Infertility is a medical problem for which only 15 U.S. states provide health insurance coverage. This renders the majority of this country’s infertile population—10% of the overall population, according to Resolve: The National Infertility Association—unable to pursue treatment.  (For more information about infertility coverage—and the lack thereof—in the United States, see my post, Giving Thanks for Infertility Coverage, at http://www.mkkennedy.com/2009/07/giving-thanks-for-infertility-coverage/)

For those of us with infertility coverage, as I had when I underwent seven intrauterine insemination (IUI) cycles six years ago, and as my husband and I had when we did IVF twice last spring and summer, we still have out-of-pocket costs to cover.  For those without health coverage for infertility or those who have exceeded the often-low limits of the coverage they have, deep pockets are required.  (For more information on IVF costs, read my posts, High-Cost IVF Meds at http://www.mkkennedy.com/2009/07/high-cost-ivf-meds/ and Uninsured IVF Costs Unaffordable for Most at  http://www.mkkennedy.com/2009/07/uninsured-IVF-costs-unaffordable-for-most/)

In these latter cases, those suffering from infertility need to determine how much to invest in treatment, for which there is no guarantee of a child, versus how much to save for adoption, if that is an option they’d like to pursue if treatment isn’t successful.  But, most of us, my husband and I included, don’t have the financial resources with which to pursue both infertility treatments and adoption.  So, if medical interventions don’t work, we’re left with failure, rather than the hope of parenting a child through adoption.

The infertile face flat-out discrimination in that their medical conditions don’t automatically enable them to have the medical insurance necessary for treatment.  They face financial ruin as they pursue motherhood and fatherhood out of their own pockets.  They suffer through invasive, embarrassing, hormone-filled, grueling medical procedures, which are physical and emotional torture.  (Many of my July posts address the debilitating effects of my second IVF cycle.)

But, one of the worst facets of infertility is the isolation, for family members, friends and colleagues are often too uneducated or uncomfortable to know how to provide much-needed support.  Today, Tracy directed her friends to Vita Alligood’s article on the Resolve website, www.resolve.org, titled “Infertility Etiquette,” so they will know how to react to her and others in the infertility camp.  The piece is a must-read for anyone who knows anyone suffering from infertility.  To read it, click on: http://www.facebook.com/l/7d71a;www.resolve.org/site/PageServer?pagename=lrn_ffaf_ie

Last, on Christmas Day, I asked for prayers for Tracy and her seven embryos.  Today, she needs prayers more than ever, as she faces the future, tapped out financially, emotionally and physically.  I am going to pray that she will someday become a mother, for, although life isn’t fair, any child, biological or adopted, would be blessed to be hers.

Titled “10 Stars Who Had Their First Kid After 40,” the lead to the article is, “The birthrate for women ages 40 to 44 has more than doubled in the past 25 years, and Hollywood is no exception to the trend.  Here are 10 celebs who became moms at midlife.”

So, the birthrate for women ages 40 to 44 has more than doubled… 

Interestingly, More doesn’t provide any statistics, no information about what the birthrate has doubled from or to.

“More than doubled” sounds impressive, but I know the numbers from my considerable research as a 40-year-old, then 41-year-old, undergoing in vitro fertilization (IVF), and double of almost nothing is still almost nothing.

The reality is this, as excerpted from Sylvia Ann Hewlett’s book, Creating a Life: Professional Women and the Quest for Children (2002, Talk Miramax Books):

“There is a secret out there, a painful, well-kept secret:  At mid-life, between a third and half of all high-achieving women in America do not have children.  A nationwide survey of high-earning career women conducted in January 2001 shows that 33 percent of them are childless at ages 40-55, a figure that rises to 42 percent in corporate America.  By and large, these high-achieving women have not chosen to be childless.  The vast majority yearn for children.  Indeed, many have done to the ends of the earth to find a baby, expending huge amounts of time, energy and money.  They subject themselves to humiliating medical procedures, shell out tens of thousands of dollars, and derail their careers.  Mostly to no avail.  After age 40 only 3 to 5 percent of those who use the new assisted reproductive technologies (IVF and the like) actually succeed in having a child—no matter how much they spend, no matter how hard they try.”

Let’s do the math here:  This means that 95-97% of women ages 40 and above, 95-97% of those who can afford to do infertility treatments, will NOT have a child.

The reality is that for most women ages 40 and older, assisted reproductive technologies (ART) will be their only hope of having a child, yet these treatments are outrageously expensive and, more often than not, NOT covered by medical insurance.  And, only the high-earning career women mentioned above (or women tied to high-earning career men) will have the insurance coverage and/or financial resources with which to pursue these treatments.

In my July 18 post, “Uninsured IVF Costs Unaffordable for Most,” I listed each and every expense associated with my husband’s and my first IVF cycle, which took place in Chicago in May and June.  The total cost for the cycle was $29,608.98.  Our medical insurer has special reduced pricing with our IVF clinic, so our insurer was billed $22,571.59.  We have medical insurance in Illinois, one of only 15 states that has mandatory coverage for infertility, yet our out-of-pocket cost was still $7,156.73 because, due to our ages of 41 and 43, we elected to do pre-implantation genetic diagnosis (PGD) of our embryos, which, at $4,000, is not covered by insurance, and we paid another uninsured $800 to cryopreserve one embryo.

