In Pursuit of Fertility

A Little Background. . .

I was never the woman who thought my life would be unfulfilled if I didn’t have kids. I’ve been a teacher for most of my life and have loved the time I have with my students during the school day, as well as my personal time once work ends. I have always said that I would happily adopt any of my students, if they needed a loving home, but thankfully, most of my students have been well cared for by their families. As I neared 40, divorced and single, I figured the door for birthing children of my own was closing and while I accepted that, a piece of me mourned the idea that I wouldn’t have my own child. (While I would adopt a student in need, I’ve never wanted to raise a child on my own; hence sperm donation was not an option I ever considered.)

Big Changes at 40. . .

Fast forward to November 1, 2018, two months after I turned 40, when I had my first date with Manny, and met the man who would become the love of my life. Like me, Manny had also turned 40 in September. After nine months of dating, and a three-week trip exploring Italy together, we knew we wanted to spend our lives together and we also decided we wanted to start a family. I knew Manny would make an excellent father, and for the first time I felt like I was in a true partnership, something I had given up on finding.

The Reality. . .

At this point in my life, I had been on the pill for almost twenty years and questioned if I would even be able to get pregnant (I had never been pregnant before), but I stopped taking it and arranged an appointment with my ob/gyn to talk about next steps and our age.

We went to Women’s Care Florida together, and my doctor said that given our age, we should try naturally for three months but in the meantime make an appointment with a fertility clinic he recommended, in case we didn’t conceive. He said normally, he would recommend trying for a year but since we were both 40, he didn’t want us to wait too long. He further explained that women at my age have a more difficult time getting pregnant because we have a finite number of eggs that significantly drops with age. Egg quality declines as well, and unfortunately there is no way to test the quality of the eggs you have remaining. While I knew egg quantity decreases with age, I was honestly shocked when he said that women only have a 5% chance of getting pregnant every month naturally at the age of 40.

I did some blood work that day and was very happy to find out that my AMH level was 2.18. Of course, I had never heard of AMH (Anti-Mullerian Hormone) prior to this appointment but the doctor explained it was a good indicator of the number of eggs you have left. Instead of the average AMH level for a woman my age, mine is closer to a woman of 35. That small piece of information gave us a huge amount of hope despite the slim 5% chance of becoming pregnant naturally. I’d heard countless stories of women getting pregnant later in life and I honestly thought we would have no problem becoming pregnant either.

Serendipity. . .

And we didn’t! I had been tracking my periods closely using the app Clue and though my period was only a day late in early September, a few days before my 41^st birthday, I couldn’t stop the intense feelings of hope and excitement. I finally gave in to the desire to buy an over the counter pregnancy test and sure enough, two lines formed, indicating pregnant. I couldn’t believe it and I was so excited to show Manny when he got home from work! I think we were equal parts stunned and happy. I took two more pregnancy tests over the next couple of days just to be sure and each one was positive.

My friends and family know I am terrible at keeping secrets and I called my mom that first night to share. My mom said she had seen a baby in a dream she had the previous weekend though she hadn’t connected it to being about Manny and me until our conversation. It seemed like a good omen and our news was the best birthday present I could ask for at 41.  Of course, I shared with my girlfriends at my annual birthday dinner. And let’s be honest, they would have figured it out anyway because I didn’t order wine with dinner which rarely happens.

I bought books about pregnancy on Amazon and my mom and a couple of out of state friends also sent me books. I painstakingly researched pregnancy journals and we even took photos to start documenting our baby bump’s progress.

Too Good to be True. . .

A short two weeks later I started spotting which triggered my immediate concern. I Googled obsessively until I almost convinced myself that spotting early on was normal and I shouldn’t necessarily be alarmed. But, of course I was. I stopped going to my aerial arts classes so that I wouldn’t put any strain on my body and said silent prayers that everything would be okay. After a week of mild spotting, I had what was similar to a very heavy period. But emotionally, it was so much worse. I purchased a bulk pack of pregnancy strips from Amazon because I didn’t want to admit the truth. While there was a faint line indicating pregnant on the first stick I used, it faded out to nothing within 3 days. I knew our short-lived pregnancy was over.

