILL come up in this process and can take an emotional toll.
  10. My Numbers: I want to stress here that EVERYONE IS DIFFERENT. Some people only retrieve one egg, but it’s a perfect egg. I have heard 15-20 eggs is “average” but it kinda doesn’t matter since all it takes is one. I know several people who retrieved under 10 eggs (as little as one, even!) but those eggs worked real well with that spermy and they were cookin a kid after one transfer. I do want to note, though, that the attrition rate is real. I don’t want to share my specifics but I’ll say that 18% of the eggs they retrieved turned into viable options for transfer. If none of those work, you can start alllll over at the top of the process with another retrieval (which, yes, means more pre-retrieval injections).
  11. Estrace: Throughout the IVF process I took an oral medication that pumped me with estrogen to keep my uterine lining in tip top shape. Bonus: my skin has never looked better.
  12. Pre/Post- Transfer Injections: I took progesterone every night for about 5 days prior to the transfer and then every night after until the pregnancy test. If the test is positive (yay!) you keep going with the progesterone for several weeks. While the pre-retrieval injections are subcutaneous, this is intramuscular so it goes straight into the muscle at the top of the butt and hurts. A lot. After a few weeks of these it helped to have a doughnut to sit on.
  13. Transfer: While done in a surgical room, the transfer is very similar to an IUI. This time, instead of using a catheter to inject sperm, they’re using it to inject an embryo. It’s going in a bit further, but you don’t even feel it. It feels a bit more intense only because there are more doctors and nurses around and you’re watching the whole thing on a monitor. You have to go in with a very full bladder, which is the only uncomfortable part…especially since you have to hold it for 10 minutes after the procedure. I almost peed on the table at one point.
  14. Pregnancy Test: 8 days post-transfer you’ll go in for a pregnancy test. With IUI you just pee on a stick at home, but with IVF you go in for a blood test. If it’s positive, you go in again to confirm 2 days later with another blood test. I was under the impression that the transfer would be the same point on the timeline as if you got drunk at a bar and had a one night stand. Nope. Because they already fertilized the eggs and let them mature to blastocyst stage, you’re already pregnant before you’re pregnant. Although the pregnancy test is only a week after the transfer, you’re already about a month along. Mind: blown. I know.
  15. Scan: One week after the 2nd pregnancy test, you go back for your first scan/ultrasound. If everything looks good, you’ll go in for bloodwork/ultrasounds weekly for about three more weeks.
  16. Bloodwork and ultrasounds: Throughout this whole process, you’ll go into the office multiple times per week. I counted over 80 appointments. It was honestly a blessing to do this during the pandemic and not worry about what work would think.
Retrieval and transfer room. It was wild watching the process on the screen.
Resources and Influencers
  • Your Doctor: Your doc should be the end-all-be-all. I’m sorry, but unless your friends specialize in infertility, they don’t know jack. They’ll all tell you a story of someone they know who struggled, but unless they’re sharing their own personal issues, it means nothing because I guarantee they don’t know as much about their friend’s issues as they think they do. Find a doctor you trust and listen to what he or she has to say.
  • Being Bridget: Bridget shared her story after the fact (see her highlight here), but I found it super helpful, mostly because she mentioned using prescription numbing patches for her progesterone injections. These were truly life changing for me. They’re expensive ($100-$300 for a pack of 10, depending on whether or not you get a coupon) and if the transfer is successful you could be doing progesterone shots for 8+ weeks.
  • Lindsay Silberman: Lindsay decided to go through the egg freezing process (love her explanation of why here) and took us along for the journey in real time (on her blog here and Instagram highlight here).
  • Linny Stone: Linny has suffered infertility and loss several times over and does not shy away from the difficulty of the journey. She’s due with her rainbow baby just two weeks before me and has been vocal about her whole process in real time.
  • Elizabeth Holmes: My favorite royal reporter wrote this wonderful piece for In Style a few years ago. She also contributed this piece to Cup of Jo about how to help your friend who’s dealing with infertility. (I know I said I’m covering that in Part 2 but figured I should share her words of wisdom now.)
  • Clubhouse: There are some great support groups on here.
  • Podcast Episodes:
    • The World’s First Podcast with Erin & Sara Foster (June 3, 2021 episode)
    • Matt and Doree’s Eggcelent Adventure (the whole IVF journey so start at the beginning)
    • Be There In Five (a generally great show that’s not about fertility/pregnancy, but I cried along with Kate as she revealed her ectopic pregnancy in this episode and loved her perspective on wading through life as a childless millennial here and here)
    • Infertile AF (the most recent episode features my friend, Emily)
    • Big Fat Negative (encompasses the manyyy facets of infertility – episode 3 is a good start)
    • The Infertile Mafia (love that they talk about celebs going through this, but this episode on fertility drugs is a good one)