What to Expect When You’re Expecting: One Couple’s IVF Journey
From vials of sperm to butt shots to nail-biting pregnancy tests, here is an in-depth look at Michelle and Emma’s fertility journey.
“The waiting is the worst part. That’s what we wish we knew,” Michelle* tells me over the phone. I can hear her eight-month-old squealing with abandon in the background as her wife, Emma*, spoon-feeds their daughter dinner. Married four years out of their eight year relationship, the Los Angeles-based lesbian couple always planned on having kids. Like many queer couples, the stork doesn’t swing by your doorstep without scientific intervention for upwards of $60K.
“It’s actually very hard to get pregnant,” Michelle explains. Emma laughs, “Funny thinking about how much money we wasted on Plan B in college.” As two, healthy, young women in their early 30s, they were both prime candidates for a fairly straightforward fertility journey. With 10 vials of donor sperm from the sperm bank, they initially planned to IUI (intrauterine insemination) because it’s cheaper and less invasive. IUI is essentially the “turkey-baster” approach—after doctors monitor your cycle, you simply insert the sperm into the uterus and hope for the best. Michelle, who planned to carry the child, explains, “The doctor looked at my ovaries and said, ‘Your hormones are great. You just turned 30. This is going to be easy!’ The fact that it was not a slam dunk was a big surprise.” The couple went through three vials of sperm to no avail, and at $1,000 a pop, this was becoming both emotionally and financially taxing. They decided to try a medicated IUI which enhances your menstrual cycle and makes you drop more eggs. After the medication, the 4th IUI attempt took.
After eight weeks of pregnancy, Michelle suffered a miscarriage—a heartbreaking event many couples endure, but very few people talk about openly. Although it is a common and harsh reality in the world of fertility and IVF, nothing can really prepare you for the emotional whiplash of hope and loss. Michelle adds, “I didn’t understand why the medical terminology would say, ‘chances of yielding such and such living children,’ and then you understand.” With four vials down, grieving a loss, and frustrated with their clinic in Beverly Hills, Michelle and Emma decided to switch paths and try IVF (in vitro fertilization). IVF involves extracting eggs, fertilizing multiple embryos, and implanting them in the uterus. While more invasive, it has a higher success rate and you only need to defrost one vial of sperm per round. After the 16 months of testing, egg extractions, fertilization, hormone shots in the ass, and lot of nail-biting—Michelle and Emma welcomed their bouncing baby girl to the world last November.
As my friend group has aged into their late 20s and early 30s, ambient conversations about egg freezing and IVF have been flippantly tossed around with very little knowledge of the physical, financial, and emotional cost involved. While sites like the Mayo Clinic can provide vague outlines of the processes required, I wanted to sit down with Michelle and Emma for an in-depth recitation of what they endured in their year and a half of fertility treatments. Whether you’re a queer couple considering IUI vs. IVF, or any person tackling fertility obstacles, here is a detailed account of what to expect, helpful tips, and all the little snafus they don’t mention in the pamphlets.
Below is an account of one couple’s anecdotal experiences with IVF, and we want to be clear that this process varies for everyone, particularly across states and countries. This should not be taken as professional medical advice, just as a detailed account of one couple’s fertility journey from both an emotional and physical perspective.
1. Securing the Sperm
“Each vial of sperm is equivalent to one try in IUI and IVF, so to be safe, we purchased three vials per potential child we wanted to have,” says Michelle. Unsure of how many children they wanted long-term, but certain they wanted them all to have the same donor, Michelle and Emma purchased 10 vials from a sperm bank. At $1K a pop, this is a steep investment. “I used my entire Christmas bonus that year,” says Michelle.
If you remember Romney’s “binders full of women,” the sperm catalog is essentially “binders full of men.” Emma explains, “When you find a donor you like, you have to act fast because these things sell out within about 48 hours." When sourcing sperm you can go one of two routes: known donor vs. sperm bank. A known donor is the equivalent of asking a friend or someone you know personally to give sperm. Emma explains, “We knew we wanted to go the sperm bank route because they do a lot of genetic testing, background on the family’s health for generations, and all the legal paperwork. Known donors can be much more of a headache on the legal end, especially when it comes to second-parent adoptions.”
2. Finding the Right Clinic
“We had a bad experience with our first clinic,” Emma says of the place they went to in Beverly Hills. “This was mid-COVID too, so I wasn’t allowed back into the room with Michelle. They kept forgetting that she was a lesbian and asking about her husband.” Michelle chimes in, “I was like, ‘I’m using donor sperm, bro.’” Emma continues, “They were very disorganized and I felt very isolated.” Not feeling as though they were being listened to or given proactive options when the IUI wasn’t taking hold, they decided to look elsewhere. “A huge reason we switched clinics before starting IVF was we could totally imagine the first clinic fucking up my IVF meds,” says Michelle.
