In the 1990s, two teachers wanted children, but struggled to get pregnant.

For seven years they went to a fertility clinic. They elected for in vitro fertilization (IVF). They did the tests, grew eggs, fertilized them, embarked on the procedures, and did the waiting.

They prayed every night, only to hear bad news each time — not pregnant.

They tried again. After another cycle and embryo transfer, the husband was on the phone with his wife where he expected the worse and said, "Not again."

"She said, ‘No, I’m pregnant.’ Finally reaching this destination — pregnancy — they took it as a sign and named their child Hope in 2001. The parents are Minnesota Governor Tim Walz and his wife, Gwen Walz. They had another child in 2006.(Quotes from Star Tribune)

Tim, of course, now, is Vice President Kamala Harris's running mate for the massively important election in November.

It's a relief to see a bit of yourself in a politician.

Almost 20 years after Walz and his wife went through treatment, my spouse and I have gone through three years of fertility treatment ourselves.

At the time of this writing, we are on the road to hopefully our own Hope with a successful second transfer. (Fingers crossed!)

Because of this, I wanted to put together a resource guide for IVF. A set of reading, watching, and listening resources. I also wanted to share this because IVF, along with all reproductive and sexual health, are on the ballot in November.

As current Vice President Harris and Minnesota Governor Walz shared this week in Philly, freedoms are on the line. Freedom to abortion, IVF care, and contraception among the top freedoms that will be under threat for more Americans if Trump and Vance win.

"In Minnesota, we respect our neighbors and the choices they make," Walz told the crowd in Philadelphia. "Even if we wouldn't make the same choice for ourselves, there's a golden rule: mind your own damn business."

The government shouldn't block what a woman can do with her body, or how she decides to create a family.

This is for you all, and any other wannabe parents out there who need or might need IVF care. Especially for those who aren't carrying the baby.

Fast Facts

• IVF care enables people to preserve their sperm, eggs, and embryos (fertilized eggs) to use at a later time. They use cryopreservation technology to make this care a reality.

• Infertility affects millions of people in America, and across the world. To give you an idea, in 2021, 86,146 infants born (or 2.3% of all infants born in the U.S.) were conceived through the use of fertility treatments. See more with the CDC

• The first IVF baby was born in England 1978 — a highly documented event. It's believed there are over 10 million people who have been born through IVF.

• The Economist reports a rise in fertility in older women in the US, even if it has fallen among younger populations. This means more Americans may need to seek fertility treatments such as IVF:

Since the 1990s the fertility rate for those aged between 15 and 19 has fallen by 77%; that for 20- to 24-year olds is down by 48%. Meanwhile, it is slowly increasing for women aged 30 and over. In 1990 teenage pregnancies accounted for one in eight births. By 2022 this had fallen to one in 25.

• Here's a good video from Cleveland Clinic on IVF.

• An introductory resource if you're a same-sex couple seeking fertility treatment.

Notable

Know your letters and definitions

• IVF: in vitro fertilization.

• IUI: intrauterine insemination. This is a procedure sometimes tried before trying IVF. Or, if you're my cowboy dad, in ranching and cowboying, this is called A.I., artificial insemination. When we first said we were trying IUI before IVF, he said, "Oh like AI." Which made me, a remote worker and reader of tech news, think Artificial Intelligence. Know your audience when throwing these letters around.

• Progesterone: progesterone is a hormone that supports menstruation and helps maintain the early stages of a pregnancy. Too little progesterone can cause complications with pregnancy. It's administered through daily shots — with slightly long needles — or through vaginal suppositories.

Cost

IVF isn't cheap. It costs thousands of dollars, and many insurance plans won't cover it. It can cost anywhere between 25K to 80K depending on how many times you need to retrieve eggs, fertilize embryos, store embryos, and embryo transfers.

If you don't have the money, opening a credit card that has a delayed interest (for say 12 months or 18 months) and saving money during that time might be a good option.

Here is a list of states that offer coverage for fertility treatment.

If you struggle to pay out-of-pocket, here is a list of grants and scholarships.

It takes two...sort of

If you're providing the sperm for IVF, the biggest thing you have to do is have an orgasm at a clinic, which is to say not much. My experience included a white noise machine with screaming seagulls and rolling ocean as the default sound (I couldn't change the sound for some reason). An awkward-feeling pad to separate your body from the default chair with a slight leaned backrest. The room had a sink, and cozy, soft lighting, along with a giant poster paper with the WiFi code in black letters.

You're given a cup and time. When finished, you mark the time, sign, confirm, and deliver.

As strange as this is, it's not difficult compared to the person with the uterus, or the person who is electing to carry the baby. Having an orgasm and sending the cup of your sample to the professionals afterwards is not hard compared to the person who has to watch their ovulation and cycle like a hawk, or take dozens of shots of progesterone.

