The Medical Side of Our Infertility Story

I’ve been blogging about our infertility experiences for almost two years now, but somehow I have never written up the details of our infertility story with the treatments we have tried, causes of infertility we’ve ruled out, etc.  I’ve blogged about the emotional side of infertility quite a bit but not so much the medical side.  Every time I sit down to do it I write tons of stuff and get to a point where I think, “This is way too detailed and nobody will want to read all of it!”  And I put it on the back burner for a while.  After announcing our pregnancy I decided I need to just make myself finish it and publish it anyways!  Is it way too long and detailed and jumbled and wordy?  Probably.  But I hope that it will somehow be interesting for those who know bits and pieces of our infertility story and are curious to know more, and useful for anyone out there who may be experiencing similar symptoms and looking for someone who can relate.  This is basically the medical background on why we did IVF and why we felt it was the best decision for our situation.

After disappointment in 2013, sadness and confusion in 2014, testing and waiting and heartbreak in 2015, and plenty of pain and tears and more waiting waiting waiting through the majority of 2016, the last few months of 2016 brought more hope than we’d allowed ourselves to feel in a very long time as we started the IVF process.

Before we moved to Arizona, we had been told by doctors that IVF (in vitro fertilization) was our best chance of becoming parents.  We didn’t want the process to be interrupted by our move, so we planned to find an IVF clinic in Arizona to work with.  We set up a consultation at Boston IVF the Arizona Center and immediately we knew we were in the right place.  Dr. Hade and his staff were amazing to work with from day one.  I felt a lot of peace when we had our consultation with Dr. Hade because I felt like finally, a doctor was looking at our situation from all the angles and agreeing with us that something was very wrong.  Dr. Hade didn’t sugarcoat things but gave his medical opinion in a straightforward way, which was refreshing.  He was very concerned because of my age (25), concerned that in all the time we had been trying to conceive, I had never become pregnant once, because this should have been the most fertile time of my life.  He ordered more blood tests and labs and looked at all of our previous medical history and fertility treatment history and after analyzing all of that, recommended that IVF would give us our best chance for success.  And honestly, even though IVF was a huge, scary, expensive, invasive process to think about, we felt a lot of relief and hope from that recommendation.

This is us with Dr. Hade on our graduation day at the IVF clinic!
We are so grateful for him and all his amazing staff.

If you know much about the ladder of fertility treatments, you’ll know that each step higher on the ladder means a more invasive, more expensive procedure.  In a nutshell, the lower steps on the ladder involve drugs like Clomid which stimulate ovulation, moving up to Clomid drugs paired with shots to trigger ovulation and closely monitored cycles, then IUI (intra uterine insemination) which pairs ovarian stimulation with inserting sperm into the uterus via catheter, then IVF which involves retrieving eggs and fertilizing them with sperm in a petri dish, monitoring the resulting embryos/blastocysts through different stages of development, then transferring one or more embryos into the uterus and freezing any remaining embryos for later use. (Of course, there are still higher steps on this ladder as the process of IVF can be more complex for some couples, for example involving donor eggs or donor sperm or embyo adoption or surrogacy, but all of those complications still utilize the IVF process in one way or another).  In our situation, we had done several medicated cycles using Clomid and other similar drugs along with HCG shots to trigger ovulation.  The cycles were monitored very closely with lots of ultrasounds and bloodwork and almost every time, everything appeared to go perfectly, but I never got pregnant.

So from where we were at on the treatment ladder, the next step up would be IUI, but our doctor recommended that we skip the IUI step and go straight to IVF.  The reason for this was basically because there was no obvious explanation for why the other treatments we had attempted had failed, and all possible explanations for our previous failures could not be ruled out unless we did IVF.  The monitoring cycles had proven that my ovaries did produce and ovulate eggs, a hysterosalpingogram had proven my fallopian tubes were clear, blood testing had proven my egg reserve was healthy, and sperm analysis had proven that Shawn’s sperm had no issues.  There had to be a problem preventing us from conceiving that was either impossible for doctors to detect at all, or impossible for doctors to detect without invasive surgery.

