How’d We End Up Here: Part II (AKA The Very Long Version)

9 May

As I mentioned earlier this week a couple of weeks ago now, it’s NIAW. So in honor of that I’m going to share the very long version of our struggles(and I don’t say very long for no reason… this is a warning, you should probably go to the bathroom before you start reading this!). I know a lot of people don’t really know or understand what it means to struggle with infertility, so I hope this brings some awareness to the whole process.

I vividly remember the day I called to set up an appointment with an ob/gyn to try to figure out what was going on. The work up for infertility is pretty standard so I knew what was coming but I was so nervous, and honestly a little embarrassed! I was 27 years old, this whole baby making thing was supposed to be easy! Of course, I’m a well-educated healthcare professional so I know the fears and embarrassment were silly but they were definitely real.

After all the tests (thyroid, prolactin, hormone levels, semen analysis) came back normal I was given the go ahead to start clomiphene, a medication that is designed to help improve ovulation. The hope was that this would help me ovulate more than 1 egg each cycle, which would in essence up the odds of conception.  The odds may have been upped, but I did not get pregnant.

We tried clomiphene for 3 or 4 months (I honestly can’t remember anymore!) before my doctor ordered a hysterosalpingogram (HSG), and all I have to say about that is OW! (OK, I’ll say a little more – this is a test to help visualize the uterus to see if there are any abnormalities in the shape; it’s also a test to check if your Fallopian tubes are clear). You can read more about it here. Everything checked out here too, so we were referred to a reproductive endocrinologist (RE).

Our RE was a gem and we could not have gotten luckier with a more compassionate, smart, kind doctor. She was completely empathetic with our struggles. At this point we were nearly 2 years in to our journey to grow our family and so far no pregnancies or any answers why. So, she ordered one more test: an AMH, to check my ovarian reserve – essentially to see how many eggs were left in the bank. It came back great! So what was the problem? Good question! We were “diagnosed” with “unexplained infertility,” which basically means that science is not smart enough to tell us what is wrong with you. This diagnosis was particularly frustrating for us to hear (although I say this not knowing how I’d feel with a different diagnosis), but hearing that everything is “normal” was definitely bittersweet. How do you begin to fix a problem when you don’t know what the problem is?

All you can do is try things you’ve not tried yet. So, I was switched to letrozole (a breast cancer drug that works a lot like clomiphene and has fewer side effects) and we decided to also add intrauterine insemination (IUI). We used a medication called ovidrel to force ovulation when the time was right. This helped make sure we did the IUI at the perfect time. The first 2 were textbook but I still did not get pregnant. On our 3rd try we added another ovary stimulating medication called follistim. I was able to produce 5 mature eggs, but not one of them stuck around to make a baby. Now what?

When our IUI’s started, we began the adoption discussion. We knew that if the IUI’s weren’t working that IVF would be the next (and last) logical step. Did we want to do that? Could we do that? Will it work? Could we afford that? Unfortunately infertility is a medical condition that often does not have any insurance coverage. In our case, some of the labs and some of the meds were covered (up to a lifetime max), but none of the procedures were. IVF certainly would not be and it is expensive. So, how did we feel about adoption? Could we handle that? How long would we wait? Could it be years? Could we afford it? (See more of my thoughts on this here.) We were given 60-70% odds that IVF would work, had total control of the process, it turned out to be less expensive than adoption, and we didn’t want to wonder what if, so we had to give it a shot, right?!

In November of 2013, we began the grueling process of IVF. It involved a lot of injections (1 every morning to make sure I didn’t ovulate early and 1 every night to make lots of beautiful eggs), a lot of ultrasounds (every few days to check on how my eggs were growing) and a lot of blood work (to check hormone levels and help adjust medication doses).

It also involved a lot of other needles as I made the leap to Chinese medicine and acupuncture. Why acupuncture you might be asking? There is actually a decent amount of research to support its use with IVF and fertility issues. So I figured, why not give it a shot? Once a week, I left work a little early to see my acupuncturist. I must admit, it was a little weird at first, but it was my 1 hour of guaranteed zen. It was amazing and I grew to love it.

About 10 days into the IVF cycle everything was looking perfect, everything except one of my hormone levels. My progesterone was too high and this just meant another setback. Although I was told it was common in women who were younger or those who produced a lot of eggs, it was definitely frustrating. Any embryos that we had after 5 days in the incubator would need to be frozen and transferred in a new cycle. So we went ahead and scheduled our “egg retrieval” (the day they take a long needle and suck all the mature eggs out of your ovary using an ultrasound to guide them… thank goodness for conscious sedation – I don’t remember a thing!) and got daily updates on our “embabies.” We were lucky enough to have 3 beautiful looking embryos transferred to the freezer 5 days later.

December 2013. This was the month that would make me a mom, or so I thought. I had no idea the type of grief and sadness that would find me shortly thereafter. The plan was to transfer 2 of our 3 embryos after taking enough medications to build up a nice uterine lining for them to hang out in for 9 months. So, on December 26 I went in for a simple procedure called an embryo transfer. But 10 days later, I got to kick-off 2014 with a phone call from my RE and a “I’m so sorry, you’re not pregnant.” What the heck?!? (or something a little less appropriate for print), followed by a lot of tears.

