After being interviewed by our medical insurer in March, I was accepted into our plan’s infertility program.  My seven previous intrauterine-insemination (IUI) cycles, T-shaped uterus, implantation problems and miscarriage enabled me to immediately pass over lesser procedures and head straight for in vitro fertilization (IVF).

Our medical insurance Benefits Handbook states, “Infertility treatments are covered as follows:

–assisted reproduction procedures (including facility charges and related expenses) due to infertility.

–ovulation induction and monitoring up to a maximum of six attempts per lifetime.

–artificial reproductive technology (ART) – limited to a combined maximum of three attempts per lifetime for the following: in vitro fertilization, gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT).”

When 19 eggs were retrieved from me in June, I naively hoped that I’d never have to go through the process of injecting myself with ovulatory-stimulating medications again.  After all, for our three insured IVF cycles, we’d only need four embryos, since our reproductive endocrinologist will not transfer more than two Day 5 embryos, and my husband and I had decided in advance that we would transfer only one for our first and second cycles, resorting to transferring two for our final attempt.

Then we went in on June 10 for our first embryo transfer, and the genetic counselor shocked me by greeting us with, “Well, we will have a transfer today.”  She then broke the news, which she felt was good news for aspiring parents “our age,” that we had only two healthy embryos.  The math is as follows:

19 eggs retrieved from my 40-year-old ovaries

-8 eggs that were not mature enough to fertilize

-1 egg that didn’t fertilize

-3 eggs that were chromosomally abnormal due to my “advanced maternal age”

-3 embryos that were abnormal due to my 43-year-old husband’s “advanced paternal age,” a term I’m making up

-2 embryos that were healthy, but stopped developing

= 2 healthy embryos

We stuck to our original decision and implanted the embryo recommended by the genetic counselor as “our strongest embryo”—a little girl—because we had to make an immediate decision about how many embryos to transfer, based on this new information; because a hysterosonogram had revealed that my formerly T-shaped uterus is now a slightly larger arcuate uterus, making implantation more likely; because my uterine lining was thicker than it had ever been, also making implantation more likely; because we had chromosomally normal embryos, eliminating the majority of first-trimester miscarriage risks; because my husband is terrified of having multiples; and because I was an idiot who didn’t put two-and-two together.

To explain the idiocy, when I met with the genetic counselor in March, I had asked her how, when conducting pre-implantation genetic diagnosis (PGD), embryologists could just take one cell away from an eight-cell embryo without doing any damage.  She had explained that, within the eight-cell embryo, each cell is identical, and embryologists know that, because the eight-cell stage is the point at which one embryo will divide into identical twins, it only takes four of those eight identical cells to create a perfectly normal, healthy person.  Somehow I never connected this mind-relieving information—that our embryos would have already split before implantation—to my husband’s and my conversations about transferring two embryos, imagining them dividing into two separate sets of triplets, making me the next best thing to the “Octomom.”

So, we had our one embryo transferred and cryopreserved our second embryo, a little boy, but, although everything was as perfect as it could have been for a 43-year-old man and his nearly 41-year-old wife, complete with uterine abnormality, our baby girl didn’t implant.

The day that I got my period, I decided that transferring only one embryo had been ridiculously stupid, so we needed to transfer two the next round.  My sweet husband said OK. 

But, with only six embryos this time, we could end up with no new embryos to add to our frozen-boy embryo for this transfer.  So, I called our insurer yesterday to clarify that we have coverage for six ovulation inductions.  I explained in detail that I’d already been through the egg retrieval and was worried that we may not have any viable embryos tomorrow.  I asked him if what I’ve done to date counts as ovulation induction or IVF.  He said that it is ovulation induction, we do have coverage for six, and we also have coverage for three cycles of “artificial reproductive technology.”  I was so relieved, because this meant that, if our little frozen guy is all we’ve got tomorrow, I don’t have to do a transfer.  I can stimulate four more times, trying to have two embryos for the next two transfers. 

But, I couldn’t stop thinking about my conversation with this insurance man.  I couldn’t stop thinking that he didn’t know what he was talking about, that he didn’t understand the terms he was using.  Why would the bulk—95%—of an IVF cycle be only “ovulation induction”?  The embryo transfer itself is a two-minute, pain-free procedure.  This two-minute procedure is the deal breaker?  So, I called back, this time speaking to a woman who had the good sense to know that she shouldn’t discuss issues she didn’t understand, and she referred me directly to the infertility department, which was closed for the night.

I called this morning, and the term, “ovulation induction,” as the insurer uses it, refers only to the procedure as it relates to artificial insemination.  Once my eggs were retrieved on Saturday, we were locked into our second IVF cycle, and we only have coverage for three.  So, tomorrow, we will have a transfer.

As of this morning, when only the results of the first wave of PGD were available, we were down to five embryos, because one of my eggs was chromosomally abnormal. 

In her message, the genetic counselor also said that she believed that the majority of our embryos made it to yesterday, which was Day 3.  Today, the second stage of PGD was conducted, and results will be in for tomorrow’s 9:45 a.m. appointment with the counselor.  My husband is on a business trip today and tomorrow, but, when he called an hour ago, he had me laughing hysterically about his new-business pitch tomorrow.

“What?  You want to talk business?  I’m sitting here, meeting with you, in Dayton, Ohio, while simultaneously impregnating my wife in Chicago.  What more do you need to know?” 

Tomorrow morning, I’ll call my husband, so we can discuss our PGD results, and make our final decision about the embryo transfer. 

Tonight, I’m going to bed praying that my husband will get me pregnant while he’s out of town.  We’d get a lifetime of mileage out of that story.