This is the fourth installment of six about our struggles with infertility. Read parts one, two, and three. This is our story, nothing more, but we share it to add another voice to this often unspoken struggle.
Our third round of IUI would be our last in Chicago.
We had always intended to depart from the city after I graduated, but the specifics of a move were unidentified for months. For the last year, my husband and I had debated possible relocations. He wanted to be somewhere warm. I wanted to be close to an airport. In the end, we settled on the Twin Cities. It wasn’t warm, but it was more affordable and offered us the ability to be right in the city, continuing our urban life, but out in the far stretched suburbs for a more relaxed feel. Being closer to family and free rent were also main draws. My brother and his wife live in a charming house in the suburbs, and they said we could stay in their basement while we plan the next few steps. Minnesota it was.
In the spring, though, my husband heard from a good friend about a teaching job in Wyoming. The same friend had tried to lure my husband out to the Cowboy state a year prior with a similar job. My husband applied but did not get an interview. This job seemed more promising, though, and my husband wanted to see where it led. Now, Wyoming was in the mix.
The last few years have been hard on my husband professionally, and we thought things were starting to turn in 2020 when he was offered a new job in a different field. However, a month after his hire, the pandemic started. He was furloughed a month later and then laid off. He took a retail job while applying to positions in other cities, but rarely did he hear back. At one point, it looked like his former company was going to bring him aboard in their Minneapolis location, but after weeks of interviews and stalling, they changed their mind.
I wanted to move to Minnesota. I wanted to live with my nieces and buy a kayak. If we moved to Minnesota, I figured I could find a job fairly quickly. I had even been in contact with several therapists and had an information meeting with someone on the Minnesota licensing board. His job path was less known, and the more he learned about this job in Wyoming, the more he was interested. It had been such a long few years for us, but specifically for him, and I owed it to him to wait on moving until he knew what was going to happen with the job in Wyoming.
However, the uncertainty of our next steps was making me unravel. Many of my classmates had secured jobs before graduation (one of my professors noted that this is not normal and likely due to the current high need for quality therapists), and in anxiety-riddled impulse, I reached out to the owner of a private practice in a Twin Cities’ suburb. We chatted for an hour, and a few days later, she offered me the job. I turned it down for two specific reasons: 1) it did not come with health insurance, and if we were going to continue on our fertility journey, we needed employer-provided, affordable health insurance; and 2) taking that job would derail my husband’s own ambitions, and I couldn’t do that.
From there, I refrained from applying for jobs while we waited to see what happened with the job in Wyoming. The bonus was that it gave us time to see how many rounds of fertility treatment we could squeeze in at our current clinic.
By the time the second IUI had failed and we were about to start the third cycle, we knew that my husband was a finalist for the job in Wyoming and was planning to fly out for a second interview. We knew what day he would know if he got the job, which allowed us to set a leave date, still unsure what state we would be going to.
One drawback to leaving Illinois was its generous laws regarding fertility insurance. Each state has different laws regarding what they cover and what they do not. Some states, like Illinois, mandate insurance companies to cover fertility treatments. Others, like Minnesota and Wyoming, do not, forcing patients to pay out of pocket if their plan doesn’t cover it. Even in these mandates, insurance often doesn’t cover medications related to fertility treatment, which are often costly. Also, most insurance companies will not cover visits to a fertility clinic unless you have been trying for a certain amount of time, depending on your age. To begin treatments, insurance companies also want to see a diagnosis of infertility. Because that diagnosis is based on heteronormative standards, same sex couples and single women often can’t get the diagnosis and therefore will not be covered by insurance. Insurance can also dictate how many rounds you can do by what they will cover, and some plans require so many rounds of IUI before a couple can move to IVF. IVF also is more complicated with insurance. Of the 19 states that have passed laws regarding fertility coverage, just 13 of them include IVF.
Our plan in IL, with the infertility diagnosis, offered us unlimited IUIs and up to four egg retrievals, if we decided to go to IVF. The state laws also dictate that IVF would be covered if we were unable able to conceive through other, less costly, methods.
We wouldn’t have the time to do IVF, but under IL laws and because we had already met our deductible, we wanted to try one more round of IUI before leaving the state.
Once my period arrived, the doctor started me on a new medication to stimulate my ovaries— Letrozole. Anytime the doctor made adjustments to my treatment plan, it had to be sent to and approved by the finance department. Basically, they make sure it’s covered by insurance and that I understand and commit to any costs associated with treatment before they move forward. Then, I had to sign a waiver indicating that I understand the associated risks of the medication. Letrozole is actually used to treat breast cancer, but studies have shown it can also help with stimulating ovaries. This seemed a bit weird to me, but with all things fertility, I shrugged my shoulders and signed the papers trusting that the doctor knew what he was doing.
The cycle was the same. Two pills a day for five days. Initially, we were slightly worried about the timing of the cycle with my husband’s trip for his interview. I did not want my follicles to be ripe and ready to go while he was out of town. However, I had a follow-up appointment three days after the end of the medication on the day he was supposed to be flying home. I figured it would still be a couple of days from there anyway, and we would be in the clear.
