"Why can’t I do this?
This thought haunted Katie Brunette for an entire year as she and her husband tried to conceive their first child. “We’re taught in school that pregnancy happens really easily and you have to be alert,” she said. “I kept wondering what was going wrong.” In June 2016, the couple turned to a fertility clinic for help.
After another year of treatment – including ovulation testing, a laparoscopy, and intrauterine insemination – their specialist recommended they try in vitro fertilization (IVF).
But Brunette wasn’t ready. As a perfectionist, she hated how her body was failing her. “There was a lot internally I was battling with,” she said. So the couple took a year off; in July 2018, they began their IVF journey.
Although it’s common for women – and men – to experience feelings of shame associated with infertility, they shouldn’t. One in eight couples struggle with fertility, according to Resolve, the national infertility association. While there are many paths to bringing a child into your family, IVF is the most effective form of assisted reproductive technology, according to Mayo Clinic.
Whether you’re about to begin your IVF journey, you’ve been on it for a while, or you’re just making yourself aware, here’s a primer.
1. Who IVF is for
If you’ve been trying to conceive (TTC) unsuccessfully, have genetic issues, or are single and ready to become a mother, your OB-GYN may present IVF as one method toward conception. If you are partnered and under 35, you’re looking at a year trial of TTC prior to IVF; if you’re over 35, it’s six months, said Dr. Wendy Goodall McDonald, a Chicago-based OB-GYN.
Although many think IVF is for women in their late thirties and beyond, “There are a lot of people who deal with this in their younger years… it’s not just something for older women,” Goodall McDonald said. “Fertility is a spectrum.”
Infertility isn’t only a woman’s issue – men need to get tested too. It’s also important to note IVF is one possible treatment for infertility. “Some people think it’s IVF or bust,” she said, but that’s not always true.
2. How IVF works
At your OB-GYN’s recommendation, you’ll make an appointment with a fertility clinic. Selecting a reputable, board-certified clinic is critical to your success and comfort during IVF, said Dr. Kenan Ormutag, a board-certified reproductive endocrinologist and associate professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis. So, be sure to ask your OBY-GYN for referrals and do your own research.
Your first appointment with your clinic of choice will include several tests. If you have a partner, they should attend as well. You may meet with a genetic counselor or even the billing office to review financials. Subsequent appointments are scheduled based on your cycle and individual health needs. The next step is medication, then collecting semen, followed by IVF, which includes two procedures: egg retrieval (a minor surgery) and the embryo transfer.
After that procedure, expect to return to your clinic for multiple check-in appointments.
3. You should prepare for multiples, one, or none
The success rate of IVF largely depends on your age, health, and other factors. Women undergoing IVF should manage their expectations and prepare for one child, multiples, or for it to fail. However, “the days of Octomom are over,” Goodall McDonald said. Treatment is much more effective than it was in the ’90s, Ormutag added.
At the Washington University Fertility and Reproductive Medicine center, where Ormutag practices, there is a 50 percent success rate for women under 37 to get pregnant. Your fertility specialist can evaluate your situation to determine the likelihood IVF will bring you closer to your goal of conceiving a child.
4. IVF is time-consuming
According to Southern California Reproductive Center, an average IVF cycle takes about six to eight weeks from consultation to transfer. However, timelines vary greatly from person to person. “Fertility care is a roller coaster ride and for some, the ride is short,” Ormutag said. “For others, it’s long.”
In Kit Graham’s case, she went to the doctor 34 times in 15 months and experienced a failed IVF cycle. Graham, author of the food and travel site The Kittchen, said she had “no idea that it could take so long, but sometimes your body’s hormones aren’t in the right place and things get delayed.”
Conversely, she knows women whose treatments were shorter. If you’re preparing for IVF, expect to be at your fertility clinic often and clear your calendar accordingly.
5. It challenges your emotional health
Women should be prepared to feel different as they undergo IVF, Goodall McDonald said. Treatment is stressful and can cause mood swings; many women feel anxious or lonely. “You know the odds, you know the risks, and you just still never expect as many twists and turns as you end up with,” said Lindsay Fischer, a mom of twins via IVF and author of The Two Week Wait Challenge. “It takes your breath.”
Fischer believes self-care is critical for women struggling with the emotional burdens of IVF. “Soak in vitamin D when all you want to do is hide below the covers, wash the salt off your face when you’ve cried all day, choose to kiss your partner when you’ve had a devastating blow,” she suggests.
6. There are side effects
In addition to emotional challenges, Goodall McDonald explained that women undergoing IVF may experience abdominal discomfort, weight fluctuations, and bloating. Some risks include ovarian cyst formation or ovarian hyperstimulation. Graham herself experienced headaches, bloating, cramps, hot flashes, chills, and insomnia during her IVF.
7. IVF is costly
According to Omurtag, you should budget approximately $9,000 to $12,000 for IVF itself and $3,000 to $6,000 for the medications. Genetic testing, which is becoming increasingly common despite ongoing controversy, adds about $3,500.
Across the U.S. there are just 15 states that require health insurers to cover IVF; only four, however, have a comprehensive mandate – Illinois, Rhode Island, Connecticut, and Massachusetts. In Indiana, where the Brunettes live, their costs are completely out of pocket, and they used their savings to cover the cost.
More and more employers are looking to add fertility coverage to their benefits to better care for their employees, Omurtag noted. “I would encourage patients to create grassroots networks with their employers to push for his coverage,” he said. “Chances are there’s someone next to you who’s struggling [with infertility]. If you let your HR people know [you need coverage], things will change.”
8. You’ll need a support system
Because IVF presents individuals and couples with a host of emotional, physical, and financial challenges, it’s paramount to find sources of support. Search #infertility and #ttc and you’ll discover there’s an active Instagram community of women encouraging each other on their path to motherhood.
Brunette herself created a blog and an anonymous Instagram account to connect with others facing infertility. “I found it very helpful to be able to relate to other women going through this,” she said. “There aren’t a lot of support groups out there for people.”
Fischer, an active member of the infertility community on social media, co-founded the InfertileAF Summit for this purpose. “[Our tribe] is a group who is ready to look at their mental health as a key component to infertility treatment. We are trying to unearth the taboo and unpopular options you have while cycling, including walking away from treatment without having a baby,” she said. “We want women to see their value outside of infertility, which is so often painfully difficult to do, but to know they are worth more than a stick they pee on.”
Brunette established a support group through her church as well, which she counts as a great blessing.
9. There are other options
If IVF isn’t working, as a next step, your fertility specialist might suggest an egg donor, gestational carrier, surrogacy, or adoption. Other women and couples choose to forgo having kids altogether. “[Some] people think that because they didn’t bear a child that there’s something they’re not bearing in life,” Goodall McDonald said. “We’re moving into a generation that’s finding fulfillment and peace in other aspects of life.”
10. It’s OK to want it
In the Brunettes’ case, IVF didn’t work the first time. In July of 2018, Brunette had her first egg retrieval, then started medication. A month later she received her first egg transfer, one that unfortunately ended in a miscarriage.
In December 2018, they tried another transfer. This past February, Brunette posted this on Instagram: “1,444 days of praying; 100 shots; 2 perfect miracles.” She’s due this August – with twins.
While IVF eventually worked for Brunette, it isn’t successful for everyone. As Brunette anticipates giving birth, she’s remembering women in her circle who still long to become mothers.
For those women, she has this advice: “Once you have a dream in mind, it doesn’t matter that it’s been six months, two years, four years. When you want it, you want it, it’s OK to want that. You don’t compare yourself to others.”