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I thought I knew how babies were made. I didn't get the birds and the bees talk. I got a drawing of a woman's reproductive system on our kitchen whiteboard. By my mother's hand. When I got my period, she explained that now I could easily get pregnant. As the story goes, my little brother was conceived on a night out on the town. Pregnancy happened so often when someone didn't "take care of themselves" or "had a slip." So I used condoms and oral contraceptives in the ensuing years. Such is the burden of womanhood.
But, as I would learn the hard way, for many women, it's a lot more complicated to make a baby.
My husband and I started trying at 30. No known issues. Six months and one early miscarriage later, I got pregnant. Completely healthy pregnancy, relatively uncomplicated birth.
As my son approached two, I removed my IUD and we went for it. I got pregnant almost immediately. Like, literally two weeks later. And then six weeks later, I miscarried. It was an early pregnancy. It happens. But then it happened seven more times over the next year and a half.
I knew something was off after miscarriage number two. But because most things are fine for most people (we've got 8B+ people worldwide for God's sake!), your doctor will wait until miscarriage number three. Because of my age and the fact that I had a son, there was no reason for my OB to worry. The first time earlier success and youth worked against me, I think. And, surprise, miscarriage number three happened.
After miscarriage number three, my OB ran what I thought was a full workup for recurrent loss: genetics, autoimmune, clotting. And finally, something came back. The lab flagged a clotting factor issue, and I remember feeling almost relieved. Could that be it? Could we have figured it out?
It didn't make sense to go further. Checking my ovarian reserve didn't seem necessary since I got pregnant practically every month. The issue was holding onto them. So he put me on baby aspirin daily and told me to start Lovenox injections the moment I got a positive home test. Then to call him.
Two pregnancies later, it seemed to be working. I was getting past the point where I usually lost them. I started throwing up like I had never thrown up in my life. It was great!
At week eight, when you could finally hear the heartbeat, we couldn't find it. Blighted ovum: the placenta keeps growing, but the fetus does not. I had been experiencing a pregnancy with all the vomiting and everything that comes with it, but it was never viable. And my body would take a while to register that and abort. I needed my first D&C.
And then my OB started to piss me off. He kept saying, "You're going to get pregnant." But calling his office was impossible. Getting an appointment was impossible. I just wanted to figure this out, and I felt like I wasn't being paid attention to. So I decided to get a new OB. Still, no one was telling me to see a reproductive endocrinologist. I had to decide everything myself.
My new OB actually did his job. He referred me to a clinic in Miami with one of the best REs. My new (third!) doctor determined I needed a second D&C. He found retained tissue from an earlier pregnancy, plus polyps. Getting pregnant seven times in quick succession wreaks havoc on your body. Nobody tells you about the things that happen in between.
If you're keeping count, I'm now 32 with 7 early miscarriages, a protein S deficiency diagnosis that apparently doesn't mean anything, and what felt like a perpetual period.
The RE ran every test left. Thrombophilia workup, 421-disease carrier screen, the works. The only real finding was an MTHFR compound heterozygous result, though even the lab report says that's not associated with significantly increased risk. All it meant was that I would take methylfolate versus regular folate. Not sold at CVS, costs a little more, harms no one. And nobody had mentioned it until now. I still had unexplained secondary infertility. No one was being careless. Every doctor I saw was following the standard of care. But the standard of care is built for populations, and I was starting to realize I wasn't the population.
At that point the clinic says, "Okay, great, let's do IVF." Not including medication, I was looking at about $35,000 to $40,000. I knew how many people need more than one cycle (70% of women), so I knew what I was getting quoted was the best-case scenario, which, so far, let's be honest, is not my experience. I used to tell people, when you save up to buy a house, you get a house. When you save up for IVF, you save up to maybe get a baby, and definitely a lot of stress.
And then my colleague says, "Well, what about going somewhere else?" She'd heard some people go to Mexico. When we hung up, I couldn't stop thinking about it.
Here's the thing: I'm Peruvian. I have family in Lima. And it had literally never occurred to me. The assumption is that of course the United States must have the best doctors and the best machines. But the genetic testing, the time-lapse incubators, the protocols, it's all the same patents from just a few providers. And the clinic in Miami couldn't even answer the phone. All of a sudden I was dealing with a clinic where you get the doctor's WhatsApp number and someone actually responds. We decided to go to Lima.
First stimulation cycle, everything looked good. We used natural fertilization. Then we waited. Day three, day four, nothing's developing. Day five, nothing's turning into a blastocyst. Day six, he calls me: none of them made it. Zero embryos.
That was a problem nobody predicted, because I had been getting pregnant naturally this whole time. How is it that I was getting pregnant every month but now can't form a single embryo in the lab? Low egg quality. I asked if there was a test for that. There isn't. You find out by trying, and you find out by failing.
