A Journey to Conception {IVF, Twins, and a Naturally-Minded OB and Midwife Group}

When we decided to get married, we knew we wanted to wait a few years to begin having children.  Doug didn’t want to rush into things, and I wanted to accomplish a few goals and take time to enjoy life as a family of two.

We traveled to Germany, I completed my Masters Degree in Special Education, we hiked mountains with elevation over 14,000 feet, enjoyed weekends in the mountains, bought a house, celebrated with many friends as they began having children, I engulfed myself in teaching, my husband faced many ups and downs in his job, we taught ski lessons at National Sports Center for the Disabled, and generally lived an exciting and spontaneous lifestyle.

Meanwhile, around 2007, we decided it was time to begin trying to get pregnant.  After a year of trying, I started to become discouraged and wondered if it was time to see a fertility specialist.  Almost three years later, we still had not become pregnant and finally sought help.

We contacted the local fertility clinic that has a reputation as a world leader.  We were reluctant, but hopeful.  When we first walked into the clinic, I had a grateful attitude towards the people inside those doors who were going to help bring us closer to our goal of having children. The clinic ran some tests, and after the first of many very long waits, called us in to deliver our results.

Unfortunately, the office would not give us any information to help us prepare for our appointment. We walked blindly into the office, where the doctor delivered a devastating blow.  He informed us that we would not likely be able to have children without a $25,000 procedure called in vitro fertilization.  He made a crude joke about not needing to worry about unplanned pregnancy anymore.  We walked out of his office devastated.  Feeling completely lost, hopeless, sad, alone, and frustrated, we went home to gather our thoughts.

Ultimately, we had three choices: 1) Have no children 2) Pay $25,000 for an adoption or 3) Spend $25,000 for IVF which is known to have a 30-50% chance of working.  I made the executive decision that we would be having children, so we knew we were a long way away from having the money we would need, and that we had some difficult decisions to make.  Doug still wasn’t sold on adoption, and I really wanted to experience pregnancy, but IVF was a real financial risk. We were nervous about the possibility of a failed attempt.  So many thoughts flooded into our minds.  “What if this doesn’t work?”  “If we try IVF and it fails, we most likely won’t be able to afford another round of IVF or adoption.” “It is a very real possibility that we won’t ever reach our dreams of having children.”  We were in a very dark place in our lives.

We decided the next step was to find a new doctor for a second opinion.  His diagnosis was the same, and he agreed that IVF was most likely the only way we had a chance of becoming pregnant.  Instead of making sex jokes, his comment was ‘I’m confident this will work for you and I’m saving a place on my wall for a photo of your baby.’”

This was exactly what we needed to hear. The idea of having kids became a real possibility again.

After the appointment with the second doctor, Doug and I went to an adoption class, and he decided that he still wasn’t ready for adoption.  So, without much discussion, we decided to start saving for IVF. I had been desperately awaiting pregnancy for quite a long time.  I didn’t know how I would possibly wait any longer, but didn’t have a choice.  We put together a budget, limited our spending, and off we went. We would need to save a lot of money before beginning treatment.

It seemed that the decision was meant to be, as money seemed to just fall into our laps over the next months.  Doug received a nice bonus at work, I was able to have a payroll error corrected, and tax refunds were in our favor.

Waiting was agonizing, so to pass the time, I decided to tackle another life goal: running a marathon.  I began training in December 2010, with a goal of running the LA Marathon in March.

During the training and saving period, we kept in contact with the Reproductive Medicine office.  I had so many questions, and the nurse was so easy to reach and extremely helpful.  She was also a runner, so she also had running advice and tips for me through the training process.  Everything about working with the new doctor’s office was great.  The relationship with the nurse really helped through this difficult time.

I ran and completed the marathon in late March 2010. One month later, we began the IVF process.

Physically, the process wasn’t fun, but it wasn’t as bad as we feared.  Emotionally, however, it was far harder than we anticipated.  It seemed that every time we turned around, there was another roadblock that raised fear, doubt, and sadness.  In the beginning, I was actually excited to get started with the shots, because that meant being one step closer to the dream.

I should give a quick explanation of the IVF process here for anyone who doesn’t know how it works.  It’s an amazing process, just one that I wish no one ever had to endure.  Initially, you are put on birth control (cruel, right?!) and begin giving yourself shots to shut down your body’s natural ovulation process.  Next, you begin another shot to ramp up the body’s production of follicles (inside each is an egg). In a typical pregnancy, the body only releases one mature egg (from one follicle).  In IVF, the goal is to have the body produce just under 20 mature follicles. Throughout this phase of IVF, you go into the doctor’s office about every other day for a blood test and trans-vaginal ultrasound. The doctors use the numbers from the blood test and the information from the ultrasound to determine whether to change the medication dosage.  Once enough of the follicles reach maturity, you give yourself another shot that makes your body prepare to ovulate all the mature eggs.  Just before the eggs would naturally be released, they use what I have dubbed the “giant-ass needle” to retrieve the eggs from your ovaries.  This needle goes through your vagina and straight up into the ovaries.  Meanwhile, a sperm sample is collected, or prepared in the event of sperm donation.  Depending on the cause of the infertility, the eggs and sperm are either placed in a “dish” to find one another, or in some cases, the sperm are inserted into the eggs.  The embryos are then turned over to an embryologist for observation. Typically, most, but not all of the eggs retrieved will be fertilized. Each day, the embryologist will call to give an update of how many are still alive and dividing.  It is typical for several to stop dividing each day.  This goes on for 3-5 days.  The longer the better, but if the embryos are not doing well outside the body, they will move ahead at day 3.