The very heavy bleeding continued for a few days and I went to see the nurse practitioner at my ob/gyn’s office because I had never experienced something like this before and I didn’t know what, if anything, I needed to do. She confirmed my worst fear and said to call if the bleeding didn’t stop or if I had any pain but otherwise they couldn’t do much. She shared that it was probably due to a chromosome or genetic issue which is the most common cause of miscarriages and not one that can be prevented.

I have several girlfriends who experienced miscarriages and I turned to them for comfort. I openly shared what happened and was very surprised to learn how many women in my life had also had miscarriages; some multiple times. Most of them were able to have healthy babies thankfully and quite a few turned to fertility specialists for assistance for various reasons. I feel incredibly fortunate for the strong women in my life and their willingness to share their own, very personal, stories. Prior to experiencing this myself, I recall seeing a couple of friends post articles on Facebook about this weird societal norm that we aren’t supposed to talk about having a miscarriage and this was also very surprising to me. (My friends who posted did so because they do not support this idea either.) I did not want to carry my burden alone; the weight is crushing.  

A part of me can understand why women don’t share when they have a miscarriage – all too often and easily we blame ourselves and question what we did to cause something so unfathomable to occur. I can honestly say that in 41 years, this was the first time I truly felt as if my body had failed me. On the other hand, I also think there is tremendous comfort in knowing you aren’t alone and creating a community of women with shared experiences to support one another can help ease the pain. Finding out how many women I know who had gone through this and still had a child, helped me find hope again.

A New Approach. . .

If you had asked me at 30 and even at 35 if I would see a fertility specialist I would have immediately answered no. I had always told myself that if I wanted to get pregnant and couldn’t, it was nature’s way of saying a baby wasn’t in my future and I needed to accept that. But what we think about ourselves at 20, 30 and even 39 can change given the right set of circumstances and life experiences. And so Manny and I found ourselves talking to a male fertility specialist at a well-known clinic in Tampa.  Literally, three minutes into our appointment with the doctor, he said “You probably have hope right now because you got pregnant once, so you think it can happen again.” We nodded yes. And his response was “Well, it’s probably not going to happen unless you go the IVF route.” Umm. . .  What?? But we aren’t here for IVF. . . there have to be other options. . .

We were both stunned. Again. We just wanted to get some tests (not that we knew what that would even entail at that point in time) and maybe try some other unknown, magical option that would be cheap and non-invasive. The IVF salesman/doctor must have seen the look on our faces because he started backtracking rapidly and said, “Well, maybe there were a few other options to try before IVF.” We parted with $200 and lab slips to get blood work done.

When I called my insurance carrier on the ride home (yes, we did a lot of things backwards), they said there was no fertility specialist in Tampa that would take my insurance even though I had up to $5000 of fertility benefits. Neither of us really cared for the doctor, but we felt invested so we agreed we would continue to see him for testing and go from there. We took our folder home and diligently followed all of the tasks on our checklist which included STD testing, watching videos about the risks of Zika and pregnancy, and a video about genetic testing. We did decline the genetic screening because the price of $400 seemed hefty with all of the other non-negotiable testing costs.

I returned to the fertility doctor’s office in late October for required baseline blood work and an ultrasound, both of which needed to occur between days 2 to 4 of my cycle. I saw two different nurses and it was a straightforward appointment, though it was my first time having a vaginal ultrasound. The blood work checked my E2, FSH, and LH levels and the ultrasound was to make sure everything looked normal so I could get an HSG. Four days afterwards, I went to USF’s fertility clinic for an HSG or hysterosalpingogram. I was actually able to get most of the cost of the HSG covered through insurance by going to USF.

I was pretty nervous about the HSG and all I have to say about it is, you couldn’t pay me to ever go through that again. I’m not sure why I had a bad experience when many women say it’s not a big deal at all. The process involves filling your fallopian tubes with dye to make sure there isn’t a blockage that could prevent you from getting pregnant. Fortunately, the doctor said everything looked good during the quick procedure which made the extreme discomfort worthwhile.  

While I was being poked and prodded, Manny also had to get infectious disease bloodwork done and provide a semen sample for analysis. Like me, all of his tests came back normal. We scheduled a follow up appointment with the fertility specialist to go over all of our tests and talk about the next steps. Unfortunately, we had to wait until January 6^th before we could even get an appointment. But at the appointment, our doctor confirmed that all of our tests looked great and we should celebrate!