“The new clinic was so much better. They treated us like a couple, they linked our charts, and they totally understood that we were making a baby together,” Michelle adds. When undergoing a process that will likely take between one and two years, make sure you find a doctor and clinic that feels collaborative, compassionate, and attentive to your needs. Shoutout to the Pacific Fertility Center LA, and specifically Dr. Evans—“she was amazing!”3. Choosing IUI vs. IVF
In simple terms, Intrauterine Insemination (IUI) is the medically-monitored turkey-baster approach, whereas In Vitro Fertilization (IVF) requires egg extraction, fertilization, and embryo transfer. For those under 35, IUI generally has a 5-20% success rate per cycle whereas IVF is generally around 50% per treatment. If you’re young and healthy, IUI is a quicker and less invasive place to start. “We saw so many lesbians influencers online talking about how they got pregnant on their first try at IUI,” says Emma.
When starting IUI, Michelle explains, “They follow you for a cycle to see how your eggs and hormones look so they can time the IUI properly. After the insemination procedure, you act like you’re pregnant for two weeks while you wait for results. This means no drinking, no caffeine, the whole thing.” After three tries that yielded nothing, they opted for medication that enhances the cycle and causes more eggs to drop. This last round of IUI resulted in an eight-week pregnancy that ended in a miscarriage. At this point in the process, Emma and Michelle decided to pursue IVF. Although they knew Michelle would carry the embryo, both of them underwent the process of egg retrieval and fertilization to have sibling embryos on ice for the future.
The steps for IVF are outlined below (4-6).
4. Egg Retrieval Process
Checking Fertility
Fertility can be checked through an ultrasound. They are looking for your follicle count and the amount of viable eggs. In the process of checking hormone levels like AMH (anti-Müllerian hormone), FSH (follicle stimulating hormone), and AFC (antral follicle count), “the hormones indicate how many eggs you have left and how well your body is releasing them,” explains Michelle. Emma adds, “Fertility can change dramatically. A year before when they checked my eggs, I had thirteen viable eggs and by the next year, it had dropped to six. I know a lot of people say they want to wait til they’re in their late 30s to freeze their eggs, but if you want to have a kid, there’s no harm in getting checked earlier.”
HSG (Hysterosalpingography) X-Ray Test
While requirements vary by clinic, most clinics require an HSG test for IUI and IVF. “They did a battery of tests to me to rule out any possible fertility problems—the same as they would do for someone that showed up saying, ‘I’ve had unprotected sex with my husband for a year and I’m still not pregnant,'” explains Michelle. She continues, “This ended up being a very painful and invasive test where they shoot dye up your fallopian tube to make sure that they’re open. This was by far the most painful experience in my entire life.” Michelle adds, “I have since talked online and it seems like 50% of people found this to be excruciatingly painful and the other half were totally fine.” Tip: Just in case you are in the 50% that finds this extremely painful, get someone to drive you home after.
Shots & Ultrasounds
“Before the egg retrieval is about two weeks of shooting yourself up with injectables that cause your ovaries to drop a ton of eggs,” Michelle explains. The injections are subcutaneous fat injections so you can inject them right into your belly fat. You learn how to mix powders into saline solutions and fill the syringes at home. “You can do these shots any way you want. Emma wanted me to inject her, but I felt better having control so I would inject myself.”
“You do that for 14 days and your ovaries get enormous. You can’t exercise. They do ultrasounds about every other day and at some point, my ovaries were so big they were touching each other,” Michelle laughs. “It kind of feels like you’re really constipated and it didn’t get painful til' the very end,” she adds.
Depending on the rate that your eggs grow, your egg retrieval procedure could be in fourteen days or more. Once your eggs are at the right level of maturity you set a date for the retrieval. Exactly thirty-six hours before the appointment, you have to give yourself a “trigger shot” that tells your body to release the eggs. “My retrieval was at eleven in the morning so my shot was around 10 p.m.,” says Michelle. “For mine, we had to wake up at five in the morning,” adds Emma.
Egg Retrieval Procedure
“In the US, most egg retrievals are done under general anesthesia. In other countries and certain clinics, they don’t put you all the way out.” The procedure involves a doctor going through the vaginal wall with a very large needle to suck the eggs out. “One thing I wish I knew before,” says Michelle, “is that when you go into the operating room, they strap your thighs down on the table, which felt a bit scary and medieval.” Emma adds, “You’re just spread-eagled, hoo-ha out.”