The final process is the transfer of usually one to three embryos into the woman’s uterus.  The woman gives herself another round of shots to prepare her body for pregnancy.  Again, depending on how well the embryos are doing, the transfer will happen on day three or five after the retrieval.  They choose the best embryo(s) to transfer.    They use a tiny flexible tube and ultrasound to place the tiny embryos into the uterus.  If there are any embryos still alive and dividing the following day, they will be frozen and stored and can then be used for another attempt later on.  After the transfer, you just wait…and wait…and wait for a pregnancy test that happens two weeks post-transfer.

So, with that knowledge, I will return you to my story.

Throughout the process, I had to go to the doctor several times for blood tests to determine the effectiveness of the medication.  The first major roadblock came when the results revealed that my body wasn’t responding as quickly as they hoped to the dose, and the round might need to be cancelled.  When you have come so far and gone through so much just to get to this point, the news is devastating, not to mention my hormones were all sky high from the medications.

With an adjustment in medication, things began to respond, and we were back on track, and just a few days behind schedule.  This is not a big deal, but in the moment, and after waiting so long, it was heartbreaking. We continued as planned, and eventually came time for retrieval.  This went great, and we had a large number of eggs to work with.  Even better news was that the next day, all but one was alive and beginning to divide.  The next two days saw a positive report each day.  Only two more stopped dividing by day 4.  On day 5, we went in for the big transfer.  We had decided to transfer 2 embryos, no matter what.  Although the doctors were very clear that the goal was to have only one baby, our goal was to have twins. As I was being prepared for the procedure, the embryologist came in and said, “I have good news and bad news.”  We couldn’t imagine what the bad news could be.  Just yesterday they assured us we would easily have 2 embryos to transfer and probably 6-7 to freeze.  “The good news is you have one perfect embryo,” said the embryologist.  “The bad news is that there is only one other even worth transferring.  The rest aren’t doing well.”

We had really mixed emotions.  We were excited to finally have arrived at this moment.  We were devastated, yet again, that there would not be any left to freeze.  All along, we kept reassuring ourselves that it would be OK if the first round didn’t take, as long as we had several left to freeze.  Our safety net was ripped right out from under us, but without anything we could do about it, we carried on.  Through the entire journey we just kept carrying on.  They sent us home with advice to rest and take it a little bit easy over the next two weeks – that and return on May 5, 2011 for our pregnancy test.

The next two weeks went surprisingly fast, and of course had both ups and downs.  Most of the time, I didn’t feel a thing, but one day I had two strong twinges in my abdomen.   This was extremely exciting, as it was possible that I was feeling the embryos attach to the uterine wall.  Several days later, I had a migraine which sent me spiraling into a deep dark despair.  See, each month for three years, having a migraine was a sign that I was not pregnant.  A migraine always proceeded my period by three days. By having this migraine, I was certain that she was not pregnant.  Three days later, May 5th arrived.

Knowing how anxious we would be waiting for the pregnancy test results, we had taken the day off work to await the news. We had been told we would get the results by the end of the business day, so we were surprised to get a call from our nurse at 9 a.m.  I, afraid to hear the news, made small talk and asked her how she was doing.  Politely, she replied that she was doing well, and asked me how I was doing.  I replied, “I don’t know, you tell me.”

On the other end of the receiver, I heard her voice deliver the incredible news: “Well, you’re pregnant!”

Despite the odds, we were pregnant!!

 I just broke down.  Doug was crying, too. I can’t describe how I felt.  I cried and cried tears of joy

Although Colleen, our nurse, was ready with information to prepare us for pregnancy, we were unable to comprehend anything more.  I asked her to call back in a little while once I had calmed down.

The moment we heard Colleen deliver the news will go down as one of the happiest moments of our lives.  From that day on, the process got better and better.  Four weeks later we found out we were having twins! Eight weeks after that we found out we were having a boy and a girl.  Each appointment after that we were able to see that they were healthy and very active.  After a long road with so many roadblocks, detours, pitfalls, and devastations, it was amazing have smooth sailing and positive news the rest of the journey.  The pregnancy was difficult for me, but the babies did great the entire time.

We were working with a combination of midwives and an OB, since we were having twins.  We had planned to birth our baby at an independent birthing center with only a midwife, but that was not possible once we found out we were having twins.  The nice thing about working with an OB who routinely works with midwives is that he is open to a more natural approach.  At 38 weeks, when they would typically induce twins, our babies still had not arrived.  He allowed us to wait another week.  Also, despite having a marginal placenta previa, he was willing to let me attempt a vaginal delivery. By the time we were almost to 39 weeks, it became clear that it was no longer in my or the babies best interest to continue the pregnancy.  Our goal was to slowly induce, but ended up that didn’t work.  We had to start with a cervical ripener, which did nothing in terms of kick-starting labor.  As my pre-eclampsia set in, we veered farther from my birth plan by starting Pitocin.  Ultimately I ended up having an emergency c-section because of bleeding from the previa.

All in all, my babies arrived, and that is all that mattered in the end.  I was sad about loosing my dream birth, and I had to grieve it.  Ultimately, however, I believe we only did interventions that were medically necessary, and am happy with the outcome.  My long-shot dream had come true.  We had not only one baby, but two!

The process of IVF and infertility in general is excruciating.  My lasting wish is that people understand that.  I want the general public to understand that by asking if twins are “natural” they are asking a deeply personal question that often brings up trauma and grief.  Thanks for taking the time to understand this process and my journey.