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History: I’m a queer, cisgender female, and my partner is a 31-year-old, queer, transgender man. We talked about wanting a baby early on in our relationship, but we knew there would be challenges. I was in my late 30s when we got together, and neither of us has sperm. He’s also not out to a lot of people in our lives, including my family, so the logistics of more dramatic interventions would have to be hidden or explained away. This is our fertility journey.
Age: 40
Location: Washington State
Occupation: Buyer
Household Income: $135,000
Late 2018
Thinking about having kids
My boyfriend, J, and I have only been together for six months, but are already discussing children. As a queer couple we’re going to have to get creative to make that happen. I’m 38 and we don’t have a ton of money saved. I don’t want to put my body through IVF, and adoption also seems too expensive. J’s parents mention over a family dinner that I should just go to a bar and “get knocked up.” I’m beyond horrified by this idea. We regret discussing this with them, and keep talking about options.
We decide that the most reasonable and affordable options are either intracervical insemination (ICI, which involves using a syringe to squirt sperm from a friend or sperm bank inside of me, trying to get as close to my cervix as possible) or fostering with the hopes of being able to eventually adopt — a beautiful option, but full of potential heartbreak and liability. We finally decide on ICI to start. We plan to limit ourselves to a $5,000 budget, and then re-evaluate if we haven’t gotten pregnant.
Cost: $0
Early 2019
Logistics
We start with a visit to my OB. My basic tests all look great. We do ask one friend for sperm, which is all kinds of awkward, but they end up saying no, which we get. I research sperm banks and figure out that it is about $800 a vial for sperm. One vial equals one try.
Meanwhile, I decide to talk to an extremely helpful LGBTQ+ lawyer about the best way to ensure parental rights for my boyfriend — she says a sperm bank is the way to go. This way the donor cannot fight for custody, but we’ll still know a lot about them based on their file. This route also means the sperm is tested so I’ll be protected from many medical complications. I now feel that using a sperm bank is well worth the money. J will still need to adopt our child in a second-parent adoption, because he won’t be biologically related. Cisgendered straight couples using donor sperm must go through this step too, but for us, it feels especially crucial to have parental protections. I worry there’s a possibility of someone in my ultra-conservative family finding out J is trans and trying to fight for custody.
The lawyer estimates the adoption will cost about $5,000. The lawyer also suggests that we consider marriage before a baby is born, because this will give J more parental rights in our blue state, though we’re still planning to have him adopt a future child too.
Cost: $30 copay for a visit with my OB thanks to insurance. The lawyer consultation is free.
April 2019
At-home insemination time
I’ve started taking prenatal vitamins and inositol, which we read online that can help with fertility. We buy them both off Amazon, along with ovulation test strips, a basal thermometer, and a lube that is supposed to help the sperm move along to find the egg. We pay $50 to the sperm bank to get access to their database of donors, and get very caught up in trying to find the perfect one. The pictures are fun, but the medical factors are more important. For example, heart disease runs in my family, so we want a donor with no similar family history. We finally settle on someone (he even looks like J!).
My OB recommends that I do a transvaginal ultrasound before my insemination to show if there are any growths or blockages in my uterus that would prevent pregnancy. Luckily, the results are all clear.
We thought it would be most comfortable to do the ICI at home, in our bedroom. Still, it feels so weird lying down on our bed with my hips propped up on pillows, and having J squirt a stranger’s sperm into me. After all is said and done, I insert a menstrual cup (that I already had on hand) — someone online recommended inserting a cervical cap after insemination to “keep the sperm swimming” up through the cervix, and this is the closest thing I’ve got.
Cost: $1,239.43 total. $86.45 for test strips, thermometer, and lube; $64.79 for supplements; $50 for sperm donor database access. I pay $181.83 coinsurance for my ultrasound; my insurance does not cover infertility, but some things can be billed as normal healthcare. It’s $856.36 for one vial of sperm and shipping.
Early June 2019
What are we even doing??
Our at-home insemination didn’t work, and we’re already starting to doubt ourselves. Our $5,000 is going to go fast. We consider Intrauterine insemination (IUI), but it’s even more expensive — at least an additional $1,500 to try, we hear— because it involves having a medical professional place a catheter to insert the sperm directly into your uterus. This is so discouraging. Then I hear from one of my friends going through something similar that she found a local midwife who’ll do IUI for just $195. I go in for an appointment. The midwife explains that since it’s hard to predict exactly when I’ll ovulate, she prefers to inseminate twice per cycle, 24 hours apart. This effectively doubles our cost, which freaks me out, but her explanation makes sense to me. I also realize from this consultation that we didn’t even do our first insemination on the right day of my cycle. You’re supposed to do it on the day after you get the ovulation indicator on the ovulation test stick. We did it the day of. Sigh. We completely wasted that first try. J and I discuss how we want to move forward. On the bright side, we got engaged last month, so are trying to enjoy the high from that, and not sweat these big decisions.
