Falling Through the Cracks

Choice Chat

For every hundred (or more) women who have chosen single motherhood through donor insemination in recent years, there is a woman like Jeanne, 50, who is the Choice Mom to three kids aged 9 to 11. She didn't have the benefit of online discussion groups to query about Choice Motherhood, or books to read about the process.

Ten years ago, the field was very different for single women who choose motherhood.

"Back then, you had to have a psychiatric evaluation and meet with a social worker," recalls Jeanne, a bank executive. "What I took away from my social worker was that I didn't need to tell anyone how I came to be a mother - that it would be better to say I accidentally got pregnant. I thought to myself, 'now I've made a well planned out, rationally thought out decision here.' But they thought it far better to get accidentally pregnant rather than intentionally pregnant."

With that industry mindset as backdrop, then-34-year-old Jeanne set out for an emotionally, financially and physically exhausting five-year journey to motherhood. She spent more than $30,000 (in 1990s dollars), had 13 IUIs over the course of a year-and-a-half and another six IVFs in the following four years.

That's far more effort, money and time than Jeanne likely would have expended had she not fallen through the cracks of the system.

Jeanne started her journey while living in Chicago, spending more than a year having monthly IUIs. No one told her that aggressive action should have been taken after just three or four attempts.

Because her lack of sperm became the characteristic that defined her for clinicians, she was not labeled infertile - a categorization that typically places a woman on a more aggressive treatment path. Instead she was assigned to a nurse for inseminations.

"I didn't know the system well enough to know better," she said. "If I'd been considered infertile instead of just lacking sperm, a physician would likely have taken a more active interest."

Her high number of unsuccessful IUIs was noticed by accident when a physician saw Jeanne's file lying atop a desk. After he noticed the high number of IUIs, Jeanne was put on a more aggressive treatment plan: tubal transfers (TET) and in vitro fertilization (IVF).

Jeanne began her IVF treatment with regular - sometimes daily - visits to the doctor's office for blood tests to monitor progesterone. Despite the highly personal and invasive nature of the treatment, she'd walk into the fertility clinic a stranger and leave the same way.

"I don't think anyone knew my name," she recalls.

And nothing happened. She was producing enough follicles, but her eggs were too small at the time of harvest (when eggs are retrieved for fertilization before transferring back into the uterus). She later learned from the physician who eventually helped her conceive that because the first physician was focusing on progesterone levels to signal when to harvest her eggs (and return them after fertilization), the physician was taking her eggs before they were viable for a successful pregnancy.

And then there were the 14 embryos. Jeanne and her physician had agreed that three embryos would be returned to her uterus. Her physician instead implanted 14. "I remember thinking I hope I'm pregnant, I hope I'm pregnant, I hope I'm not THAT pregnant!" she says.

To make matters worse, the even-keeled and upbeat Jeanne was treated poorly. "I'd been waiting 25 minutes (for the IVF transfer) under a sheet in a room that was 55 degrees," she recalls. "When my doctor came in, she was angry with the anesthesiologist because I was not medicated," she recalls. "As she inserted the speculum, I could tell she was frustrated that she even had to deal with me being conscious. . . I felt like a piece of meat."

Jeanne went home and stayed on her back for four days per doctor's orders. But none of the embryos survived. She later learned from her subsequent physician that she had a tipped uterus. Lying on her back was counterproductive. If she was to lie down at all, she learned much later, it should have been on her stomach.

"It just shows the difference between dealing with someone who knows and cares about what they are doing, and dealing with someone who is just doing this as a business," she says.

More than three years into the process, Jeanne relocated to Minneapolis. She went to a local fertility specialist to finish what she had started in Chicago. It was after one round of IVF failed that her new physician sat down with her for 90 minutes to answer all her questions, and discuss her options. Although an accomplished woman with a strong business sense, Jeanne had never yet had a doctor willing to talk with her so long and with as much attention.

Her new doctor didn't anesthetize patients for IVF. Instead of monitoring progesterone levels, he watched the size of eggs. He only transferred a few embryos at a time.

She had to pay out-of-pocket because her insurance plan didn't cover his clinic. But almost immediately after switching to him, Jeanne got pregnant.

Her joy was short-lived: the pregnancy turned out to be ectopic. She had to undergo emergency surgery and the removal of one of her fallopian tubes. Now her doctor was able to push insurance for coverage, since she had diagnosed infertility.

A second attempt took again. And at 39, Jeanne's first daughter was born. Two years later, Jeanne's twins - a boy and a girl - were born.

Today, Jeanne has several nieces and nephews who were conceived the same way. Her parents owe more than half their grandchildren to IVF.

While many aspects of donor insemination have changed in ten years, Jeanne's difficult journey illustrates how easy it can be for a single woman to fall through the cracks, spending invaluable time and money without results.

What Jeanne took away from her experience is the need to thoroughly research doctors, clinics and success rates.

That means paying attention to live birth success rates, not just chemical pregnancy success rates. Jeanne's first clinic considered a miscarriage she'd had at 10 weeks a pregnancy. That didn't take into account the fact that the embryos weren't viable because the eggs were too immature for the embryos to develop heartbeats. But for statistical purposes, it did count as a chemical pregnancy.

"What I can say is that anybody with fertility issues needs to research the success rates of their clinics. It's just throwing [money] in a big hole if you don't have the success rates," she says.

"It was very different when I was going through this," Jeanne says. "But I would urge anyone doing this to first talk to as many different people as they can. Talk to individuals, to doctors, to clinics. . . everyone."