A Happy Mothers Day at Dominion Fertility Mother’s day is this Sunday, May 11 and what perfect timing to share one of my most inspiring (albeit lengthy) patient stories. N.S. was one of my first patients at DF in 2010. At the time she was turning 40 with unexplained secondary infertility for about a year. She started with some simple Clomid cycles, of which one sadly ended in a biochemical pregnancy. Eventually she and her husband decided to try IVF. On their first cycle in 2011, all of their embryos arrested and her transfer was cancelled. Ugh. She had excellent ovarian reserve despite her age, and we were hopeful but realistic. She tried another IVF cycle, transferred 3 embryos and no pregnancy. Ugh. We met, we evaluated our options, and we were realistic after two failed cycles. On her third IVF cycle, we transferred another 3 embryos, again without pregnancy. At this point we decided to revert back to ovulation induction cycles, given that she had her first child without any treatment at all, and her only pregnancy with us was with Clomid. She went through another 3 FSH IUI cycles that year and another 2 IVF cycles, with 1 and 4 embryos transferred respectively without success. At each step we met, realistically reviewed options and her increasingly poor prognosis, and yet she remained remarkably persistent and optimistic. At this point she was turning 42, and they adopted a child. While undergoing the adoption process in 2012, they decided to just do one more IVF cycle. This would be their sixth IVF cycle – and while she continued to respond well to medications, we talked more and more about doing PGS or some further evaluation of the embryos, a technology emerging at that time. Again, the fresh embryo transfer of 3 was negative, but for the first time we had multiple embryos for freezing. Now it is 2013 and the adoption process was complete. Although busy with their newly expanded family, she returned for a cycle using her frozen embryos. We thawed and transferred 2 embryos, but again no pregnancy. Ugh again. I didn’t see them for quite some time after this. I thought they had stopped trying, or perhaps gone to another doctor for a second opinion, both of which I would have expected. She returned to us in 2014, and she is almost 44 years old. Her chart is so big from labs and sonograms and tests that it had to be broken down into separate volumes. Her oldest child is around the age of my oldest child, and I have now watched him grow from a wobbly toddler into an articulate young boy. Time seems to fly, except in this awful world of infertility. We only have 2 embryos left from that 2012 cycle. We talk a lot about using an egg donor as a backup plan. Or just stopping altogether. I am realistic and honest with them about their remote chances of conceiving at this point in the process. I am saddened by the limitations of what we can do and can’t do in our field, I am second guessing my own management of her case. So we thawed and transferred those last 2 embryos, now 1.5 years since their conception. I marked my personal calendar with her name on the day of her pregnancy test. I thought of her on my drive into work, and much to the annoyance of my staff, impatiently fumbled through the lab results as they came hot off the press to find hers first. POSITIVE. We all can’t believe it. Every two days I cross my fingers, again annoy my poor staff by impatiently fumbling through her results, and watch her Bhcg double. Awesome. First sonogram – all looks good, phew. Final sonogram – fast heartbeat, all looks great! On this mother’s day, I am grateful to have had the chance to care for such an inspiring woman. I was always impressed with her witty, practical, and proactive approach to such a difficult emotional process, her relentless optimism, her kind-hearted nature towards all of our staff in the toughest of times, and ultimately, her dogged persistence. As one of my very first patients, she has been an inspiration to me as a doc and I will never forget her story. Happy Mother’s Day, N.S., and to all mommies and mommies-to-be out there today. -Dr. Reh
Posted on: Sun, 11 May 2014 18:54:43 +0000
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