When I first began my own fertility journey, I went in bright eyed and optimistic, excited at the prospect of having a baby. My health insurance at the time was one I had obtained through the NY health exchange. As a hairstylist, I am not entitled to corporate healthcare, and therefore have always paid out of pocket for my insurance. First, I had to find a fertility doctor that took my insurance. Secondly, I had to get a referral. After my consultation with the doctor, I was immediately directed to the billing department. There was a snafu with my insurance, and I needed to call and get it handled. The first person I spoke to was very matter of fact when he said, “Ah yes, fertility services such as an insemination are not covered until your doctor can prove that you have been trying on your own for six months with no success.” Had I been familiar with feminist philosopher Christine Overall at the time, I might’ve argued for my positive right to reproduce, and that in New York City, I should have “access to a variety of treatments intended to support pregnancy and birth and to enhance, repair, or restore fertility” and nor should my access to these services be denied based on social identity characteristics such as sexual orientation (Overall 27). Instead, I coolly asked the man, “And how would you like me to try “on my own at home”, sir, when I am dating a woman?” After a pause and a grunt from the flustered man, I asked to be transferred to a superior. The superior, perhaps a bit more understanding but not remarkably helpful, informed me that she did not have a protocol in place for same sex couples in regard to the “six month rule”. She offered to extend the coverage and waive the rule in what I am sure she thought was a gracious manner. Meanwhile, she did not address the lack of protocol for same sex couples, even though I was surely not the first person to hit this roadblock. Yes, I appreciated that her actions allowed me to pursue fertility services, but I still don’t know why that should be considered a favor instead of just my right as a policyholder.  

Throughout my years in fertility I have been at the mercy of my doctors and my health insurance companies. After all, health insurance corporations are the ones deciding what medical care is considered appropriate, and what is worth covering. In the year that it took me to get pregnant the first time around (via intrauterine insemination), I engaged in countless phone calls with the insurance company over what was and wasn’t covered, the surprise bills that showed up in my mailbox, and the difference between medications that were only sometimes permitted. There was the person who could not explain why sperm washing was not covered, even though it is impossible to do an IUI (a service that is covered) without first washing the sperm. Over and over I complained that the insurance company’s lack of consistent answers was stressing me out, the one thing the doctors reiterated would stifle my chances of success. The insurance agents would apologize, then usually transfer me to someone else. 

After my wife and I got married, and after we had our child, we moved onto her corporate insurance provided through her job. This was a massive step up and it alleviated a lot of stress. Finally, we had a company that approved procedures with no back and forth. Finally, we had a company that covered our medication. We no longer receive surprise bills in the mail, or if we do, they are sporadic and easy to adjust. In January of 2020, New York enacted its mandatory IVF coverage for patients under corporate insurance. IVF, or in vitro fertilization, falls under ART and is a complicated and multiple step process. When New York implemented the new law, I immediately switched from undergoing IUIs to IVF. After all, it has a much higher success rate. On the second day of my cycle, I went in for bloodwork and an ultrasound. That evening, I started my first round of injections, two shots to start. Some women choose to have their partner hold the needle and inject the medicine, but I found it easier to just do it myself. Every night, two to three injections, and after a few days, I started morning shots, as well. First thing every morning, I went to the doctor to get an ultrasound and a blood test. They do this to monitor the size of the follicles and calculate ovulation. The goal is to grow as many follicles at once, that are able to achieve the right size and maturation, before retrieving those follicles prior to ovulation, which is done under anesthesia. After the retrieval, the eggs are inseminated and then we wait six days to see which eggs made it to the blastocyst stage, which is the stage right before an inseminated egg turns into an embryo. After this stage, some doctors recommend getting the blastocyst biopsied so that it can be genetically tested before a transfer. Other doctors recommend going straight to a transfer, which involves using a catheter to insert one (or two) blastocysts into the uterus with the hope that it will attach and turn into a full fledged embryo, then fetus. Compared to IUI and ICI, going the IVF route involves anesthesia, more injections, more appointments, is more invasive and, this goes without saying, more expensive. And though the success rates are higher when choosing IVF, there is still not a guarantee you will get pregnant. Did I mention that every single person will advise you to lower your stress levels if trying to get pregnant?