Recovery
Recovering from the procedure takes about two weeks and you’re not allowed to have penetrative sex or go into any hot tubs or pools due to the small perforations in the vaginal wall. Since your ovaries are so enlarged, you aren’t allowed to exercise for risk of “ovarian torsion.” Michelle was able to go skiing after a few days and says she just felt like she’d been “kicked in the crotch.” Emma, on the other hand, was “wrecked,” in her words. “One time I coughed and peed on the floor. My pelvic floor was all wonky and I was laid out for two weeks.”
If you, like Emma, have PCOS, you can run the risk of OHSS (ovarian hyper-stimulation syndrome), which can make you very sick. Thankfully, Emma didn’t suffer from OHSS, but it’s best to be very cautious in your recovery.
5. Embryo “Hunger Games”
“People in the know call this The Hunger Games because the attrition rate is high,” says Michelle. To explain this in actual numbers, Michelle started off with 24 eggs retrieved. Out of the 24, 18 were mature, and 14 of them became embryos. All of these are unusually high numbers. You then give the embryos five days to reach the blastocyst phase. “By day five none of my embryos reached blastocyst phase. We had all these high numbers and then suddenly we were freaking the fuck out.” Thankfully 10 of them made it on day six (again a very high number), and after checking for chromosomal abnormalities, 9 out of the 10 were healthy. Testing for abnormalities is an optional step—“My job covered insurance so we went for it,” says Emma—but it can help ensure a healthy embryo and reduce the chance of miscarriage. For Emma, she had a 50/50 chance of yielding no embryos because of her PCOS but after starting with 13 eggs, 8 made it to embryo, 4 made it to blastocyst, and 3 were healthy. These are much more typical numbers to see in The Hunger Games stage. Just as in the vials of sperm, doctors recommend having three healthy embryos per child you plan to have. At this stage, embryologists “grade” the embryos based on how healthy they look. This is also a stage where you can find out the sex, but in choosing an embryo you’re really looking for the healthiest.
6. Embryo Transfer
More Shots
Preparing for the transfer is similar to the retrieval process, except it's a five-week process instead of two. The goal is to get your body to think it’s pregnant for five days in order to implant the five-day-old embryo. “They had me take birth control at the beginning,” says Michelle, “to get yourself to baseline so they can time everything.” Michelle struggled with the birth control, saying the estrogen made her severely depressed with “Jekyll and Hyde mood swings.” The entire process included three weeks of estrogen, a week of steroids, and intramuscular progesterone shots. “What I didn’t know is that these shots are daily, and if it’s successful you do it for the first ten weeks of your pregnancy.” These shots can be very uncomfortable and painful, but after a few weeks, Emma was a pro at giving her wife shots in the ass.
After the Transfer
They give you a 60% chance of IVF working if you’re otherwise healthy and the embryo is healthy. One thing to keep in mind is that, whether or not the embryo takes, your body is so hopped up on the shots that you feel pregnant for two weeks. Doctors administer a blood test two weeks after the transfer to confirm whether or not you are pregnant. Michelle explains, “Some people start peeing on pregnancy tests five days after the transfer, but I didn’t want to drive myself crazy. I did a test the morning before the blood draw to set my expectations.” Emma explains, “At this point, we’d had a lot of negative pregnancy tests, so we were both pretty freaked out.” After three minutes, the test was very positive. No squinting at lines this time, Michelle was definitely pregnant. With confirmation from the blood test, they knew the IVF had stuck.
“Technically you’re pregnant, but so many things can still go wrong,” cautions Michelle. Miscarriage is still very likely. After monitoring HCG (pregnancy hormone) levels in blood tests, and weekly ultrasounds for 10 weeks, you fully graduate from the fertility clinic to the OB-GYN and you’re treated “like a regular pregnant person” from that point on.
In Conclusion
“There are no guarantees, and everyone’s experience is going to be totally unique,” Michelle and Emma reiterate of the process. The reality of the process is more emotionally and financially brutal than it is often painted to be in the media. Ideally, you work at a company that provides fertility insurance and parental leave, but we aren’t all lucky enough to have Starbucks’ employee plan. “Just know,” begins Michelle, “that if you choose to undergo any of this, you’re a whole lot stronger than you thought. Things that seemed scary at first like procedures, shots, and testing—it will become routine. You are a badass.” Ultimately, Michelle and Emma’s journey ended with a healthy, adorable (and I actually mean it, she’s genuinely cute) daughter and they are braving the tides of maternal bliss and new-baby exhaustion. So whether you’re planning to undergo IUI, IVF, or just considering putting your eggs on ice, we hope Michelle and Emma’s story can demystify some of the opaque aspects of your fertility journey.
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