Infertility and Assisted Reproduction
Personal Stories of Infertility and Pregnancy Loss
I was not one of those women who always imagined having children. My husband always told me he wanted children, but I felt more cautious about it. Then at a wedding we saw an old high school friend who was pregnant, and suddenly I knew I wanted children. It was my husband who then needed the convincing!
Six months later, when I was 29, I stopped taking birth control pills, which I had been on since I was 18. I told my husband I wanted to be pregnant by the time I turned 30. I thought this was a reasonable goal, as it was eight months away.
I had started birth control pills because I had had irregular periods, and was diagnosed with Polycystic Ovary Syndrome (PCOS), but never thought to ask at that point whether it could affect my ability to conceive, and 11 years later, I didn't even remember my diagnosis.
Shortly after stopping the pills, I started charting my cycles, to try to pinpoint when I would ovulate. The situation was frustrating because my temperature remained consistently low. I had one round of ovulation, but then by mid-summer I started to spot constantly for weeks on end, so I scheduled an appointment with my OB. He performed an endometrial biopsy to make sure my endometrial lining was healthy, and then an ultrasound which confirmed the likelihood of PCOS. He optimistically recommended Clomid to induce ovulation, along with charting my cycle to time the intercourse correctly. After two unsuccessful rounds of Clomid, during which I didn't ovulate at all, he referred me to a reproductive endocrinologist (RE).
The RE, after a quick consultation, put me on Metformin and determined that more Clomid at a higher dose was the way to go, however even a massive dose failed to make my ovaries ovulate. It did make me weepy and have visual disturbances, so there would be no more Clomid in the future. I visited my family over Christmas feeling sad and confused (not to mention very warm from all of the hot flashes). My 30th birthday had come and gone. Upon returning after the holidays, I was put on a cocktail of injectable drugs for ovulation induction with timed intercourse. The needles and injections were horribly scary, and I felt like the protocol was not explained very well to me. Nevertheless I was thrilled when after only a few days, I was told I had a large enough follicle and should take a trigger shot of HCG to ovulate and then have sex.
About three days after my trigger shot, I noticed that my ovaries were very tender. Over the course of the next few days, nausea, pain, and bloating continued, and I could barely eat. Knowing from my information packet that I could be experiencing ovarian hyperstimulation syndrome (OHSS), I called the clinic to be monitored.
A week after the trigger shot, I had to be hospitalized for OHSS, as my hematocrit level had risen too high. I was sick, shocked, and scared, and found myself having to cancel work meetings, and concerts, as I was not anticipating the cycle turning so brutal. The OHSS was very hard on my body, causing me to gain over 15 pounds of fluid in a matter of days, which put pressure on all of my internal organs. While my OHSS resolved, the cycle was not successful.
Later in the spring, we attempted another ovulation induction cycle, with a slightly lower dose of FSH (follicle stimulating hormone). This cycle came with its own nasty surprise. Halfway through the stimulation phase, the clinic nurse informed me I should convert the cycle to an IVF cycle because I had too many follicles growing at the same rate. We had about 24 hours to decide what to do. The clinic offered a shared-risk program: basically three IVF (in-vitro fertilization) cycles for the price of two, and a substantial portion of the money back if you were not pregnant after 3 cycles. The catches were if you got pregnant after the first IVF cycle, you still paid the whole amount, and by agreeing, you became locked into doing your cycles with the clinic.
My husband and I decided to try the program, since we did not have insurance coverage for treatment. It locked us into what turned out to be a devastating two more years of cycles, during which I got OHSS badly enough to be hospitalized two more times, and only achieved a chemical pregnancy. My RE turned out to be rigid about medication, despite the fact that my body clearly over-responded. Scheduling was a nightmare, as communication was poor, so I found myself unable to plan vacations or participate in as many activities as I would like.
The RE was aggressive about transferring multiple embryos each cycle, which made me very nervous about multiple pregnancies. For our final IVF cycle, we decided to try growing the embryos to the blastocyst stage. While my body produced 46 eggs and 30 embryos, they clearly were of poor quality. A severe case of OHSS prevented me from having a transfer at all, and only 7 embryos were frozen. We performed two frozen embryo transfer cycles with these embryos, but only 4 survived the thaw and none implanted. It was now fall 2007. While I got my refund check for part of the cost of the cycles, I felt like I had been through two years of hell with the clinic. Both my husband and I were seeing therapists, and my husband was taking anti-anxiety medication.
We decided we needed a break and time to explore other options. We had started to examine adoption as an alternative, but I felt concerned about issues with both foreign and domestic adoption, and wanted to wait some more. So we spent a couple of months, through Christmas, trying to regain some footing on our life.
After Christmas, three years from when I first stopped taking birth control, I decided I wanted a second opinion. While we agreed we would not do any more IVF, there were still a few more treatment options. I got a recommendation from a friend for a different RE. Their clinic took a much more personal approach, and tested me carefully to see how the PCOS might be affecting my body. As I was not insulin-resistant, I stopped taking Metformin. We decided to try ovulation induction with timed intercourse again, this time with a much more gentle approach and extreme caution about hyperstimulation. After a three tries, a low-dose FSH protocol led to a successful cycle!
I am now almost seven months pregnant with a healthy singleton. My background of infertility has left me with a lot of worry about this pregnancy, but everything so far has been uneventful. I don't want to be the poster-woman for "keep trying and eventually it will work," because I know everyone has different psychological, mental, and financial limits. I think if we had gone the adoption route, we would have been happy as well. I do feel like my experience has demonstrated the importance of your reproductive endocrinologist to the potential success. Each woman responds to the drugs differently, and while IVF may be the best treatment for some conditions, other treatments can end up being successful. Infertility treatment is not an exact science, and I think personal and individual attention to the patient will provide the highest likelihood of success.
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