After discussing next steps, we decided we wanted to try Intrauterine Insemination (IUI), a fertility treatment in which the man’s sperm is placed inside the woman’s uterus to promote fertilization. The odds of success with IUI are about 10% a cycle and no more than three cycles are usually recommended before IVF is considered. We were hoping since neither of us had a potential problem contributing to infertility, we just needed a little help with the timing and IUI does that by controlling your ovulation day. I ordered and received the necessary medicine for a cycle – Clomid (an oral tablet), and Ovidrel, a single dose self-administered syringe, and we waited for the start of my next cycle.

When I called the clinic a couple of weeks later to check on our financial aid package which would help cover the costs of the IUI cycle, I was told that they had not yet processed our paperwork and it could be another two weeks before they did. Having been emotionally prepared to start an IUI cycle with my next period, finding out we wouldn’t be able to was quite upsetting. For us this was the final straw and we opted to have our records transferred to the Reproductive Medicine Group, an office recommended by a friend who had a healthy baby boy via IVF with them.

Take Two. . .

We scheduled an appointment at RMG for February 19^th, and we both liked our new doctor and the nurses immediately. Because we had already had testing done and he had our records, the doctor agreed we could jump right into an IUI cycle when I got my next period. I still had the medication we would need for the procedure. We were also ecstatic to learn that the cost of IUI at RMG was half the price of the other clinic’s and they actually took my insurance. Humana, shockingly, had not given me correct information when they said there were no fertility clinics in Tampa that accepted Humana.

While looking at our calendar, we realized we would need to wait an additional menstrual cycle before starting IUI because we had a trip already booked and paid for to go to Asheville over spring break in mid-March and the timing wouldn’t work with the ovulation injection. But even waiting an extra month at this point, didn’t dull our excitement that we were finally moving forward with a treatment plan at a clinic we really liked.

And Then the Unexpected. . .

Covid hit the US. We learned the day before spring break started that it was likely Hillsborough County Public Schools would be moving to e-Learning status after the break, and we cancelled our Asheville trip because we didn’t want to risk getting or spreading Covid while flying. The US economy began to shut down and fertility treatments were not considered essential doctor appointments so our IUI treatment was back on hold to our dismay.

We made the most of the next couple of months. I taught from home and Manny finished his engineering classes at USF online. We continued to monitor my periods using the app and ovulation strips from the drug store to see if we could get our timing right. With the strips, we determined that I ovulated before the app indicated I was due to. I continued to receive email updates from RMG about their Covid status. When I got an email at the end of April saying they had permission to re-open I called immediately and scheduled an appointment.

And Then the Really Unexpected. . .

Fortuitously, my appointment on May 4^th coincided with my period and we were hopeful we would finally be able to start an IUI cycle. When I went in that Monday, the doctor said I was clear to start taking 100 mg of Clomid for 5 days, the first step in IUI. I did share that my period had been unusually light over the weekend and one day late, somewhat unusual for me, but the ultrasound looked good and I started on the Clomid.

I went back in on Wednesday, May 13^th for a follow up ultrasound and to get the okay to administer the ovulation trigger injection, Ovidrel. While the nurse was performing the ultrasound to make sure I had follicles stimulated by the Clomid, she was unusually quiet. At this point she had performed a couple of ultrasounds on me and she was usually friendly and chatty. I started to feel a sense of dread and it increased when she said she needed to step out and talk to the doctor. It felt like she was gone forever and while I was laying on the table waiting, I thought about all of the bad things she could come back and tell me. When she finally returned, carrying the sonogram image, she said, “Great news. You are already pregnant!”

I could not believe it. What I thought was a light period had been implantation bleeding. I got dressed, in shock, and went to meet the doctor in his office. He reassured me that taking the Clomid would not have an adverse effect on the baby, which was an immediate concern of mine. He said I was 5 weeks and 3 days pregnant and he wanted me to return in a week for another ultrasound. The next week I got to see a video of the baby’s healthy heartbeat and again a week later, at 7 weeks pregnant. Each visit gave me reassurance that we would have a healthy pregnancy and baby.

As I finish writing this, we are 15 weeks pregnant and everything is going well! Getting pregnant naturally at 41 was an unexpected gift and we can’t wait to meet our little one in early January.