Losing a pregnancy is complicated. Trying again in the pandemic was right for me

"It was $40 for two weeks," he said with a sigh. I wondered what it would have been without insurance, something I couldn't afford just a few years ago, let alone prescriptions with this high of a price tag.

I opened one of the boxes, revealing 10 preloaded syringes — which would last me only five days — to treat my newly diagnosed Antithrombin III deficiency and MTHFR gene abnormality. In another bottle, a few weeks' worth of progesterone suppositories awaited.

This was already far beyond our initial, somewhat breathless decision last year on our honeymoon where we said, "If it happens, it happens, and if it doesn't, it doesn't." It was also a bit too close to our most recent and third pregnancy loss in a year.

"If this doesn't work," I said, while he looked over instructions on how to inject the blood thinners, "would we go as far as IVF?"

It had taken me a few weeks during a pandemic to work up the nerve to go in and have 10 vials of blood drawn to get a diagnosis. Yes, I am that terrified of medical procedures, so even hearing the question come out of me was a surprise.

But these injections and suppositories wouldn't lower my chance of another miscarriage; they'd only lower the chance of it happening because of clots preventing blood traveling through the tiny vessels of the placenta to the fetus, who is then starved of nutrients.

This had, presumably, happened to me twice in quick succession — once with twins, and another most recently. At my age of 42, I had a 33% percent chance of not seeing my pregnancy through to the second trimester, and here we were, trying to beat those odds again.

In vitro fertilization wouldn't offer much better odds, either. All the reassurance would surround only the fertilized egg itself being healthy, and without chromosomal abnormalities. My chance of a pregnancy resulting in a normal weight, full-term singleton birth from one round of IVF is a mere 2.2%, according to a 2016 report published by the US Centers for Disease Control and Prevention.

In the two months since our last loss, my husband and I had multiple conversations on whether or not we should try to bring another human into the world on purpose again. Through the overlying fear of another miscarriage, we had other things to consider, like climate change, a pandemic with unknown effects on fetuses and whether or not being pregnant would make me more at risk of worse Covid-19 symptoms.

A friend even suggested that maybe it would be a good idea to wait for US presidential election results in November. Given our age, a sense of urgency won, and the ultimate want to have a child together, in addition to the two we each had from previous relationships. Would that urgency carry us further through fertility treatments?

"You never really know what you'll actually do until you're in it," said Margaret Rogers, 33, of Charleston, South Carolina, over the phone recently. In addition to the birth of her daughter, who is 3, Rogers has already weathered through three pregnancy losses, one heartbreakingly at 16 weeks in January.

"It was so devastating," she said. "I was so upset with the pregnancy loss and then Covid-19 hit, and it was definitely a really tough time figuring out if it would ever happen for us."

Infertility is a common problem, according to the CDC, which reports "about 12% of women aged 15 to 44 in the United States have difficulty getting pregnant or carrying a pregnancy to term." Assisted reproductive technology brought 76,897 infants into the world in 2016, of the 3,941,109 who were born.

Limited access to fertility treatments

The American Society for Reproductive Medicine released a statement on March 17 recommending clinics suspend fertility treatments. That included the "initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers" and even cancellation of transfers, fresh or frozen, only continuing to care for patients who were mid-cycle.

"We kind of felt like we were on a moving train," said Lauren Hickson, a 33-year-old first-time mom in Morristown, New Jersey, of her decision to move forward with treatment. "We didn't want to undo all of that progress and risk further delaying, so, while it was definitely a concern we wanted to continue."

Her clinic, the Reproductive Medicine Associates of New Jersey, agreed. While its website now proclaims it's "open and operating at full capacity," after the ASRM announcement in March, Hickson worried her clinic would shut its doors.

"I called as soon as I saw the ASRM guidance," Hickson said. "I spoke with my nurse several times a week by phone, so I never felt in the dark."

At the time, she was one week away from her first transfer, where an egg the clinic had retrieved and successfully fertilized in January would be inserted into her uterus. At first, she was told to stay on her medication while the clinic reviewed their options. Then, the relief came when Hickson heard from the nurse that they were "fully committed to continuing" her treatment.

During an in-person appointment, Hickson said her doctor told her that the CDC didn't advise women to not get pregnant, so why should infertile women be treated differently? "It's discriminatory," Hickson added. "The fact that they were so considerate and willing to prioritize our parenthood journey made all the difference in the world to us," Hickson said, who is now pregnant after a successful transfer on May 6.

Colleen Tate, a 32-year-old school counselor and licensed therapist in Philadelphia wasn't as lucky. "In March, our clinic advised us that they were closing for new treatments and only working with active IVF cycles and current pregnancies," she wrote via email.

Tate and her husband had been trying for months to conceive naturally for their second child without success, so her doctor suggested she seek IVF treatment in April. Now, with the clinic closed to new treatments, it seemed like that wasn't a possibility. "There was no time frame or expectation on when they would be able to reopen for treatment."

Though the clinic didn't reopen until June, Tate said she conceived naturally in May and her clinic was able to see her through the beginning of her first trimester. Still, she added that being pregnant through a pandemic hasn't been ideal.

"I feel for my husband," she wrote, since he's had to miss out on her prenatal appointments. "We have decided not to find out the gender so my husband and I can share in something firsthand together."

Megan's clinic in New York City also shut down for two months soon after her retrieval. (She preferred to only use her first name for privacy reasons.)

"They quickly figured out new processes and opened back up," she wrote through Facebook. "The clinic was great about remaining in touch throughout the shutdown period so I definitely felt like I could reach them and my doctor directly if I had questions." After an unsuccessful transfer in June "with a few Covid tests throughout," she is now nine weeks pregnant.

Prohibitive cost

If the pandemic limiting access wasn't enough, IVF also comes with a significantly high price tag, with starting prices upward of $12,000 to $17,000.

Some clinics offer their own insurance programs, but Rogers said some of those options were discontinued during initial Covid-19 shutdowns. Only 14 states (mine included) have laws that require them to cover infertility treatments and two states — California and Texas — are required to offer those treatments (but not necessarily cover them), according to the National Conference of State Legislatures.

"It's kind of like gambling," Rogers, who doesn't live in a state where insurance programs are offered, said in attempting to figure out financing. "My husband and I decided to not do the insurance program (the clinic offered) because it is a higher fee up-front." Rogers noted that she's also banking on the fact that she's fairly healthy and will "hopefully just need one round."

At Rogers' age, she has the best chance of that one cycle resulting in a pregnancy — 35.9% compared to only 21.7% if she had been closer to 40, according to the CDC.

Rogers' doctor was also able to retrieve five eggs (but freezes them and implants one at a time), and the CDC gives her chance of pregnancy a 59.3% success rate if she were to attempt all of them. But each of those rounds would come at an extra cost, sometimes half as much of the initial price tag. If a patient requires other medicine or wants to do genetic testing or sperm extraction, the total cost could be $25,000 or more.

"I'm confident that science is working in my favor, but there's still so much unknown and risk," Rogers said. "It does bring me renewed hope," she said later. "Because I know I have those five embryos and five chances of getting pregnant at a higher success rate than in the past. That's all I can cling to right now."

An alarm chimed five days after ovulating, telling me to give myself a shot in the stomach. Every 12 hours that alarm triggered events I hoped would click into normalcy: walking to the bathroom, sitting, pulling up my shirt; the smell of alcohol, the sight of a needle sinking into my skin, inflicting pain.

When my doctor described the process, I had assumed it would cause me to faint. I'm not sure why it doesn't.

Maybe it's hope. Maybe it's that I will do anything for this kid. They deserve that — even before they're a positive line on a test.