Cost: $101.20 total. $100 for a midwife consultation, $1.20 for parking.
Late June 2019
Buying more sperm
The sperm bank has a deal: if you buy six vials of sperm you get free storage for a year. This will push us over our $5k budget, but we do it anyway. I decide to get a 0% interest (for a year) credit card, and put the expense on that. While we’re splurging, I also buy even more supplements off Amazon, adding Vitamin D and omega-3 (recommended by my midwife) to my cart.
Cost: $4,601.93 total. $4,487.76 for the sperm, $114.17 for more supplements.
August 2019
It’s time for an IUI
We head to the midwife’s clinic for our insemination. I’m nervous at first, but it isn’t really any worse than a Pap smear. After the midwife does her thing, I have to lie still for 15 minutes, so she leaves us alone and tells us to do whatever helps me relax. We think that me having an orgasm will increase our chances, but we found conflicting information about this online. We’re not sure if that was what she was implying when she left. We try to make it happen, just in case, but it’s way too awkward for me to get there in this strange, medical setting.
Cost: $462.89 total. $100 to ship the sperm we bought last month, $17.89 for more test strips, $195 for first insemination, and $150 for second.
November 2019-January 2020
J has surgery and I have another IUI
Our first IUI cycle didn’t work. We take a few months off from trying because J is getting a hysterectomy. This is a procedure that he needs physically and mentally, but it does lead us to have a pivotal discussion. Since J is nine years younger than me, we consider whether he should wait, just in case I can’t get pregnant. He feels bad that he doesn’t have sperm to contribute and isn’t contributing his younger eggs or body by getting pregnant. I feel bad that he struggles with this. I ask if he wants to try any fertility treatments — I can’t possibly imagine it being a good idea for him emotionally, but want to hear from him and not put words in his mouth. J says he cannot picture having his body do something that he considers to be so “feminine” (of course, transgender men can absolutely carry children, but this is how J feels individually). Ultimately, he just needed to hear from me that I wasn’t expecting him to contribute eggs or get pregnant.
It’s good to get on the same page. His recovery is tough, but everything goes well overall. We both love his surgeon (an OB) and feel really seen by her, so I decide to switch to her for my own care. I like that I don’t have to explain our story to her.
However, we have another failed IUI in December. This one really hits me. Since we are already over budget, we feel like we just have one try left (with our two remaining vials of sperm). I decide to go see my new OB and see if there is anything she can do to help us. The tests she runs come back fine, and she assures me that two failed IUI cycles isn’t cause for panic. She recommends we try three to six total before trying something new.
Meanwhile, we’re going to start working on the process of becoming foster parents. We aren’t sure that is the right path, but know it takes a long time to be approved. The foster care application process is largely free, and they even pay for little things like taking fingerprints.
Cost: $493.08 total. $100 to ship the sperm, $345 to the midwife, $5 copay, $43.08 for labs
February through early March 2020
Alternative medicine
I’m gearing up for another IUI cycle. I start going to acupuncture and taking Chinese herbs (prescribed by the acupuncturist, who works with my midwife). It’s difficult to leave work for these sessions, as my employer isn’t big on work/life balance, and I certainly haven’t told them what I’m going through. I’m the only woman in my department, and already have a tough time. A week out from our insemination, I have the sperm bank ship our last two vials of sperm to the midwife’s office.
Cost: $262 total. $110 for four sessions of acupuncture (I am thrilled that my insurance covers this, I just have a copay!), $52 herbs, $100 to ship the sperm.
Late March 2020
COVID-19
The coronavirus has come to the U.S. My work tells us to go home, and I figure it will just be a week or so. A few days later, J is sick. We don’t know what’s wrong with him. It seems like a bad flu? We quickly Google and realize that he needs a test for COVID-19.
His test comes back positive. I wonder if he’ll be okay, and I cancel my IUI cycle because we are in quarantine. I’m taking care of J while working (and worrying). I’m SO upset about the cancelled cycle, but then feel petty for feeling that way when J is ill. Luckily, I find out that we can have the clinic ship back the sperm, so at least that isn’t lost and we can try again when J is well.
