5 questions to ask when you're considering infertility treatment

I was a healthy, athletic 34-year-old woman when my husband and I began trying to get pregnant. I never thought for a second I would have problems getting pregnant. Every month when I got my period, I felt confused and heartbroken.

Infertility is a struggle, and it was the biggest challenge I ever faced. Here was something I had little control over and couldn't just work harder to overcome. What I could do was seek help from medical professionals, and that made all the difference.

Experts say women under 35 who are trying to get pregnant should seek help after about a year of trying with no results. Women over 35 are encouraged to seek help after six months. Talk to your doctor before trying to get pregnant if you don’t have a male partner, have a condition like endometriosis or pelvic inflammatory disease (PID), or even irregular periods.

If you're ready to seek medical help on your journey to becoming a parent, it’s a good idea to do your research. Look into the fertility options available to you, and discover which are covered by your health insurance plan. Here are five good questions to ask:

1. Does my health insurance plan cover fertility treatments?

Maternity and newborn care are considered essential benefits under most health plans, but infertility care often is not. Coverage runs the gamut: Some insurance plans cover in vitro fertilization (IVF) but not the accompanying injections that women may also require. Other plans cover both. Some plans cover limited attempts at certain treatments. And some plans do not cover IVF at all.

Men will want to check what their plan covers for semen analysis and male infertility care. Remember that “infertility is a couple’s disease,” says Joanne Armstrong, MD, senior medical director and head of Aetna’s Women’s Health. "There are risk factors that involve the female and the male, so make sure both partners are evaluated."

If you have a choice of health care plans, you'll want to pick one that offers as much coverage as possible. But here’s an important caveat: Just because a doctor tells you that you are a candidate for infertility care doesn’t mean you will automatically be eligible for services covered by your plan. Aetna members can learn more by checking out its Infertility Treatment FAQs.

2. Where do I begin if I want to discuss infertility treatment options?

Your first stop should be your Ob/Gyn's office. He or she can order diagnostic tests to measure hormone levels and analyze semen for male partners. These steps will determine what medical problems, if any, are hindering your attempts to get pregnant. Your gynecologist can also advise you how to best time intercourse during ovulation and, if necessary, can prescribe ovulation-stimulating drugs.

You’ll want to start with the least invasive methods, which are often what an Ob/Gyn offers. A gynecologist tends to be less expensive than an infertility specialist. Depending on your insurance plan, you may find yourself paying less out of pocket as well. Also be sure to check that your plan covers the particular medication your physician prescribes. Some plans cover one type of ovulation medication but not another. If your medication is not covered, ask your physician about switching.

Men with abnormal semen results are often referred to a urologist. The urologist may prescribe medication or suggest surgical solutions, depending on the diagnosis.

3. How do I choose an infertility specialist?

If the efforts of your Ob/Gyn or urologist aren’t successful, your next step is to find an infertility specialist, also known as a reproductive endocrinologist. Typically, your gynecologist will point you in the right direction. My husband and I considered two local specialists. After talking with both on the phone, we felt we had more of an immediate connection with one over the other. If you're not satisfied with your Ob/Gyn's recommendations, you can check out Fertility IQ, a database with patient reviews of infertility doctors.

You'll also want to make sure your doctor is in your insurance plan's network. Aetna members may find in-network reproductive endocrinologists through the DocFind online provider directory, for example. Aetna also maintains an Institutes of Excellence infertility network, a select group of facilities providing high-quality, high-value infertility care.

Your plan may have additional services and certification requirements for those seeking infertility care. Before undergoing infertility treatment, Aetna encourages members to register with its National Infertility Unit. The NFU issues authorizations for treatments such as injectable drugs, IVF, and preimplantation genetic diagnostic or PGD testing. (PGD is used to test embryos for specific chromosomal or genetic disorders that you or your partner may transfer to the embryo.) Members can also call the unit to ask questions about infertility care and coverage.

4. How many cycles of infertility treatment will be covered?

My husband and I first tried intrauterine insemination (IUI) before moving on to in vitro fertilization (IVF) and frozen embryo transfers (FET). In an IUI procedure, doctors inject sperm into the uterus with a catheter. With IVF, doctors surgically retrieve eggs from the woman, fertilize them with sperm, and transfer the viable embryo(s) back into the woman's uterus. Women can use their own or donor eggs. While there are cases of families getting lucky on the first IUI and/or IVF, don't be discouraged if it doesn't happen for you right out of the gate. It can often take multiple attempts before you get pregnant.

Check to see how many attempts your insurance plan will cover. And be sure to talk to your doctor to create a strategy. “Knowing what insurance benefits you have available to you may be a factor in deciding what treatment to undertake,” Armstrong says. Many doctors will encourage up to six rounds of IUI before starting IVF. Some insurance plans will only cover IVF if you've had a certain number of IUIs.

With IVF, you have to determine how many embryos you want to have implanted at one time. Our fertility specialist believed in transferring only one because complications are more likely to occur with multiples in utero. Insurance companies may have their own policies regarding the preferred number of embryo transfers at one time. Aetna, for example, strongly encourages the use of single embryo transfers when a quality embryo is available. An additional cycle of embryo transfer may be covered if the first cycle fails.

5. What's my coverage for surrogacy and adoption?

If IUI or IVF do not work for you, you may decide to find a surrogate to carry your child, or adopt. If you plan to have a gestational surrogate (a woman who will be implanted with your eggs or a donor's eggs), your insurance may cover the retrieval and fertilization of your eggs. Many plans do not cover services received by the surrogate. (Her out-of-pocket health care costs may also be your responsibility, depending on your surrogacy agreement.)

In my case, I began considering adoption after our first frozen embryo transfer didn't take. That was the route that one of my closest friends followed after her first embryo transfer also proved unsuccessful. Today, she and her husband are the proud, glowing parents of an adorable 4-month-old son. If you choose to adopt, check to see whether your insurance plan or your employer offers reimbursement for adoption expenses. Happily, if you have a Health Savings Account (HSA), adoption costs are an eligible expense.

Fertility treatments can be daunting. But with the right tools and research, growing your family is possible. We ultimately saw success with IVF, which produced four viable embryos. The second embryo transfer resulted in pregnancy — our beautiful baby boy was born in 2016.

We still have two embryos “on ice,” as we like to say, and my mom has appropriately nicknamed them Elsa and Anna. We don't know what will happen when we try to implant them in the future. But we celebrate every day with our son, knowing and appreciating the journey we took to have him.