The Greatest Single Choice of My Life: What’s Next? Part 1.
Part 1 of 2:
So you’ve decided to become a single mother by choice, no doubt one of the single biggest decisions in your life...now what? Well, the first step is likely going to be a lot of tests. Once I decided this was what I wanted to do I then had to figure out where to go from there.
After joining a couple of Facebook groups for single mothers by choice (that are linked on my resources page) and doing a little research, I knew that the first step was to find a Reproductive Endocrinologist (RE) as well as to get baseline labs done. A reproductive endocrinologist is an obstetrician/gynecologist (OB/GYN) that specializes in male and female infertility, and are trained in providing fertility treatments such as egg freezing, intrauterine insemination (IUI, also known as artificial insemination), and in-vitro fertilization (IVF).
Thankfully, due to my previous infertility journey with my ex-husband and my over-researching ways, I was already familiar with a lot of the tests that would need to be done to give a better picture of my own fertility status and that I had not had done yet.
I chose to go to a local OB/GYN first to get the labs I knew that the RE would want to see, one to save time and money, but also because all the REs I was finding were at least 5-6 hours away from where I live, just one downside of living in the mountains. I also thought they might be able to give me a recommendation for any REs that they knew, or had perhaps worked with before. Given that I’m so far away from civilization, anything that I could do here where I live would be an added bonus.
You can get the labs done by the RE if you choose, however, I think there are a couple of reasons why you do not want to do this. First, you may need to shop around for RE’s, which could take some time. It’s super important to find an RE that you click with, that you trust their protocol is right for you, that is willing to work with a single mother (yes, there are still clinics in this country where doctors will not accept single mothers by choice, insert mega eye roll here) and that isn’t going to just take advantage of your situation and is just interested in your money.
Second, it could cost a lot more, due to the likelihood of insurance covering fertility treatments being slim to none. If you’re one of the lucky ones to have fertility coverage then by all means go for it, but for the rest of us, the costs add up real quick and this is one thing you may not have to pay for.
Pro tip: if you go to your primary physician or OB/GYN or anyone else besides the RE, DO NOT tell them that you are getting labs for possible fertility treatments. Normally, I wouldn’t condone lying but this is one case where it will save you a lot of money and hassle. Just simply say that you want the labs for your own information, to get a baseline, whatever lie you have to make up, just DO NOT utter any word relating to fertility. The second those words go into your chart they will never leave, and your insurance company will use it as an excuse to not pay. Even if they say they cover baseline labs. I’m currently fighting with mine because I made this costly mistake and I likely won’t win and will have to pay probably $1000+ for the lab tests I have had done so far.
So, getting back to those tests, I saw my new OB/GYN in Mammoth in early October and was pleasantly surprised when not only was she stoked for me and my decision, she also knew a RE that her and her husband had worked with when they lived in Southern California, before coming to Mammoth. She happily ordered the labs for me and I went on my way. Those initial labs consisted of the following:
AMH: Anti-Mullerian hormone, secreted by the cells of the developing egg sacs (follicles) in the ovaries, and is generally considered a good indicator of a woman’s ovarian reserve (quantity of eggs left), but does not indicate anything about egg quality. AMH is also a good indicator of how well a woman’s eggs will respond to IVF. Normal ranges vary by age, but is generally 1.0-4.0ng/mL. (1)
FSH: Follicle Stimulating Hormone, regulates the reproductive processes in the body, it stimulates the growth of ovarian follicles, before the release of an egg from one of those follicles in the ovary, or ovulation.(2) Normal range for women who are still menstruating are 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L), with high levels generally indicating poor ovarian reserve.(3)
Estradiol: a form of estrogen in the blood, secreted by the ovarian follicles, and determines the ovaries ability to produce eggs. It is also used to see if the FSH result was accurate or not, because estradiol suppresses FSH. If FSH is normal but estradiol is high, this could indicate estradiol artificially decreasing the FSH level. Both FSH and estradiol are checked on cycle day 2-4 of the menstrual cycle. Normal range for menstruating women is 15-350pg/mL, with a high level indicating poor ovarian reserve.(4)
The AMH was the one I was the most stressed about because I knew it would essentially tell me a lot about my own fertility status and how easy and/or hard a road it would be from there. Of course, AMH isn’t the end all be all of fertility tests and a “good” result does not guarantee any sort of outcome. There are so many variables to consider and it only shows a small part of the picture.
Late October in Mammoth, photo by: @honeybirdfilm
In the meantime, I got to work to find an RE. I narrowed my search to three clinics, the one recommended to me, and two local to my hometown, one that a friend went to for IVF and was successful (twice!), and that my ex-husband and I had already been to for a consult. The one that was recommended to me was farther away than I would prefer but did not have an initial consult fee, which is kind of unheard of in the fertility world, so I really liked that right off the bat. The other two had a fees of $300-400 just for a consult! I didn’t even bother with those (but kept them in mind for backup), and made an appointment with the recommended clinic.
On November 27, 2019, I traveled to Laguna Niguel, CA for my initial consult appointment. I met with the RE himself first, and he thoroughly explained what my options were, what he thought the best protocol for me was (which just happened to match exactly what my tentative plan in my head was), emailed me an explanation of the IVF process right then and there, and allowed me to ask as many questions as I wanted. I got a great vibe right from the start, especially when he told me that his own children were conceived through IVF!
He was super happy with my AMH result, which I won’t share the exact number but I will say that it is very decent, if not good, for my age. My FSH and Estradiol were also “good” and in the normal range. We both agreed that egg collection with embryo freezing (IVF) was the first step, in order to have “younger” fertilized eggs available for the future, and then planned to move on to IUI after that. He told me that I would be on a “short protocol” due to my great lab results.
From there I was sent to talk to one of the nurses who is the Third Party Clinician Coordinator. What the heck is that?! She handles and works with the sperm donation side of things. So she gave me a list of sperm donation agencies that they usually work with, as well as went over their IVF calendar. I decided that late February was a good time to do the embryo freezing/IVF, and then start the IUIs in April. She then sent me to the Billing Manager to discuss the financial aspect.
The Billing Manager of course went over the overall costs, the payment schedule, loan companies that they work with, and gave me a list of more tests to get done before February in order to be able to move forward with the IVF.
One thing I also learned while I was there is that they have another office in Bakersfield, which is only four hours away from where I live, as opposed to five to six hours to Laguna Niguel, so I could do a lot of the tests and procedures from that office if I wanted.
I left with a smile on my face, knowing that this was the clinic for me and I have been nothing but happy with them so far. Next on my to-do list was to get some more lab tests done, so I quickly got to work again, but since this post is already long enough, I will save this story for the next one. Of course, as the fertility journey usually goes, this is where I hit my first bump in the road, but don’t worry you won’t have to wait too long to find out what it was. 😉