Cost: $57.03 total. $19.48 vitamins and $37.55 test strips (I have been testing every month since we started trying to conceive, as each month of data helps improve your accuracy). Return shipping on the sperm is included and doesn’t cost any extra.
May 2020
Navigating fertility treatments in a pandemic
After being incredibly sick for about a month, J is feeling better. Crazily, I never got sick.
The midwifery is not open for inseminations due to COVID-19. I am freaking out and look around for other options. We hear about someone who doesn’t seem super qualified but who will do it. I text my midwife to see what she thinks of this plan. She says not to do it, and that she will do the IUI for me despite everything. She’s decided on her own comfort level and feels fine doing this for us. I’m so grateful and relieved.
Yet, two weeks later, we find out that this cycle has failed. I’m devastated and cry for a few days. It feels like I get more upset each time. Plus, we are now out of sperm.
We are still working on our foster parent application, but everything is a nightmare due to COVID. There are steps — such as getting DMV records and meeting with an existing foster parent — that we can’t complete because so many things are closed or operating on a very limited basis. Our social worker’s hours have also been cut, so it sometimes takes weeks to get a response. It feels like we will never be parents, and it doesn’t help that we are locked down and the world seems to be in shambles.
Cost: $445 total. $100 to ship sperm, $345 to the midwife.
July 2020
Another option
Remember when I was absolutely against IVF? Now I can’t stop thinking that it’s our only chance to have a child. But I’ve received estimates of IVF costs ranging from $25,000 to $35,000. That is not an option. In my research, I find that a lot of people go to foreign countries, and I find a clinic in Mexico with a doctor who seems great (she gave me a free consultation) that will charge $8,000, including medications, for one IVF cycle. We would still need to provide sperm.
I make appointments with my PCP and my OB to discuss this idea, and they both (gently) tell me in no uncertain terms that this is a terrible idea. I should not be leaving the country during a pandemic, as the borders could close and either my embryos or I could be stuck in Mexico. They rattle off a whole spiel of reasons not to do this. I end up crying in my OB’s office.
I know that she really feels for me. But she doesn’t cave and tell me to go to Mexico, like I wish she would. She does tell me that she can prescribe me Letrozole, a drug that will cause me to ovulate more eggs and increase my chance of getting pregnant with IUI. I’m frustrated this option wasn’t offered earlier, honestly.
Cost: $23.95 total. $12.65 vitamins, $10 in copays (I have cheaper copays now, this is $5 each for the visits to my PCP and OB), $1.30 for Letrozole.
August 2020
Another IVF option
A friend of mine also wants to do IVF, and we have been comparing notes. After I tell her about the clinic in Mexico, and she tells me about a budget clinic she heard about in the U.S., on the other side of the country from us. They have a waiting list, and I read several reviews that reference having to do a lot of research and follow-up yourself. I think that this is a sacrifice I can handle, though. The estimated cost for IVF with them is $12,000, including travel. I book the soonest consultation I can. If this clinic won’t work for us, we will try medicated IUI with the Letrozole I already have.
Cost: $0
September 2020
All of our hopes for IVF are in this consultation
After our consultation with the budget clinic, and one other phone consultation for follow up questions, we decide to go for it. To prepare, I go to my home clinic for a few more blood tests and order more sperm and have it shipped to our IVF clinic. I also order my medications, which I will need to bring with me on the plane in a cooler to the clinic. We pay our IVF fee ahead of time, because they will give us a 5% discount for doing so.
We’re still working from home, so luckily we can take our work with us. I don’t give work details, and just say I have to travel for medical reasons. I fibbed to my family and told them we’re doing this because J has a medical issue. They think we’re using donor sperm and doing fertility treatments for that reason, and due to my age.
Cost: $7,076.36 total. $12.65 supplements, $4.55 pregnancy tests, $639.56 sperm (it’s a little cheaper this time), $195.12 sperm shipping (it costs more this time because it is going further), $78.33 coinsurance for blood tests, $2,391.15 for meds (they’re at least discounted because of their relationship with my IVF clinic, and my insurance covers a portion of a few), $3,705 for the IVF fee, $50 IVF clinic phone consultation.
