about rubbing salt on a wound. Infertility treatments can be difficult enough, but treating infertility can be costly as well. The rising costs of medical treatment in general is a major problem in the U.S. today. It seems unfair that the limit to having children should come down to money but in many circumstances this is true. Dr. R. suggests that you explore the potential total cost for treatments that are suggested along with the overall chance of having a child (see Chapter 15 to look at dealing with the costs of IVF). Your allocation of resources may be significantly altered if you establish guidelines up front; otherwise, you run the risk of the “Vegas syndrome” (believing that just one more hand will make you a fortune or one more IVF cycle will get you a baby). For example, suppose a 41-year-old woman wants to use IVF to have a child that is biologically hers. One center has estimated that for some women in this situation, the chance to have a child can cost as much as $400,000. And even if a person spent that much, there is no guarantee that a successful pregnancy will occur. Knowing that, a couple may choose to use donor eggs for a much higher chance of success for much less money.
Like everything, infertility costs vary and can depend on where you live, which physician/practice you see, and most importantly, whether your treatment is small, medium, or large.
When you’re starting out, expect to pay $20 to $45 for an ovulation predictor kit and about the same for home pregnancy kits. This is the easy stuff. We haven’t brought in the professionals yet.
What about insurance, you ask? “What about it?” we answer. Only 16 states have mandated coverage for infertility, meaning that for those who aren’t fortunate enough to live in one of these areas, infertility treatments are paid for out-of-pocket — yours, that is. Even if you have insurance coverage, you may be amazed to see how little of your bill is covered. Some insurance plans cover only monitoring, meaning the frequent blood draws and ultrasounds. Because these can run well over $5,000 per cycle, this coverage is a help. Other plans cover only the medications (which can cost between $2000 and $9,000), which is a help, but by no means relief from the total cost.
Many insurance plans, however, will cover the tests and procedures related to diagnosing your particular infertility problem. This can be very helpful as well because many cases of infertility require blood work, ultrasound, and even an exploratory surgical procedure to determine a cause for infertility — a mere starting point for treatment. This generally applies to both you and your partner, but double-check this with your insurance company prior to signing up for the “party platter” of tests.
Once diagnosed, and even if you escape diagnosis (20 percent of infertility is unexplained), that’s when the real costs can kick in. Should your problem be resolved quickly and easily, you may get by with the cost of a few months’ worth of Clomid (a pill that causes super ovulation in order to push your ovaries into producing one or more follicles that can be fertilized), a few ultrasounds (which generally cost anywhere from $200 to $500 depending on where you live and which physician practice you frequent) and approximately $200 per blood draw for the basic tests needed to monitor your cycle. If you need IUI (intrauterine insemination), the cost is generally $600 per insemination.
If you are to be monitored via blood work and ultrasound throughout the month, some clinics offer “package” prices, which can range from $900 to $2,000 for blood work and ultrasounds for one month.
If your cycle requires injectable gonadotropins (Repronex, Follistim, Gonal F, Menopurto, to name a few), you are looking at a cost of $1 per unit. Gonadotropins now come in an injectable form containing between 300 and 900 units. IVF cycles can use between 75 and 600 units per day for 10–12 days. If you are also adding in luteal support (which occurs after the egg has supposedly been fertilized), progesterone and estrogen may run you a few hundred dollars per cycle (a bargain compared to other costs!).
Keep in mind that these are all approximate costs. Later on in the book, we discuss places to purchase medications that may offer better deals and other methods that you can use to cut your costs.
If you move up to the big time, keep in mind that the average IVF cycle costs between $10,000 and $15,000. Of that, about $4,000 to $5,000 is spent on medication, and another $4,000 to $10,000 goes to your clinic.
But, for now, we suggest taking it one step at a time. You’ve bought this book, and if you get pregnant from the information you find here, consider it a great bargain!
Chapter 2
What Does Anatomy Have to Do with It?
IN THIS CHAPTER
You may think that you know how to get pregnant. Doesn’t everybody? Not necessarily! In this chapter, we review basic male and female biology, educate you on the inner workings of your menstrual cycle, and explain how sperm is supposed to work. Then we unlock the secrets of conception and how sex is meant to get you to pregnancy!
Reviewing the Female Anatomy
Were you paying attention in Biology 101? You may have taken a quick peek at the film on the miracle of birth and announced loudly to all your friends, “Eww, gross, I’m never having kids!” And yet here you are, some undisclosed number of years later, wishing you had paid more attention back then. Don’t worry; we’re here to fill in the gaps in your reproductive education.
The human body has the basics and the accessories — just like at Macy’s! When you buy an outfit, you can be dressed with just the basics, but the accessories really pull your outfit together. When you’re trying to have a baby, the parts that you don’t see — the “accessories” — determine whether you can get pregnant.
A naked woman is pretty unrevealing from a reproductive viewpoint. You can’t see the organs that count in childbearing, so you can’t tell at a glance whether yours are present and functioning. Take a look at what should be inside every woman, starting from the outside and working your way ”inside.” (See Figure 2-1.)
Illustration by Kathryn Born
FIGURE 2-1: The female reproductive organs.
The vagina
The vagina mostly serves as a passageway, first for the penis to deliver sperm up near the opening of the uterus, and later for the delivery of the baby. If you have a very small vaginal opening, intercourse may be uncomfortable. If your vaginal opening is large, as it may be after having a baby, sex may be less pleasurable. Neither condition, however, has any effect on your ability to get pregnant.
The vagina secretes fluid during sexual arousal, making it easier — and a lot more enjoyable! — for a penis to enter the vagina. Sometimes (especially when you have to have sex at a particular time),