I Am The 1%
My infertility journey started last year at FIX – the FemInEM Idea Exchange – as I sat in a hotel room with another EM physician and a bottle of champagne, celebrating the beginning of my injections. My journey was not the typical journey of infertility. I hadn’t spent years trying. I had spent years trying NOT to get pregnant. Marrying my husband had given me two daughters in their pre-teen and teen years, so technically I was experiencing a form of motherhood. My husband had a vasectomy previously. Our doctors recommended sperm retrieval not a reversal, leaving IVF as my only option for pregnancy. We went through extensive blood work and testing. They diagnosed me with diminished ovarian reserve and wanted to do a laparoscopic surgery to see if I had endometriosis. But being the doctor that I am, I knew nothing was wrong with me; our only problem was getting my husband’s sperm. Or so I thought.
So at FIX last year I started my first try. I went for my egg harvest and came out of my propofol haze to find out I had 8 eggs. Only 8. My friend who had to do IVF for the same reason with no infertility of her own had over 20. The downhill spiral started before the propofol had worn off. What if I do have a problem? What if I have diminished ovarian reserve or endometriosis? Should I have had the surgery? What if I can never have a child? All of these questions started running through my head as I waited 5 long days for my transfer to occur. The next day they called me to tell me only 5 of the embryos had fertilized. The self-loathing talk in my head was going a million miles an hour – I obviously did something wrong. We had planned on inserting two embryos – that way we had twins and could be done but also increased our chances of having a pregnancy. 5 embryos. That is 2 ½ tries. I’m good at math. 2 ½ tries isn’t great. But as long as I have one baby, I would be fine – that’s what I told myself.
On our transfer date, we were (trying to be) ecstatic. It was October and we were “going to put a pumpkin in my belly” (see above). As I said, our plan was for two embryos, until we went in to the office and found out we in fact ONLY had two embryos. There were two other embryos that were in morula phase, but needed to progress to blastocyst. Our embryologist was very nice and broke the news to us very well. We looked at each other, without much discussion and said “okay we have two, we will have two more. Those will grow. Let’s put in two.” And we did.
I spent hours that day laying on the floor with my legs propped up against the wall, trying to force these two embryos to make a home in my uterus and wondering what I had done wrong. I questioned why we only had 8 eggs, why did only 2 make it to blastocyst phase? Maybe the doctor was right. Maybe I was WRONG. Maybe I have my own reproductive problems. Maybe it wasn’t just my husband. Maybe I had managed to get to 31 without ever having a pregnancy scare because I am infertile. The next day, I hadn’t heard anything about my two other embryos. It was Sunday. I waited until Monday and emailed my nurse to call me with results. My husband was at work, at the fire station. She didn’t call. She sent me an email. "No frozen embryos . :( " Sad face – like the one with the colon and the parentheses – yes that. Breaking bad news is always a challenge. I break bad news to someone almost EVERY shift in the ER. An email with a sad face to a woman jacked up on hormones….not a great option. The downward spiral became hurricane force at that point. I had two embryos inside me that were my only chance of getting pregnant. Fifteen THOUSAND dollars for one chance, and a 60% chance of success at that. ARGH.
Fast-forward. The day I was supposed to have my pregnancy blood test was during ACEP, the biggest Emergency Medicine conference of the year. I was in Washington DC with all of my colleagues and the 3rd year EM residents. My doctors told me I could do a home pregnancy test. Then qualified that with “it is possible it will be negative but you will be pregnant.” The idea of finding out at ACEP, among all my colleagues and residents, that I was not pregnant was ridiculous to me. I didn't intend to hit rock bottom at a work function. I waited until we got home. But my husband could not be present for the blood test, so we did a home pregnancy test together. It was positive. We were overjoyed . For a short time.
The next day my blood quant came back. 49. My nurse called, an improvement, and calmly explained that it was lower than they would expect for a 9-day quant. And I was really at day 11. I knew immediately that something was wrong. I agreed to a 48-hour repeat. The next day, I started bleeding, heavy. I spent every free minute of my overnight shift looking up infertility issues – endometriosis, surgical cure rate, diminished ovarian reserve, fresh vs frozen transfers. I accepted that this pregnancy was not going to be viable and I started equipping myself with the knowledge I needed to make the next step decisions. Two days later, my repeat quant was 98. EXACTLY doubled. I was still bleeding. My nurse called again – wanted to know if I want to keep repeating beta quants every two days or just wait for my 6 week US. I immediately refused – I did not want to be the patient I see in the ER getting repeat quants. I didn't want to be the patient at all. I did the math. I doubled out my beta quant. By the time I hit 6 weeks, my quant would be above 1500. I agreed to the 6 week US.
Fast-forward. My husband and I went in for the ultrasound. I started having nausea. I was peeing every hour and drinking water by the gallon. I had started to FEEL pregnant. And that downward spiral of negativity in my head had finally quieted. I allowed myself to believe I may be pregnant. I was not 100% convinced, but emotionally it was the highest I’d been in a month. A young blonde female doctor I had never met before came in to do my US and reviewed my history. As soon as the trans-vaginal probe went in, I saw the clear stripe of my uterus uninterrupted by any collections of fluid. It was utterly empty. Immediately, the tears crept into the corners of my eyes. I had an ectopic - that thing I am always eager to diagnose – now I have diagnosed it in myself. She scanned my adnexa, and there it was – a gestational sac, with a yolk sac, no fetal pole, no heartbeat. My doctor looked at me and said the most honest thing she could, “I am so sorry. You probably diagnose these way more than I do. Its extremely rare with IVF, less than 1%.” Yes I do diagnose them more than she does. And yes, I am in the 1%.
- I do suffer from diminished ovarian reserve, which is a common cause of infertility in women. The jury is still out on whether or not I have endometriosis also.
- Ectopic pregnancies are very rare with IVF. The rate is approximately 1%.
- We will try again with another round of IVF in the future...