My husband and I are blessed, unlike the majority of Americans, in that we have great infertility coverage, and I was able to pay the out-of-pocket by cashing out part of my retirement plan.

But, I didn’t get pregnant that time around, necessitating another try and more money.

In my July 20 post, “Giving Thanks for Infertility Coverage,” I list the 15 states in the United States—only 15 out of 50—that have mandatory medical-insurance coverage for infertility, including the restrictions associated with each.  The bottom line is that, even with infertility coverage, you need cash—and lots of it—in order to even try to get pregnant.

And, the above costs reflect using my eggs and my husband’s sperm.  Many women ages 40 and older are unable to use their own eggs, but that is never mentioned in any celebrity stories.

Five years ago, when I was 35 and attending infertility support group meetings organized by Resolve: The National Infertility Association, I met three women, each of whom got married for the first time at age 39.  All three immediately started trying to conceive, with no success.  And, each of the three was told by each of their three different reproductive endocrinologists that she had less than a 1% chance of having a child with her own egg.  One woman adopted a child, and, after I got pregnant and didn’t attend meetings anymore, I didn’t hear updates about the other two.  And, I would have, if either had had a child.  Infertile women love to share success stories.

Needing to use donor eggs, sperm or embryos can result in being excluded from infertility coverage altogether, not to mention the costs of procuring the necessary donor material.  In Arkansas, Hawaii, Maryland, and Texas, “the patient’s eggs must be fertilized with her husband’s sperm.”  This, of course, excludes not only married women with infertile husbands, but also unmarried couples and single women from receiving infertility coverage. 

And, let’s not forget the dramatic increase in chromosomal abnormalities being passed on as both women and men age.  When eggs and sperm are reproductively elderly, they are often abnormal. 

At my first consultation with the Center for Maternal and Fetal Health at the local hospital, the doctor presented me with a maternal-age chart outlining the likelihood of having a baby with Down Syndrome or any chromosomal aneuploidy.  Below isn’t the full chart, but just the odds at age 29 versus 39 to 49, where the chart stopped.

Maternal Age—Down Syndrome—All Chromosomal Aneuploidies

29—1/472—1/417

39—1/50—1/28

40—1/39—1/22

41—1/28—1/17

42—1/22—1/14

43—1/17—1/11

44—1/14—1/9

45—1/11—1/7

46—1/9—1/5

47—1/7—1/4

48—1/5—1/4

49—1/4—1/3

Isn’t it amazing that celebrities, regardless of how old, never give birth to children with chromosomal abnormalities?

Here is More’s list of celebrities who had their first child after age 40:

Holly Hunter, now 51, who had twin boys at age 47.

Mariska Hargitay, now 45, who gave birth to her son at age 42.

Halle Berry, now 43, who had her daughter at 41.

Jennifer Beals, now 45, whose daughter “arrived after she was 40.”

Helen Hunt, now 46, who had her daughter in 2004.

Nicole Kidman, 42, who had her daughter at age 41.

Geena Davis, now 52, who miraculously had three children after age 45 with her fourth husband.

Marcia Cross, now 47, who had twin girls two years ago.

Beverly D’Angelo, now 57, who had twins with Al Pacino when she was 49.

And, most infuriating, Salma Hayek, now 43, who had her daughter at age 41 and is quoted as saying, “There is no reason woman should feel rushed to have a child.”

WHAT?

At the end of this article, More has a tag stating, “Watch Headline News’ Showbiz Tonight on September 23, 26 and 27 for more on these later-in-life moms.”

Oh, I will. 

And, I’ll compare the experiences of these moms with my experiences, those of my friends and neighbors, and those of the women who e-mail me because of my infertility blog.  None of us have unlimited financial resources, making our insurance coverage—or lack thereof—irrelevant.  None of us are easily having “miracle families,” defying not only the infertility odds, but also the odds of chromosomal abnormalities.

It would have been responsible and honorable for More, a magazine devoted to women 40 and older, to do more than list these celebrities, giving hope to its aging readers that they can still wait to try to conceive.  And, it was completely, inexcusably irresponsible to print Salma Hayek’s quote, “There’s no reason women should feel rushed to have a child,” without some sort of disclaimer.

Salma Hayek isn’t living in the world most of us inhabit.  She is a movie star, married to the super-rich son of a billionaire.  And, if she got pregnant naturally two years ago, it is yet another example of her freakish luck, not something any other woman should use as justification to postpone having children.  

Age-related infertility is avoidable.  Over and over, I cringe when media outlets fail to report the big picture to their viewers, listeners or readers, instead choosing to hype yet another sensational story about aging celebrities having healthy babies.

All the money in the world can’t turn back the biological clock.  Some, if not most, of these celebrity moms didn’t use their own eggs…

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.