Monday, May 23, 2016

Kayla and Rex's Infertility Journey

I was the little girl that asked for baby dolls every single Christmas until most would have considered me too old. I have always loved children and knew that I wanted some of my own. As I grew up I could always predict what the next step would be. I graduated high school, went to college, got married and fully expected to take the next step into starting my family as smoothly as all the other life steps.  When we had been married for about a year and we were nearly done with college, we decided it was time to start building our family. I went off birth control six months prior to when we actually started trying because I heard it could take a while to get out of your system and I wanted my body to be fully ready when we started to try. I did not want it to take long. I am the kind of girl who figures out what she wants and takes every little step to make sure it happens.  We were finishing college with internships and student teaching and we were sure our parenthood induction was waiting just around the corner. Six months passed and we were getting ready to move. I decided before we moved that I should have a quick visit with my doctor just to check if everything was okay.  She ran the typical pre-conception tests.  The results came and there were no real signs of a problem. The doctor told us everything looked fine and we should just keep trying. I had just accepted a job as a 2nd grade teacher and we moved back to the Boise area.
By the time we had been trying for a year, I was starting to get frustrated.  Through research, I found that the next best step would be to have my husband, Rex, evaluated. He had a semen analysis and it came back that he had low motility (swimmers are slow). Rex’s doctor then referred us to an RE (Reproductive Endocrinologist), a label we would become very familiar with over the next few years. Rather than being upset with the referral we were hopeful and excited because there was a problem to be solved.
Everything with fertility is a waiting game. It took a few months but we finally had our fist consult with the RE. I was surprised at how busy the office was. It was filled with people who were obviously trying to have children just like us. For once in this trial I didn’t feel as alone. Infertility is very rarely talked about and when it is, you seem to always be getting advice from people who pop children out left and right without any trouble. Our first appointment was overwhelming to say the least. The doctor spoke in big terms about all the possible scenarios. I completed the tests and work ups throughout that week driving back and forth from school to the doctor which was a 45 minute drive. They put Rex on some vitamins to improve motility. My test results came back with no apparent problems and within a few months the vitamins had increased Rex’s motility to acceptable parameters. With this news we were now eligible to do our first medicated Intrauterine Insemination (IUI). The doctor was sure it would work because my egg quality was great and I was only 22 with no known problems. I was hopeful and positive but we soon found that the IUI had failed. We went on to try two more IUI’s all in consecutive months. We received news that our last IUI had failed during my last week of school. I got the phone call in the middle of class and had to wait until my students went to recess to check it.  Those were always terrible phone calls to receive. I would go in for a blood test in the morning and then wait anxiously all day until about 5:00pm for them to call me with the results.  This time the message came with another bit of news. The doctor said that after three tries the chances of IUI working decrease dramatically so we needed to meet and talk about other options. We met with her and she told us her thoughts. She had a slight suspicion that I could have endometriosis and Rex was having inconsistent sperm samples. The options were surgery to see if I had endometriosis or Invitro Fertilization (IVF). The Doctor strongly recommended the IVF route. She said that, even if I had endometriosis, IVF would override any problems that endometriosis might be causing so the surgery wouldn’t do much. The only thing surgery might do is give us a diagnosis. Rex had to go to work and I sat through the IVF financial consult by myself.  It was terrible being there all alone and hearing that our dreams of having a baby would not come without $10,000 or more and a lot of paperwork.
                  After receiving all this information, we still felt that IVF was not for us yet. So I started researching. If I was going to do IVF in the future then I would at least like to know if endometriosis was my reason for having to do it. Side note: Endometriosis can only be confirmed through a surgery called laparoscopy. Almost everything I researched led me to believe the surgery was not a big deal. Torn between my research and what my doctor had said I decided to get a second opinion. The doctor had also encouraged us to continue with a few more IUI’s while we made our decision but I was sick of being pumped with hormones, stuck with needles, being on an emotional rollercoaster, and we were out of money. All of our treatments had to be paid for up front and without insurance and it had been several thousand dollars each month. So we decided to just take a break from treatments for the summer and explore our options. During this time, Rex also worked for the airport part time and we got to fly for free We took a few trips to the Oregon Coast, Seattle, and Hawaii. Hawaii was perfect for us to relax from all our worries and just have a good time together.  I had to get a referral to go to the Endometriosis Doctor for a second opinion so it took a while to get in.  The doctor was very confident and I felt totally comfortable with everything he was saying.  He told me that the surgery was a great option before we spent thousands of dollars on IVF and that he had done the procedure many times and had seen great results. We were excited. We had a new plan and we had direction. I was to call the office as soon as my next cycle started and they would get me in for a laparoscopic surgery. Lucky for us my cycle is always right on time. During my wait for my next cycle, I had a dream that I gave birth to a sweet baby boy. The dream was very vivid and when I woke up I was so happy I could hardly stand it. From that point on, I was sure the surgery would work and we would get pregnant on our own. I finally had my surgery and they found stage 2 endometriosis. It was mild and they removed it. The doctor did not think it was significant enough to be causing all our problems but he still encouraged us to try on our own for six months because there was always a possibility that this was causing the problem. Recovery didn’t take long and that was good because two weeks later I started my second year of teaching second grade. Emotionally we were starting to struggle. We had put so much time, effort, and money into trying to start a family and nothing was working.  We could not even think about doing IVF because it would cost well over $10,000. 
