How to get pregnant at 38 with a sterile partner?

February 17, 2013 11:27 AM

I'm 38. My partner is 53 with a 20 year old vasectomy. I spent ten of my most fertile years in a lesbian relationship and I feel like I've missed my chances to conceive. What are my options? How much is it likely to cost? And what can I expect my insurance to cover?

I would really like to have a kid but I don't know where to start. I know I'm running out of time. My partner's vasectomy is old enough that a reversal is unlikely to be successful. I have HMO insurance in the US. Where do I start and is getting pregnant going to be extremely expensive for me? I'm not willing to have a friend donate sperm.

posted by dchrssyr to health & fitness (11 answers total)

What your insurance covers will depend a lot on your specific policy and what state you live in.

You're really not going to know how difficult or expensive this is until you try. Even at 38 you could get artificially inseminated and get pregnant the first time. Everyone's different. Talk to your GYN or PCP about your options (though they may not know much about the insurance side). Get a recommendation for a good fertility doctor/center (I don't know but I would guess they do know a lot about the insurance side).
posted by mskyle at 11:33 AM on February 17

First things first: you need to find out how your own ovarian reserve is doing. Schedule a fertility workup with your doctor. (there's also an over-the-counter pee test that can give you a rough estimation of where you stand on things, if you want a quick SWAG answer.) If your fertility is in good shape, then you're probably looking at IUI (intrauterine insemination) with donor sperm. The donor sperm will cost you anywhere from $250-$1000 or more depending on how selective you are; the IUI procedure itself will cost $250-$500 per try. Women with no fertility problems average 3-4 IUI attempts before they get pregnant.

If your fertility is compromised, you have a couple of options. You can try to boost your fertility for IUI using drugs like Clomid and Follistim; Clomid, which is a pill you take, costs about $20 a month without insurance. Injectable gonadotropins are much more expensive, on the order of one to three thousand dollars a month.

If fertility drugs + IUI aren't enough to get you pregnant, then you move to IVF, which is where eggs are harvested from your ovaries, fertilized in a petri dish, and then re-transferred back to your uterus. This is where the really big money comes in; IVF costs $12K-$20K per cycle, depending on what specialized procedures you need. If you need donor eggs as well as sperm, you could double that cost.

All of those numbers are costs without insurance -- insurance coverage of fertility varies wildly. But you also have no idea what of this you'll need until you go to a doctor and find out where you stand on the fertility curve. Some women lose the ability to easily conceive their own children in their mid twenties, some women remain highly fertile into their mid forties. Book your doctor, pee on the stick I linked to above if you want to get some idea of which way the wind is blowing, and good luck to you!
posted by KathrynT at 11:45 AM on February 17 [8 favorites]

The absolute cheapest route from A - Baby is the DIY route: buy ovulation predictor sticks by the 100, figure out when you ovulate, order sperm on the correct schedule, self-inseminate.
posted by DarlingBri at 11:49 AM on February 17 [5 favorites]

This site provides accurate information, but you should of course ask your doctor. If the vasectomy is not reversible, aspiration and IVF is possible but involved, not very reliable, and expensive. Your other options are getting sperm from an anonymous donor (if the 'friend' part is the problem), but it may be worth investigating your own fertility first.
posted by a robot made out of meat at 11:59 AM on February 17 [1 favorite]

Start by seeing a fertility doctor, as others have said. Also, if this was me, I would go for donor sperm upfront, because even if your partner still has viable sperm, you'd be adding the potential complications of advanced paternal age to the potential complications of advanced maternal age, and why go to immense expense and trouble to do that (unless it's important to your partner to have a genetic relationship to your child, of course)?

A fertility doc will be able to give you both informed predictions about your potential fertility.

Best of luck to you.
posted by Sidhedevil at 12:39 PM on February 17 [4 favorites]

You're really, really going to want to check with your insurance. Maternity expenses are frequently covered, but fertility treatments are generally not part of that.

