[Editor’s note; In 2009, shortly after marrying her (first and only) husband, Paolo, Elizabeth Heath was diagnosed with premature menopause and resulting infertility. Paolo and Liz are now parents to a baby girl, Naomi. In this series, Liz recounts the couple’s struggle with infertility, and how they finally achieved a successful pregnancy and parenthood.]

By the time Paolo and I were together again, five months had passed. I moved to Italy May 2009, and settled into the often bumpy process of adjusting to a radically different life, all the while planning our wedding, which was set for September. Shortly after I arrived, we had our first visit with an Ob/Gyn in Orvieto, who was known for “getting women pregnant.” (Note: I don’t think this was meant to imply that he personally impregnated lots of women, but in Italy, one never knows.)

Our first pass at pregnancy was a treatment cycle with Clomid, the fertility drug I’d been reluctant to take in the U.S. Clomid acts to stimulate ovulation, and it is almost always the first line of attack when treating infertility. A 5-day cycle of Clomid usually produces one mature egg. A woman doing a Clomid cycle has periodic ultrasounds to monitor the development of the follicle, which contains the growing egg. In some cases, Clomid alone is used, but when there is a concern that the follicle will not release the egg (ovulate) for fertilization, then a “trigger shot” of HCG, or human chorionic gonadotropin in synthetic form is given.

HCG is a hormone normally produced after a fertilized egg has nestled into the uterine lining. It’s the hormone that causes the blue or pink line or plus sign to show up on a positive pregnancy test. When administered artificially, it triggers the follicle to release the mature egg, which will soon be met by an eager sperm. Together, if the mood is right, those two will make a baby.

So, with my baseless optimism still intact at this point, we ran the bases with Clomid. Five days of medication, ultrasound monitoring, a trigger shot of HCG in the butt, then orders from the doctor to wait about 36 hours before having sex (or “having a rapport,” as the Italians like to say).  We did our part, and then waited to see if I got a period. And of course, I did.

Read Related: Facing My Infertility Part 1, Part 2 & Part 3

When we returned to the miracle worker Ob/Gyn, he recommended against another Clomid cycle, as he felt that with my FSH and LSH numbers, it would be an exercise in futility. Then he brought up the inevitable subject that I had been trying not to think about up until now: in vitro fertilization.

Briefly, in vitro fertilization, or IVF, involves the artificial stimulation of the ovaries to produce multiple eggs in a cycle. Those eggs are surgically removed, or “harvested” from the woman, and then put together in a lab (in vitro means in glass in Latin, but in medical terms, means a living organism grown in an artificial, non-organic environment) with the male partner’s or donor’s sperm. Once fertilized, the eggs are transferred into the woman’s uterus, with the hopes that one of them will take. The original “Test Tube Baby,” Louise Brown, born in 1978 in England, was the result of a successful pregnancy with IVF. A most extreme example of IVF (and irresponsible medical practice) is “Octomom” Nadya Suleman, who had eight of her fertilized eggs transferred, and all eight took. So, the process has been around for decades, and is a widely-used treatment for infertility.

I still hated the idea of taking handfuls of drugs and going through such extreme, nonorganic means of becoming pregnant. But as the reality of my barren ovaries became increasingly difficult to ignore, I had to come around to the idea.

The good news was that in Italy, in vitro fertilization is a free service, covered by the national healthcare plan. Free! That’s what a country with 0% population growth is willing to do to make more little Italians. The bad news was that IVF was only free for women aged 41 or younger. Older than that, and the success rates were simply too low to justify the state paying for the treatment. So at 42, I’d missed the cutoff point by a year. Ouch.

Still, IVF treatment in Italy, even when not covered by the health plan, costs a fraction of what it costs in the U.S. And by a fraction, I mean like less about 20% of what it costs in the U.S. The miracle worker Ob/Gyn who determined he could work no miracles on me referred us to an IVF clinic in Chianchiano, a city about 45 minutes from us. There, we soon learned, a cycle of IVF treatment cost 3500 euro, or about $4500—still a lot of money for us, but a bargain compared to U.S. prices.

By now, we were well into August. Paolo and I were already legally married, as we’d had a civil ceremony—required to continue my visa status—on August 1. Our church wedding—the “dog and pony show” as I referred to it then and still do—was set for September 19. So we figured we had some time to get the ball rolling with the IVF clinic. Except, we learned when we called, the lone doctor at the clinic had no room for new appointments in August and was on vacation the entire month of September. The soonest we could see her was early October.

So we waited, and waited some more. All the while, the Florida RE’s warning kept ringing in my ear: Every month that passed was like three or four for my withering ovaries. Tick Tock had never been such a nerve-wracking, heartbreaking sound.