One possibility was dysfunctional fallopian tubes, which means the fallopian tubes do not pick up and carry the egg from the ovary to the uterus even though the tubes are clear and the ovaries ovulate–a scenario that is impossible to prove because there is no way to test fallopian tubes for functionality.  Another possibility was endometriosis, which means that tissue that normally lines the uterus grows in places it’s not supposed to (like on the ovaries, fallopian tubes, and intestines) for no good reason and causes all kinds of problems, including infertility.  This scenario is only possible to confirm through a laparoscopy, an invasive surgery to detect and remove the tissue, but since I didn’t have all of the symptoms of endometriosis and since there is no lasting cure for it anyways (even after removal, the tissue grows back), we agreed with our doctor that if we were going to be throwing thousands of dollars at a problem, it would be better spent towards IVF than at surgery that wouldn’t solve the problem of our infertility.  Even though there was no way to prove it, I felt in my gut that our problem was dysfunctional fallopian tubes and had felt that way ever since one of our previous doctors had mentioned it as a possibility.  If that was the reason for our infertility, then spending a couple thousand dollars on an IUI would be really stupid because IUI wouldn’t work if my eggs couldn’t make it through my fallopian tubes.  IVF was the only option that would rule out the possibility of failure due to dysfunctional fallopian tubes because it eliminates the fallopian tubes from the entire process.  This is why our doctor’s recommendation of skipping IUI and moving straight to IVF made a lot of sense to us and brought us a lot of hope, especially because our doctor was very optimistic that IVF would be successful in our case.  We felt like for us, it was a better choice to invest more money in a procedure that had a very good chance of working, than invest a smaller but still significant amount of money in a procedure that had much lower odds of success in our situation.

So.  We decided to go ahead with IVF via an FET (frozen embryo transfer) as our doctor had recommended.  Shortly after we started the beginning stages of the IVF process, I found out something that just added to our conviction that IVF was the right decision for us.  A relative of mine who knew of our infertility informed me that they had undergone some extensive genetic testing for other issues and found out that they could be a carrier for Primary Ciliary Dyskinesia.  Basically it’s a genetic disorder that causes the cilia in some parts of the body to not function properly.  Cilia are little hair-like structures found in many different areas of the body, and PCD can manifest completely differently in different people and affect completely different parts of the body depending on the particular affected cilia.  The way PCD can cause infertility is if it affects the cilia in the fallopian tubes, which have the role of moving the egg from one end of the fallopian tube to the uterus.  If the cilia in the fallopian tube don’t function properly, then the egg never moves far enough through the fallopian tube to get fertilized and make it to the uterus.  I don’t know whether or not I have PCD, but it was so interesting and validating to me to learn about a possible cause of my infertility that I’d never heard of before that fits with all of my symptoms.

Because IVF is a complicated process that deserves a thorough post in and of itself, I’m going to end here.  I hope this helps anyone reading to understand some of the medical issues and complex treatments that can be involved with infertility.  At the very least, hopefully now you understand why the unsolicited advice to “just relax” is probably the #1 least helpful thing anyone can say to someone struggling with the invisible but very real medical disease that is infertility!  I promise, anyone who has been trying to conceive for longer than a year has tried “relaxing,” and if there’s a medical condition preventing conception, then relaxing some more won’t help!  If you’re reading this and you’re at that point where you’ve been trying longer than a year without success and you feel like something’s wrong, trust your instincts.  Go to the doctor, and if they brush you off, go to another doctor.  Get help.  You don’t have to commit to any treatments right off the bat, but it never hurts to be your own advocate and start asking questions, having tests done, and getting answers.  We are really blessed to live in a time when there are more medical advances than ever before in the field of reproductive science, and you just never know what path might take you to your miracle baby.