If in the somewhat probable event that you aren't covered, this is going to be expensive. Less than $10,000 is unlikely, and $50,000 is not impossible. And that's just getting to conception. Once you conceive, any maternity benefits you have kick in, though at 38 you're pretty much automatically a high-risk pregnancy (kicks in around age 35), so even that's going to cost you. Call it another $10,000, though your insurance will cover a big chunk of that if you've got maternity benefits.
posted by valkyryn at 3:55 PM on February 17

At 38 your eggs typically have a higher rate of chromosomal abnormality. That doesn't mean yours do, just that their odds are not in your favor. Hence the tests etc proposed above should be your first port of call. Best of luck -- hope that everything works for you. As time goes on, your fertility will of course decrease further so time really is working against you.

If you discover you have fertility issues on your part, egg donation is an option. Expect 20 to 30k for everything -- it's essentially an IVF plus all the donation fees. (Egg donation, like sperm donation of course, shouldn't be taken likely; it has all the ethical complexities of adoption.)

A less obvious, cheaper option is embryo adoption. When a couple performs IVF, often through egg donation, they will freeze any unused embryos. These are sometimes donated to other couples with infertility issues at little cost.
posted by NailsTheCat at 7:09 PM on February 17 [1 favorite]

I also wanted to add a note about the 2nd cheapest route from A - Baby. Chlomid is still the first stop for pregnancy achievement when you climb even gently on the fertility treatment wagon, and your regular GYN/GP may be perfectly willing to prescribe for you. So Chlomid + OP sticks + FedEx sperm + self insemination is still very low cost and basically how every lesbian woman I know over 35 conceives.

FWIW, my mother had my sister at 38 and conceived naturally; my sister had my niece at 40 after one round of IUI and donor sperm. Neither pregnancy was classed as high-risk, both births were vaginal with no interventions, all babies totally healthy. If you have good eggs and no blockage, this is do-able, so you should start with a fertility workup to assess that.
posted by DarlingBri at 8:19 AM on February 18 [1 favorite]

Please do not ask an ob/gyn for Clomid without first finding out your overall fertility situation. Very few ob/gyns can give you a panel that covers AMH, FSH, LH, and estradiol levels, all of which have bearing on what you need to do next, including whether Clomid is a good idea.

PCOS - polycystic ovarian syndrome - is very common among women (as many as 8% have it) and is contradicated big time for Clomid use, due to the risk of ovarian hyperstimulation. A woman with PCOS at age 38 is potentially more fertile than a woman without the condition, since the "polycysts" include lots of antral follicles, which can be stimulated with Clomid or other drugs to release more eggs.

Hyperstimulation makes it impossible for you to ovulate or conceive that month, is painful, causes your ovaries and body to swell with edema, and in rare cases can be fatal.

I am the same age and have the opposite problem to ladies with PCOS - I don't have enough eggs. As I posted elsewhere, the ob/gyn I unfortunately trusted with my fertility issues was ignorant, and it took the better part of three years to get diagnosed. Get an RE. At your age, it's normally suggest you get into a reproductive endocrinologist's office after 6 months, but since your partner is older, with a vasectomy, you might start now.

I think the suggestions of considering donor sperm and donor embryos are also awesome. But, even if you have to pay out of pocket, do get some tests to make sure you're in good shape.
posted by mitschlag at 11:09 AM on February 18

Thanks everyone. All the information is overwhelming but your supportive answers have given me some places to start. My cycle started today so by Wednesday morning I should know if my FSH levels are normal enough to conceive (via the First Response Fertility pee test). I'll make a doctor's appointment with my PCP and go from there. I'm hesitant to follow the path of infertility treatment because I've seen so many women struggle with the emotional impact of it and the side effects. Maybe I'll be one of the lucky ones.
posted by dchrssyr at 1:42 PM on February 18

Wanted to add: I have zero problem with buying sperm. I just don't want the complications of knowing the donor.
posted by dchrssyr at 7:12 PM on February 18