October 2020
The big trip for egg retrieval
Because of the intensive monitoring needed when preparing for an egg retrieval, we have to spend three weeks across the country staying in an Airbnb near the clinic. We guess on how to time the trip, because we can’t go in for my first monitoring appointment until my period comes. We arrive on Sunday (when it’s meant to come), but by Thursday it still hasn’t started. Finally, our doctor gives us the go-ahead, and there’s a whirlwind of constant ultrasounds, blood tests, medication, and hopes for a good outcome. We’re juggling my appointments with working. When we can, we go for walks and they restore our sanity. The hormones from the meds are tough. At one point I cry in the dog food aisle of a store because I miss my dogs so much.
Retrieval day finally comes, and I feel like it is the most important thing I have ever done. The procedure goes fine, J laughs at how drugged I am when they bring me out. They retrieve six eggs and inject them with sperm. Four fertilize overnight, but only two mature into embryos by day three. This is super disappointing.
We are further disappointed to learn that my body is not ready for the doctor to transfer my embryo into my uterus (my uterine lining isn’t the right thickness, I’m told). We can freeze the embryos and transfer them later, but we were hoping to get the whole process done in one trip. We go home, wishing we had more but happy that we have any embryos at all.
Cost: $4,858.65 total. $2,663.66 in travel costs, $25 for acupuncture, $200 for a dog sitter, $570 for food, $502 for Ubers (it would have been more than double to rent a car), $897.99 in monitoring (paid to the IVF clinic)
November 2020
Preparing for the embryo transfer
We haven’t done genetic testing, but our embryos were graded by sight. One is good, one is fair. Originally, we wanted to transfer two at a time, but that was when we thought we would have more than two. We decide to transfer just the good one, as its chances will be higher on its own.
Cost: $713.04 total. $383.04 five nights in a hotel, $300 one round trip plane ticket, $25 medication, $5 copay.
Early December 2020
Transfer time
The transfer day arrives. The doctor shows me a picture of our embryo and it looks like abstract art. But it’s so full of promise. The procedure feels just like IUI, but I can watch on the ultrasound machine as the embryo is implanted. I take a photo for J, who had a commitment and couldn’t come with me.
In my Uber ride back to the hotel, I tell my driver about the transfer and she is thrilled that this is our maybe baby’s first Uber ride. She friends me on Facebook so I can tell her if I’m pregnant.
Cost: $1,230.82 total. $50 for a dog sitter, $800 for the frozen transfer, $51.82 additional transfer meds, $206 food, $89 for Ubers, $34 for vitamins.
December 2020
The two week wait
My pregnancy blood test is scheduled for 12 days after the embryo transfer. I can’t wait, so I take a home test after eight days. I know it’s too early and I’m setting myself up for disappointment.
Except, I’m not disappointed. There is the faintest second line. I want to scream, but J is here and working and I don’t want him to know yet. I text my sister and my friend the picture and ask them if they think it’s positive. They say it definitely is. Oh my god. I’m so happy but also skeptical. I decide to call the IVF clinic and ask what they think. The nurse also says she believes I’m pregnant!
I have a special reveal planned for J. He cries and babbles. It’s the cutest moment.
The blood test confirms the pregnancy, and the IVF clinic has me order more meds to support my body in early pregnancy. The odds of a miscarriage are high, my doctor tells me. We are ecstatic but still so worried it isn’t real.
Cost: $92.55 for medication, call to IVF clinic was included in the cost paid for my care.
January through March 2021
Pregnant and happy
I’m still a patient of the IVF clinic and required to have additional monitoring until I get 12 weeks into my pregnancy. I still do the progesterone shots every night, along with vaginal estrogen, oral estrogen, oral progesterone, and oral steroids, all of which should help support the pregnancy. It’s an uphill battle, but each ultrasound is amazing, showing me that our miracle baby is still alive. In March, I’m released as an IVF patient and now my OB is in charge.
It has been a year since we started our foster parent application. We have completed all the steps, but we aren’t licensed because it still hasn’t been processed. We don’t want to foster when we have a newborn, so we call and put our application officially on hold.
Cost: $367.03 coinsurance for bloodwork and ultrasounds
Total Cost: $22,054.96
Reflection: These two years have been a wild ride. I am now 32 weeks pregnant and I’m only just now starting to believe that the pregnancy will really stick, and that in a couple of months we will have our baby boy. I tear up just thinking about it. I wish we hadn’t spent so much time and money on IUI, but I don’t think I could have been convinced to jump straight to IVF. In the end, it is funny that we ended up doing exactly what we said in the beginning we wouldn’t – spending a lot more money and doing IVF. I am so grateful that we got pregnant and were able to pay it off before the baby arrives. J and I got married in February, and we feel insanely lucky.
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