A good friend of ours works at an airline and offered my husband use of a buddy pass to get to his interview. It worked like a dream for the flight from Chicago to Denver, but there was an issue with the amount of fuel at the regional airport and flights between Denver and Wyoming were condensed that day. This meant that each flight was full, and they couldn’t accept standby passengers that day. My husband’s next best option was to drive the four hours to Wyoming. As he was rushing through the Denver airport, I got on the computer and booked him a rental car (and there were not many to be had). He picked up the car and made it to Wyoming with enough time to prepare for his interview the next day.
Having the rental car, though, changed his return plans. He would need to drive back to Denver and return the car instead of flying out of Wyoming. Our friend changed his return flight to Denver-Chicago. After his day-long interview, my husband drove three and half hours to Longmont, Colorado. We have good friends there who graciously let my husband crash in their basement for the night so that he could get to the airport early the next day to return to the car. (Seriously, all of the love from our friends to pull off this trip for my husband warmed my heart for weeks.)
My husband’s flight back to Chicago was scheduled for noon, but it was already booked. He would have to wait for a later flight. However, storms were scheduled to arrive in Denver later in the afternoon, so my husband was hoping a seat would open sooner.
That same morning, a Friday, I had my follow-up appointment. The clinic was unusually quiet. An ultrasound tech that I had not had before called me back to her room.
“Have you had an ultrasound before?” she asked.
“Many,” I laughed.
“Great, you can probably do this by yourself at this point. You don’t need me anymore.”
She inserted the probe and began examining my left side first. She found two big black blobs, measuring at 18 and 20 mm. Then on my right, one at 23 mm. It was the first time I had had more than one enlarged follicle.
I knew the drill. I expected a call from my nurse later in the day, around 3-4 p.m., saying that I needed to trigger that night and then come in two days later for the IUI. I called my husband and told him as much. “You just need to be here by Sunday.”
I had to work the rest of the day, and since there was about an hour before my shift began, I had planned to go to the Starbucks across the street and read until it was time for me to go to the store. I was making my way to that neighborhood, taking residential streets, when I got a call from the fertility clinic. This was strange. I had just left there less than 20 minutes ago. I wondered if I forgot something.
The nurse said that my follicles were so primed and ready to go that the doctor wanted me to trigger that moment. I was a 30-minute drive from home, where my trigger shot was nestled in my fridge, but I told her I would take it as soon as I could. “Then, the doctor wants you to come in tomorrow morning for the IUI.”
Crap. My husband was currently three states away without a dedicated flight home. I told her this and said that we may need to use some of his frozen specimen. After our first failed IUI, the doctor recommended that we freeze some of his specimen so that if the specimen he produced on the day of the procedure had low numbers, they could use the frozen sample to offset it. The nurse said she would tell the lab to have it ready to unfreeze, and we both agreed to cross our fingers that my husband could make it home on time.
I called him right away, and said, “We are doing this tomorrow. You have to come home.”
Then, I frantically drove back to my apartment, took the shot, and then back down to Lakeview for work. My husband, in Denver, had gotten through security and was going from airline to airline looking for an open seat on any flight to Chicago. At work, I told my coworkers about this lunacy, and one recommended he drive. “Well, driving from Denver to Chicago would take 18 hours and I need him here in 21.” We all laughed saying this felt like a rom-com, somewhat similar to Jonathan Taylor Thomas’ “I’ll Be Home for Christmas.” A few hours later, my husband texted me and said that a Southwest flight had been delayed, and because of that, there was a single open seat on a flight from Denver to Chicago. He bought it and now had a way home.
The next morning, we went to the clinic. It was the first time we both had gone in at the same time. The clinic was starting to relax its precautions (it would ramp them back up several weeks later as the Delta variant raged through the country) and allowed partners to come in for procedures as long as they could show proof of vaccination. Additionally, it was also the first time my husband could produce his sample on site. They still preferred that men bring them in, but you can request to do it there. Knowing my husband’s hectic travel schedule, I figured this would be easier for him, plus it would give us a fresher specimen. This was our last shot, and I was willing to do whatever we could to make this one stick.
After he returned to the waiting room from his part, we waited. I figured it would only be 20-30 minutes, but when the wait grew to 45 minutes, I started to panic. It was that same distorted panic I had experienced before in this same waiting room. My bladder was uncomfortably full, and I was convinced that the nurse didn’t like us.
Eventually, we were called. I popped up on to the exam table while my husband sat in the chair next to me. Again, this was the first time he got to be with me while having an IUI, which I hoped would make it extra lucky.
To soften the nurse, I made a joke about how the hardest part of the procedure is the full bladder. She then explained why they ask for the full bladder as it makes getting into the cervix easier. I could feel her pushing things in and out of me as she talked, not pausing the slightest. I started to cramp during mid-explanation and grabbed my husband’s hand. In a minute or two, she was done.
She propped my hips up, turned on the timer, and left us to wait the 10 minutes. I was thankful to have my husband there to distract me during the wait. The nurse was gone not even a minute when my husband’s phone rang. It was his friend in Wyoming. He asked if the school had called him yet, and he said no. His friend said to act surprise when they do, but it was unanimous decision. He got the job.
Heather M. Mangan 