As a pediatrician, I spent my days (and a lot of nights) caring for other people's children, never dreaming that we would not be able to become parents ourselves. After over a year of trying without success, we consulted with the fertility program where I was doing my residency, went through the initial workup, which labeled us as "unexplained infertility" although my anti-Mullerian hormone (AMH) was quite low indicating a poor ovarian reserve.
It was suggested that we try three rounds of Clomid with an intrauterine insemination (IUI), which we did—all unsuccessful. At the time, the next logical step was in vitro fertilization (IVF) but we decided to put those plans on hold and adopt internationally. That process took about 2 years but after many ups and downs we were able to bring our beloved daughter home from Russia, and we settled into being parents. A few years later, we wanted to expand our family a second time and weighed the options of IVF versus adopting again. During these years we had still been trying on our own to get pregnant and every month when it didn't happen felt like a failure.
Having successfully navigated adoption before, we decided to try and adopt domestically; however; we had two failed adoptions and switched gears to IVF.....a path that would give us a sense of control again. We had several friends who had successfully had babies with SGF and when we met with Dr. Greenhouse, I felt completely comfortable giving him full control of this process (something that isn't easy as a physician!). We underwent a full evaluation once again since it had been so long since our initial workup and the results confirmed what had been found previously—unexplained infertility, so everything on paper looks like it should work.
Dr. Greenhouse recommended that we proceed with IVF. During the first round stimulation process, it became obvious that I was a poor responder and didn't have very many follicles to retrieve. Dr. Greenhouse kept my spirits up by reminding me that it "Only takes one!" and also that quality is much more important than quantity when you are talking about eggs and embryos. By Day 5 post-retrieval and fertilization, only three embryos had survived but all looked like good quality embryos. We proceeded to transfer one fresh embryo and to freeze the other two.
The Ups and Downs of Treatment
Oh joy....we were pregnant! I allowed myself to believe that finally after a total of 9 years I was going to have the experience that all of my patients' parents have had! The first ultrasound looked good....it confirmed an intrauterine pregnancy and we felt a sigh of relief. The next ultrasound showed a yolk sac but no fetus but we held onto hope that perhaps the fetus was just a slow grower. The following week confirmed what I had feared.....we had a blighted ovum and would miscarry. I consulted with my OB/GYN and I opted to go ahead and proceed with a dilation and curettage (D&C) in the OR so that I could maintain control, reduce the risk of hemorrhage at home, and to quite simply, move on to the next step. We were devastated. I had been through a lot of difficulties in my life, but to be honest this was one of the hardest things to endure, mostly because I had allowed myself to be happy and to feel relief seeing the positive pregnancy test for the first time in my life.
The next day after the D&C we met with Dr. Greenhouse. I wanted to have a plan that would minimize the risk of a repeat blighted ovum as much as possible. My OB/GYN had drawn labs to work me up for a potential clotting disorder, which could have contributed to the miscarriage, and she had also sent fetal tissue for genetic testing. Dr. Greenhouse presented us with several options and we decided to try one more round of stimulation, to freeze the new embryo(s), and send all of our frozen embryos for genetic testing. I didn't want to transfer an embryo that genetically didn't have a chance of surviving and being healthy. In the meantime, my clotting workup showed that I had a low protein S level, which didn't contribute to this miscarriage, but could in theory contribute to fertility issues. The genetic testing from the miscarried fetus showed trisomy 2, which is incompatible with life....on one hand I was relieved to know that this is a random event and I hadn't "done" anything to cause the miscarriage, but I was also concerned about what this meant for our other embryos.
In the end, this pushed me to definitely want to proceed with genetic testing of all of our embryos in order to select one with the correct number of chromosomes. Our second round of stimulation produced only one embryo so our total of three (two from the first cycle, one from the second) were sent for genetic testing. Only one embryo was found to have the correct number of chromosomes so our choice was an easy one......to transfer this one embryo during a frozen embryo transfer cycle. Our transfer was January 21, 2015, and we were so fortunate to have Dr. Greenhouse perform the transfer (he is our good luck charm!) and success!!!!!
This time around, getting the positive pregnancy test was a happy moment but I did not fully allow myself to believe it until we saw a growing fetus with a strong heartbeat. Honestly, all throughout the pregnancy I held my breath, not really allowing myself to relax until I held him in our arms. I had been started on Lovenox (a blood thinner) at the time of the positive pregnancy test due to the Protein S deficiency but ended up stopping it due to first trimester bleeding. Dr. Greenhouse referred me to an outstanding hematologist who followed me throughout my entire pregnancy. In the end, I never did have to go back on Lovenox and did not have any further bleeding events during the pregnancy. As I type this, baby Jack is 4 months old and asleep in his swing. I thank God every day for our beautiful daughter Sophia and for our amazing Jack—both miracles in their own ways.
Our Journey at SGF
I am a tough patient and a worrier by nature, and Dr. Greenhouse and every single person at SGF helped walk us through this process. The level of individualized care we received was unparalleled. During my darkest moments, it was Dr. Greenhouse's reassurance that got me through. His mantra of "it only takes one" could not have been more true, and we are forever grateful to him and to the entire SGF team. I would tell anyone considering fertility treatments to put one foot in front of the other, which I know some days is hard, and to trust in the experience of the doctors who do this every single day. I would also try and take one step at a time. It is so hard not to get ahead of yourself in this process, and I caused myself a lot of unnecessary stress in hindsight. After a total of 10 years, Ed and I finally have our family of 4, and two of the most amazing kids I've ever known.....and for this we are eternally grateful.