It's not hard compared to the person who has to go under anesthesia for procedures. The person who has to transform their body and grow a human baby, and then give birth, and nurse that baby for six months.

As the spouse not carrying the baby, I suggest go into support mode:

• Cook, clean, improve the house, do the chores and errands. Take on as much of this load as you can.

• Share the emotional burden. Ask questions, read what's going on with your partner/spouse/significant other. If you don't know, learn about menstruation and ovulation cycles. Start to learn about the birthing process, and taking care of a newborn.

• Help build the baby registry. I should have done more of this early on.

• When it comes to IVF, there are many mini journeys. Pregnancy isn't the end, but when you're in the thick of fertility care, it can feel like the only goal. Each week feels like a milestone. Take every part of this — from first consultation to bringing the baby home — week to week.

Endometriosis

Definition: Endometriosis (also known as Endo) is a painful chronic disease where the cells that make up the inner wall of the uterus grow outside of the uterus. Endo can make it hard to get pregnant, and be a reason lots of people can't have a baby without fertility treatment.

With endo, cells grow where they aren't supposed to. Like bits of peanut butter from the inner realm of a Reese's Cup growing on the outside of the chocolate after it's made.

Uterus tissue can grow in different parts of the pelvis, and in some cases on other organs from the bladder, lungs, and even the brain.

These growths can pull and tug the uterus into different directions, and usually cause ultra pain — on top of the regular pain that comes from a period.

The rogue uterus cells, the endo, can make it hard for sperm to meet the egg. Essentially, instead of a 6-lane well funded highway of a non-endo effected uterus, you can get a more windy, two-lane mountain pass at night in a snow storm. This makes it hard for the swimmers (the sperm) to reach their destination.

And, possibly, endo might have a hand in destroying an impregnated egg that's on its way to implanting on the uterus, where of course the impregnated egg straps in for the 9 month ride to create a tiny baby.

It's not really known how endo might do this. Do the extra uterus cells crash in on the inner uterus wall? Do the cells attack a fertilized egg? All unknown.

For context, about 10% of women worldwide have endo, according to the World Health Organization. Many don't know they have it until they hit fertility problems, or experience loads of pain.

• Here's a great video from SciShow that explains Endo.

Politics

• Stat news does excellent reporting on fertility.

• The Republican Party has endorsed a platform that endorses fetal personhood. Republicans have endorsed IVF (many have used IVF care, hello Mike Pence), but to extend human rights to an embryo would create conflict with administrating proficient IVF care.

The Republican Party wants to do this by extending the 14th amendment, and giving states the ability to extend personhood to embryos and fetuses. See page 15, graph 5 of this 16 page document approved before the Republican Convention in July, and circulated among the Trump campaign.

Advocate to project the right to sensible IVF care, and the right for an abortion.

• Resolve is an excellent advocacy group for those facing infertility. They are politically active and push for laws that protect IVF care. Search their site if you need them. They helped push laws in Alabama and worked with us when the Alabama Supreme Court temporarily shut down our clinic's ability to give care.

• Why LGBTQ people deserve excellent reproductive and sexual care.

• My spouse Megan was interviewed for the New York Times back in February. Her quote says it best:

“But having three embryos in the freezer is not the same to me as having one that implants and become a pregnancy, and it’s not the same as having a child. We have three embryos. We don’t have three children.”

Final Thoughts

The Mental load

Three years is hard. Seven years is hard. Years of trying. Paying for treatment is hard. Hoping for one future, and getting another is hard.

I'd say the best advice is staying in the moment, taking one week at a time. And don't be afraid to say nothing to family and friends. Let them know you'll have an update when you have an update.

If aunt Tilly keeps asking, stand up for yourself and say you are uncomfortable being asked so often. Advocate for your needs. It's exhausting to constantly to have this question buzzing around you: is it working, are you pregnant? Build boundaries.

Saying no, or "thanks for your thoughts, but we aren't giving any updates until we have one" is one step for helping yourself.

You don't owe your network news.

Professor Emily Oster's advice is also good: Despite all the care and thought you put into creating and caring for a new person, don't forget you're a person too. It's okay to take care of yourself. Rest, buy an ice cream, workout, watch a movie. Remember you're a person, too.

The rest of the library

• From Serial productions, a narrative podcast about fertility, The Retrievals. (Maybe best listened too after the experience)

• 15 good fertility podcasts.

• Lucy Jones wrote an excellent book on how pregnancy transforms your body. Here is a great review.

• For expecting dads, if you need something, The Expectant Father is something. We need a bit of an update with the expectant literature.

• How climate change will affect fertility treatments.

• The future of fertility and another article on Silicon Valley's role in making the super baby.