“There were many layers to that struggle, different challenges at different times,” says Valerie, a resident of Philadelphia.
At 33 years old, Valerie, a surgical nurse at Penn Medicine, had never had so much as an abnormal period. Yet, doctors couldn’t decipher exactly what was causing her and her husband’s miscarriages and difficulties conceiving.
Valerie and Jason had gotten pregnant within two months of trying initially. But, then they miscarried. Over the next six months, they struggled to conceive again.
Diagnosing a Mystery
“Initially, the challenge was not knowing. There was this lack of understanding, this mystery. We thought we should start investigating.” Valerie says.
Between 1 in 10 and 1 in 20 women has polycystic ovarian syndrome, or PCOS, according to the U.S. Office on Women’s Health. That means as many as five million women don’t produce an egg every month, which lessens their chance of conceiving.
Valerie didn’t fall under that diagnosis, though. She and Jason appeared healthy—no physical obstructions or fibroids. They had lab tests to check hormone levels. Those came back normal, too.
Except for one.
One of the tests showed that Valerie had a slightly elevated level of follicle stimulating hormone. This signaled that she may have poor quality or quantity of eggs. But nothing was certain.
“That was the first challenge.” Valerie says, “The insecurity, as a female, of feeling as though I was unable to get pregnant. I took it on my shoulders, even though it’s not an exact science, and there are many pieces to it.”
Learning the Language of Fertility
She and Jason were still in the beginnings of the process. They talked openly about it. Valerie worked to keep her ego in check and not take things personally. They focused on learning this new language —the terminology of fertility—and navigating this new system, even though they were both in the medical field.
“I can’t imagine not being a nurse and going through this,” Valerie says.
The couple decided to start on a method called intrauterine insemination, or IUI. In this process, doctors collect the husband’s sperm and wash it out to make it as potent as possible. They then monitor the wife’s cycle. When her ovaries release an egg, they insert the sperm and let nature take its course.
“Every step of the way has its own challenges. You look at your partner, you look at yourself, and you say, ‘What are you willing to do? How far are you willing to take this?’” Valerie says.
Despite multiple attempts over three months, the IUI wasn’t producing any results. In-vitro fertilization (IVF) was on the table. This process involves doctors fertilizing an egg outside of the body, and then inserting it into the woman’s uterus.
Constantly QuestioningValerie hesitated at first. Financially, IVF is expensive, with no guarantee that it will work. The average cost per cycle in the U.S. is $12,400, according to the American Society of Reproductive Medicine.
“I thought I would never do IVF, that I would never go there. There’s this stereotype leading into it that people who do IVF are utterly baby crazy,” Valerie says. “It seemed like an extreme use of science. I didn’t know what to make of that.”
Yet, she was committed. A trained swimmer, Valerie knows that once you dive in, there’s no looking back. But doctors still couldn’t explain the couple’s fertility challenges, outside of that one slightly abnormal test.
“It’s probably a frustrating place to be as a clinician, to say you don’t know why,” Valerie says.
Physical PainsIn order to be within the Penn Medicine network, the couple switched doctors to Suleena Kansal Kalra, MD, MSCE. This enabled them to use financial aid that Penn reserves for employee fertility treatments. They sat with their new doctor and explained their recent decision—to try IVF.
“Her confidence made me nervous,” Valerie confesses. “I work with surgeons in an intensive care unit. I see confidence given to families all the time. They want to give people hope, but hope is a double-edged sword.”
Then the physical challenges began. Valerie started on a host of hormones for a month to prepare her body for IVF. A nurse explained the different medications Valerie would be administering to herself, some orally and some via needles.
“This part would be incredibly overwhelming as a non-nurse. I found it nerve-wracking as a nurse,” she says. “Who uses needles in everyday life if you’re a lawyer or an art teacher?”
Financial StressesThe couple had to order five medications through the mail. Each one is so tailored to the individual taking them, that pharmacies and clinics don’t have the demand to keep them on-site. Here too, the financial challenges presented themselves. A single vial of medicine could cost thousands of dollars.
“I’m on the phone with some pharmacy or the insurance company saying, ‘Damn it. I’m trying to get pregnant.’ I felt like I was inventing the wheel to get things that I knew other people had gotten,” Valerie says.
“All the time, I’m thinking, ‘This is just because I want to be pregnant,’” she adds. “Emotionally, I was really high strung and hurt by this.” The struggle was making her question her resolve to get pregnant.
And financially, it wasn’t just about the price of the medications. Valerie had to miss work to wait for the deliveries, which could arrive anytime between 8 a.m. and 8 p.m. “And they would show up at 8:05 p.m.”
Every other day, she had to go back to the doctor for blood work and ultrasounds to monitor hormone levels and follicle growth.