BELLEVUE, Wash. — Infertility in the United States is common.
According to the Centers for Disease Control (CDC), among married women ages 15 to 49 with no prior births - about 1 in 5 are unable to get pregnant after one year of trying. That's about 19 percent of women and does not include men, who also face forms of infertility disease.
Jessica McCabe is among more than 200,000 Washingtonians who have an infertility disease.
McCabe was 39 when she was working on her book. The well-known ADHD advocate, speaker, and YouTube personality was also trying to focus on her future family.
"I knew about egg freezing in my 20s but I just couldn't afford it," McCabe said. "I knew it would have been a good idea, but I just, I couldn't. You know, it's another area where if it had been covered by insurance - the story would have been a little different."
More than 20 states - plus Washington D.C. - have passed infertility insurance coverage laws. Washington State is not among them.
At the county level - King County has provided its employees with infertility insurance coverage for at least 20 years, including IVF.
According to King County's Human Resources Department - the county’s medical insurance plans are comprehensive and offer coverage for infertility treatments. Each plan varies slightly.
Two procedures commonly used to help couples who need fertility assistance include IVF and IUI. Through in-vitro fertilization - eggs are surgically removed using a needle that goes through the back of the vagina. Those eggs are then fertilized outside of the body. IUI is an intrauterine insemination where sperm is placed directly into the uterus using a speculum.
The night before McCabe and her partner Raffael Boccamazzo sat down with KING 5 to talk about their infertility journey and how it impacted their family planning - they got engaged.
"It was a spontaneous thing," Boccamazzo said. "We did things out of order."
The West Seattle couple emphasized the importance of doing what's best for your own family and there is not a family plan that works for everyone.
They are now the parents of a nearly three-month-old baby girl. For now, her parents have chosen to keep her name and photos of her face private.
Their baby girl was born on Feb. 29 after McCabe underwent a C-section. Her parents chose that date among the three recommended days because of how special it was to conceive her.
A look back on the journey
Once McCabe said there were several unexpected barriers when she was finally able to start her "journey" to becoming a mother.
"When I first started, I thought I had options, right? I thought, OK, I can just freeze my eggs, get that over with - knock that out really quickly, so that I can write my book," McCabe said. "And I found out that I had fewer options than I expected.
Part of her exam included checking her AMH (Anti-Mullerian hormone) levels. She was informed those levels were lower than expected for a woman her age.
Her outlook on preserving eggs or embryos changed.
"It's probably going to take a couple rounds for this to work and then I did the process and my body didn't respond as well to the medications as they expected," McCabe said. "I got way fewer eggs than we expected which, you know, narrowed our options."
According to the Mayo Clinic - three days after fertilization, a healthy embryo will contain about 6 to 10 cells. By the fifth or sixth day, the fertilized egg is known as a blastocyst — a rapidly dividing ball of cells. The inner group of cells will become the embryo. The outer group will become the cells that nourish and protect it.
McCabe and Boccamazzo's first round of embryos did not make it to blastocyst.
The list of options dwindled again.
With a described "ticking clock" and expensive infertility treatments - the couple felt like they were not able to fully choose what would happen next.
"We either don't get to keep these at all, or we're transferring [all three of them] them now," and There were three of them," McCabe said. "We knew that there wasn't a high chance but I didn't really have a choice. I had to try."
As they continued to try and conceive - they found Dr. Kat Lin, the medical director for Reproductive Medicine Associates. In the past few weeks - the Seattle clinic opened its second location in Bellevue to keep up with what they say is a growing demand for infertility treatment and fertility preservation.
"When we found Dr. Lin, it was really hopeful because it felt like we were given back the choice to have our own family with my own eggs," Dr. Lin said. "She was really optimistic about my odds and she was doing some really cutting-edge stuff.
At the same time, McCabe and Boccamazzo were moving and undergoing a lot of stress. McCabe also described smoky air conditions across Western Washington, which she believes may have negatively impacted how this new round of treatment went.
The hopeful couple reached a crossroads due to treatments costs which were not covered by their health insurance.
At this time - they would have to choose between an IUI cycle or moving forward with donor eggs to conceive.
"When we looked at how much it would cost to do another round and how much it would cost to do donor eggs, if that's what we ended up needing to do, we realized, we couldn't afford both," McCabe said. "It was either take another chance with this amazing doctor where it could work but there was no guarantee. Or go to donor eggs? It felt like the choice was taken away there too, and it was really heartbreaking, especially looking back on it now."
With support from her partner and her doctor - the plan shifted to selecting an egg donor.
The couple took their time to find the right donor, which they said they ultimately did.
“There's so many factors involved and so many variables, so many things that could go wrong...health related, physically financially, you know age, there's so many things," Boccamazzo said.
Leaning on each other throughout the entire process was important to these new parents.
Boccamazzo said he was as much involved with options and discussions as McCabe thanks to Dr. Lin's approach.
Looking back, Boccamazzo said he hopes support expands for fathers throughout an infertility treatment process and postpartum.
"Family is what you make of it," Boccamazzo said. "We have this. We so often have this idea that family is two parents and the genetically related child, but your family really is what we make of it."
While Boccamazzo said it would have been "heartbreaking" if they did not end up having a kid because of their desire to do so - there would always be something that was special.
"We were still a family," Boccamazzo said. "Just the two of us. Family doesn't depend on having a child."
Will Washington join other states with infertility insurance laws?
A bill to establish infertility insurance laws in Washington state was introduced for the last legislative session, but it failed to move forward.
That bill was introduced by Rep. Monica Stonier (D-Vancouver).
KING 5 reached out to Rep. Stonier, who said she is in fact planning to introduce a new bill.
"The bill continues to enjoy bipartisan support," Stonier said in a statement to KING 5. "It's a priority for the labor community and employers, and advocates for economic and racial equity. I am looking forward to introducing this bill again in a year when the state may be better equipped to fund it in a form consistent with best practices."
RMA Dr. Lin said she understands the difficult position hopeful parents are put in when it comes to the lack of insurance coverage for many and the out-of-pocket costs. She is hopeful Washington will join other states in establishing infertility insurance laws.
"Think about a treatment that actually has both the ability to treat a disease condition and the ability to prevent that disease condition in the future," Dr. Lin said. "IVF is a perfect tool for that.”