We tried a different protocol. ICSI instead of natural fertilization, because why not try something else? The best doctors are the ones willing to admit there's a lot we don't really know. It worked. Six embryos. Genetic testing told us two were chromosomally normal. I only want one more kid, so we were going to make two be enough.
My doctor and I operated under the assumption the issue was always around retaining pregnancies. If he could get a euploid embryo into my uterus, we should be all good. First transfer. No implantation. And then started the year of no implantations.
For almost a year, I kept having cycles cancelled because my lining wouldn't thicken on oral estrogen, which is the standard. Three cycles called off. Each cycle takes months. Months just disappeared. I kept hearing from other women about estrogen patches. But the answer was always the same: the research says the delivery method shouldn't make a difference. Multiple doctors told me this.
Despite 30-plus years of IVF, it is still the wild west. I saw a doctor recently at one of the best clinic networks in the country who looked at me and said, "We really don't know that much about embryos." And yet the system behaves as if it knows more than it does, because when you're a doctor, you have to give people a plan. You think probabilistically. Patients don't think probabilistically. They think about this cycle, this embryo, this month. And that mismatch is where so much of the unnecessary pain lives.
The third cancelled cycle was when I said enough.
I went to my doctor and said, "Hey, have you heard of the ERA biopsy?" And he said, "The research on ERA receptivity is that it's only been shown as helpful for people who have two or more failed transfers."
I had one embryo left.
"Wait, so you want to wait to do a test that is only warranted if I fail with my last embryo?" He said, "Well, yeah, but you're young, and we can do more stimulation cycles." And I heard it. The same thing from the beginning. You're young. As if being young was an answer to anything that had happened to me so far.
I said no. No more time, no more money. And money was the least of it. It was the emotion I had to carry through every waiting period, every loss, every medication cycle. I remember the birthday parties I didn't attend because I was crying on the couch, barely able to open my eyes. I remember the days I would hide under a blanket rather than playing with the kid I did have. I remember telling my husband that he could've married a different woman and had three kids. I hoped I could blame him. But no. I also remember the resentment. My wonderful husband has attended fewer than a handful of appointments over the last two years. It's not because he doesn't want to. It's because in this, he did his job. The ups and downs from medication were mine. He also got a brand-new job. And a promotion.
The reality is, I am not willing to give up everything to have a baby. My kid. My relationships. My time. My career. My money. I don't think many of us are. As my husband would say, "Not in this economy." The journey just to get to a positive beta has to be better. And it can be.
I pushed for the ERA biopsy. I pushed for estrogen patches even though more than one doctor insisted oral estrogen is the standard. Patches are more expensive and not covered by insurance, so no one defaults to them. My healthcare wasn't simply a choice of following the evidence. It had been deeply influenced by pharma prices and insurance. With a code, I got a month's supply for $180. Expensive, sure. But compared to months of cancellations and potentially losing my last embryo? What are we doing here?
It worked. My endometrium finally started responding. After almost a year of cancelled cycles, two years seeing specialists, and four years after we first started trying.
It took me a long time to understand the difference between a study being debunked and a study being promising but emerging. Between a finding being mixed and a finding being contradictory. No evidence of benefit is not the same as proven not to work. And for interventions where the downside is trivial, a few extra dollars, an extra cycle of time, a medication with no adverse effects, the threshold for trying them should be much lower than it currently is. What harm can vaginal probiotics really cause? What's the cost of taking methylfolate instead of folate? What's the real risk of trying patches a few months earlier? The system treats "no strong evidence" as a wall. I think it should be a door the patient gets to walk through, with full information about what we know, what we don't, and what it costs.
I did the ERA biopsy. I've learned I have a hostile uterus (high five, Meredith Grey!) and an unfavorable vaginal microbiome. Is it the answer to everything? Say it with me… "Maybe." But I now know, for the first time, the actual landscape of what I'm working with instead of guessing.
To his credit, my doctor was not the problem. Every time something failed, he was willing to try something different. But you only get to "let's throw the kitchen sink at it" when so many things have gone wrong. And the thing I keep thinking is: what if you could get there sooner? Not by testing everything upfront. But by not making assumptions. By giving patients the information to understand what each step actually costs them in time, in money, in emotion, and letting them decide what risks are worth taking. By treating "no evidence" as a conversation, not a conclusion.
It's taken me a long time to stop being angry that I don't get pregnant easily. There was a time when I didn't want IVF to be any part of my story. I hated it. But then I realized that some of the things that were the most painful didn't need to be so. A lot of these problems aren't science problems. They're problems of mindset, of cost, of dynamics. And I realized we can build something different.
After all we've been through, how hard could it be?