We tried another transfer a few months later, but my lining wasn’t cooperating. Cue the order for another procedure. This time it was a hysteroscopy – where they put a camera inside your uterus to get a better look. They can also remove any small polyps or other “things” that could be in the way. I had a small bit of “tissue” removed but it was unlikely causing any problems. One month later, our final embaby was transferred back home. This transfer involved a few more medications (extra steroids in case my body was producing some immune response against the embryo preventing it from implanting, and PIO – progesterone injections that involve a very long, thick needle going into your muscle – Mike was an excellent nurse administering these morning and night!). As you can probably guess, we weren’t successful this time either.

When we sat down with our RE for the WTF appointment (yes, it’s actually called that!), she had no words and couldn’t explain why things didn’t work. The month we went through IVF could’ve just been an “off month” for my eggs and she encouraged us to consider another IVF cycle to see if we got different results (what an expensive gamble!). We were also given the name of an immune doctor in Chicago who specialized in recurrent miscarriages (not us) or unexplained infertility (us!). We were also told it may be time to consider donor eggs (say what?! I was only 28!!) or donor embryos.

The wait was about 3 months for an appointment with the immune doctor so we decided to focus on TCM (traditional Chinese medicine) for the time being (Note: We later found out that immune doctor appt would cost a minimum of $5-8K out of pocket so quickly canceled that!) Mike started joining me for my weekly acupuncture sessions. We both started taking Chinese herbs (and lots of them!) and adjusting our diet based on TCM principles. Six or seven weeks later we got a positive pregnancy test for the first time ever. Nearly 3 years after the start of our journey.

Shocked was not even close to how we were feeling and in all honesty I’m not sure I could adequately put in to words exactly what was running through my mind! When we found out my OB didn’t even want to see us until 10 weeks along, we quickly called our RE to see if they’d see us sooner. I needed proof that this was really happening. We got a blood test a few days later that definitely confirmed the pregnancy and got set up for an ultrasound at 7 weeks! About a week later (a Friday), I was in the OB’s office for an early ultrasound due to some light spotting. There was nothing on the ultrasound to confirm the pregnancy so we did repeat labs. It was possible it was just too early to see anything or that I was miscarrying and there was nothing to see. However, the lab results showed my hormone levels were rising as expected so I was called in that same day to get another ultrasound with better equipment. Still nothing visible. Now the concern for an ectopic pregnancy was raised… but it was still possible it was just too early. I was given education on what I’d notice if it was an ectopic and what to do in certain instances and was told my OB would call me on Monday. Um, have a nice weekend?

What a grueling and depressing weekend. We were supposed to go away, but the fear of the unknown kept us home. I spent a lot of time researching ectopic pregnancies and reached out to my RE for advice. Come Monday morning, I was called in for another ultrasound and more blood work. Hormones were still rising but the ultrasound showed nothing. No where did they see anything. No sign of an ectopic, but no sign of a normal uterine pregnancy either. It was recommended that I get methotrexate, an injection to terminate the pregnancy. If it was ectopic, it did not seem to be resolving on it’s own and methotrexate does not work well once hormone levels reach a certain point (and I was getting pretty close). And if it was not ectopic, it did not seem to be a viable pregnancy as something should have showed up on the ultrasound by now. Agreeing to this injection was one of the most difficult decisions I think I’ve ever had to make. How do you give up on something you worked so hard for and wanted for so long when you don’t even know if that’s the right decision? It was impossible. I put a lot of faith in my doctor that day.

So on July 1, 2014 I got my first methotrexate injection. Labs are required each week to make sure that the the medication is doing it’s job. Unfortunately, the first injection didn’t work as intended (this happens in 20% of ectopic pregnancies) so I had to get another dose the next week. Three days later I was in the emergency room with abdominal pain. It was pretty mild, but I had a gut feeling something wasn’t right. I’m not sure the ED doc was convinced there was anything wrong but after several hours, they finally ordered an ultrasound. Sure enough my tube had ruptured and I was bleeding internally. This time, they were able to find our baby – the little heart beating away in my ruptured Fallopian tube. I went back for surgery at 3AM that day completely and utterly devastated that the world would be so cruel.


As expected the emotional recovery was long and challenging. We took several months off to heal. But as heartbroken as we were, we were hopeful. For the first time in a long time we felt like we might beat this infertility bug. We tried for a few months with the help of TCM (herbs and acupuncture) but with the loss of my Fallopian tube we thought western medicine might be helpful too. So I went back on meds to stimulate my ovaries and we had ultrasounds to check to make sure the good ovary (the one that still had a Fallopian tube) was at bat. After a few months of this our drug coverage ran out and we chose to stop treatment.

When we made the decision to start trying to conceive, we never imagined we’d be here nearly 5 years later still waiting. When we started fertility medications, we never imagined we wouldn’t get pregnant. We had no idea the pain we’d go through when we lost our first baby. Yet, here we are, trying our hardest to stay hopeful that someway, somehow we will find our happy ending that we’ve been longing for.

As I write this, I can say that I am so incredibly grateful for the person I’ve become, the person I would not be if it were not for all of the struggles, the tears, the heartache. I have so much more compassion and have definitely taken this saying to heart:

"Be kind, for everyone you meet is fighting a battle you know nothing about.":



I am so appreciative for what I have learned along the way, and I know I will be grateful for all these challenges that will help me appreciate motherhood just a little bit more.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: