In the beginning.
Before getting married, my husband and I both shared we wanted kids. Definitely plural, like maybe even 4! (Clearly we had not yet investigated daycare prices in the DC area!). We decided that after we got married, we'd wait one year to just give ourselves a chance to adjust to being newlyweds before we started trying. I was under a very false impression that we'd get pregnant easily. In my family, my sister had gotten pregnant on her honeymoon a few years back. And my extended family is full of big families, and out of my 50+ cousins (yes, you read that correctly), I'd only heard of one instance of a family struggling with infertility.
Moving on to IVF.
Well, I thought it would happen quickly, but nothing happened. And then nothing happened again. And then repeat that for a year. In discussion with my OBGYN, he mentioned we should try for two years before moving on to seek additional treatments. If you are in this same situation (and over the age of 30, I'd push harder on that!). After two years of trying we starting working with Dr. Eric Levens at Shady Grove Fertility. We did so much testing (for both of us), tried various methods, and at one point I felt like we'd never have kids. It was a tough time. Eventually, we moved on to try IVF, and the very first transfer was successful! I was amazed! And the next year Anais arrived.
Thoughts on Health Insurance.
Fertility treatments are expensive. And no one is up front with pricing - it's hard to predict since they can't know how many appointments you'll need, or how much medication until you are in the cycle. At once point, I had to get medicines, and on the phone, they told me the price without insurance coverage was over $3,000. But they couldn't tell me how much insurance would cover until I made the purchase and submitted it to insurance. At that point, I ended up having my dad on the phone with them for a three way call to give his credit card, as I didn't have an additional $3,000 available at the time (We were in the process of buying a house). It only ended up being a few hundred dollars, but it felt like this was happening all the time. Insurance covered testing, but it didn't cover our initial fertility treatments.
We were lucky that my husband's employer was located in Maryland, which is one of the few states that mandates IVF coverage (with limits). It does require you to exhaust all other potential avenues first, so we did have to pay tens of thousands of dollars out of pocket for our initial treatments which never worked before we could qualify to have IVF coverage. The Maryland law allows you to do 3 IVF treatments per live birth (which just seems like it's really insulting if you have a miscarriage or stillbirth) and you can spend up to 100k before it's maxed out.
The implication of this policy I'll talk about below. This was probably the deciding factor in how we ended up with twins - the 3 tries per birth.
Six months after Anais was born, I went back to Dr. Levens to talk about potentially having more kids. I was 37 when Anais was born, so I didn't want to wait too long. We started with another round of testing, only to find I had Hashimoto's Disease, and would need to stabilize my TSH levels to a lower number before we could try to have kids. Apparently, it's not uncommon to be diagnosed with this after pregnancy. It took nearly a year to stabilize, as I'd try a medicine for 3 months, then go back for blood work, and they'd have to up it slowly each time.
We had on fertilized embryo from our IVF with Anais, and our insurance required us to use that first before they'd cover IVF. Keep in mind, they'll only cover three cycles, and a Frozen Embryo Transfer (FET) is much cheaper than IVF. So we did consider if we should pay for that one ourselves, to maximize our chances with IVF being covered by insurance. In the end, we used insurance, and it didn't work out. We then waited a month and then did another round of IVF. When we went in the morning of the transfer, we found out we had two viable embryos, and it was up to us if we wanted to use both. I was older then, at 38, and while they don't recommend this for younger women, your chances are less and less as you get older. The doctor told us that with a singleton, we have a 40% chance of a baby, but with two embryos, we have a 60% chance of one baby, and a 10% chance of twins.
We had to make a decision that morning. Honestly, the reasons I chose to do both embryos, is because if this one didn't work, we only had one more chance with insurance, and I thought if we can't make this happen with insurance, we may not be able to afford to continue trying. So yes, we had twins in the end because of insurance limitations. The funny part is, having twins is way more expensive than another round of IVF. I didn't think about that at the time though.
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