During our wait Rex got a new job. This was exactly the job he wanted and was right in the field he had studied in college not to mention we found out that his new insurance would cover infertility. Seriously, there are barely any insurance companies in the United States that cover infertility. They would cover six IUI cycles in a lifetime and two IVF attempts. This was truly the best news. This would not make our treatments free, but would certainly make them more affordable. Things were finally falling into place. It had already been almost 6 months since my laparoscopy and we had not seen results. Our next step after two years of trying, three IUIs, and a laparoscopy was IVF. We immediately got started. I went in for our IVF consultation. It was very overwhelming but very exciting at the same time. I was so nervous to start because this meant I would have doctors’ appointments every day until egg retrieval. I also had to work. I would go to my appointments in the morning and teach in the afternoons. Egg retrieval came quickly because my body had responded so well to the medication. They retrieved nineteen eggs.  The next day there were eleven mature and eight had fertilized. The next call came and only seven were still mature and we only really had three that would for sure be good for a five-day embryo transfer.  I asked if this was a rapid rate at which the embryos decreased and the nurse said it was slightly unusual. I then asked if we needed to do a three-day transfer and she said no a five-day was still very much the plan since I had three eggs that were making optimal development and four that could possibly catch up. A few days later it was transfer day. I left school early to be at the doctor’s office at 1:00 for the transfer. As soon as I got in the car, I saw that I had barely missed a call from the doctor. I quickly listened to the voicemail she had left and felt my heart sink when I heard they had discovered something and I needed to call as soon as I could. I called them right back and they informed me that none of the embryos had made it. The embryos had not developed anymore after day three. I immediately started bawling.  I was in shock. I was driving to my embryo transfer and I had just been notified that they all died. I called Rex and told him that it didn’t work and we have nothing to transfer. Hearing those words come out of my mouth broke my heart. I went back in my mind to the weeks previous. I replayed all of the scenarios, both the good and the bad. This was not one scenario I ever anticipated. I had 19 eggs and now all of them had died off. We did not have anything to transfer. We drove to the doctor’s so she could try to piece together what had happened. We sat in the waiting room not talking, just sitting and thinking about how this happened.
                  In one years’ time we had done three IUI’s, one laparoscopy, and one IVF cycle, all failures. The doctor proceeded to tell us that the only explanation for the embryos was that they grew too quickly because my body responded so well to the meds and that affected the quality. She was not sure this was the case but other than that it just seemed like a really unfortunate fluke. She encouraged us and remained optimistic. The appointment ended with pictures of our embryos and their progress before they arrested. Before we left, the Doctor said, “Call whenever you are ready to try again and I hope it is soon.” I was so overwhelmed with the thought of trying again. I had already missed so much work and not to mention my body had been through so much in the last year. Pumping more hormones in seemed like the worst idea. I was ready to take a break both physically and mentally. It was almost Christmas and I had barely even taken time to enjoy the season.  Our rental house contract was almost up and we needed to focus on finding a house to buy. House hunting would be a fun adventure to distract us. So we spent the next few months house hunting and trying to forget about our fertility worries. However, when it is something you want more than anything in the world, then there is no way you go even a day without thinking about it but we gave it a valiant effort.
A few months passed and we had bought a house and we were now ready to return back to our journey of starting a family. I sat across from the doctor and rehashed what had happened in the last IVF cycle. It had been almost six months since our first IVF. I was optimistic and we chose to begin as soon as I went on summer break. I decided to try acupuncture along with this new cycle. A friend had recommended it to me and I thought it would be good to try.  Things looked better than the previous time from the start. My body loves the medicine so it does not take much to get my follicles stimulated. We retrieved twenty-one eggs and eighteen fertilized. The doctor was optimistic and she told us she would like us to do a day five transfer because things were looking so much better. The doctor called with an update on day three, I had twelve grade “A” embryos. We were in route for a day five transfer. I pushed for a day three transfer because last time our embryos looked fine on day three but arrested by day five. The doctor was confident this would not be the case again. I got off the phone and told Rex the news. After much deliberation, we finally came to the conclusion that with 12 good embryos, even if we did a three-day transfer, there was bound to be some leftover to freeze if the day three transfer didn’t work. The day three transfer would give us piece of mind that we did all we could in case we were in the same scenario as last time where all embryos arrested. If we did a day three we would at least have a few back in the womb where they belong and we would never have to wonder what if we had transferred sooner. I called the doctor and told her that we would be doing a day three transfer. The doctor was not too thrilled that we were going against her better judgement. To be honest, I wasn’t sure why we were either. We had a qualified doctor advising us of one thing and we were going to do another. However, through this whole journey I have learned that sometimes you have to be your own advocate. Sometimes you have to add your knowledge to what the doctors are saying.
 The transfer was over within minutes.  We were so excited to have made it to this point. Last time we had been robbed of a transfer. Now it was time for the two week wait. I tried my best to take it easy and not think about it all too much. On day five, I got a call that seemed to confirm our decision of the three-day transfer. We learned that not a single embryo had made it to day five again .The nurse on the other end of the line said the doctor was very surprised to see this. I broke into instant tears. The nurse said “At least you made the call to transfer on day three. It should give you piece of mind to know that you have two good embryos back in your body where they belong.” She told me to be positive and focus on the two babies that were already in me. So that is what I tried to do. I tried to remain optimistic despite the fact that the two little embryos we had transferred on day three were the only hope we had left that this cycle would work. This was our last insurance try. Finally, the two week wait was up and it was time for the blood test. I anxiously awaited the call. The call eventually came and my pregnancy blood test was negative. I was so sad. I try to be so optimistic and push forward but that day I just let myself be sad and it felt good. I have experienced defeat in many capacities but never like that.  A few days later I had to meet with the doctor to go over what happened, why it happened, and where we were going to go from there. The doctor said at this point we needed to look farther into male factor. The fact that on both tries everything went great until day three told her that we were dealing with male factor. She said day three is when the sperm has a major role in embryo development. She recommended using donor sperm or getting a DNA fragmentation test.  The DNA fragmentation test is a much more intricate test then the semen analysis. We thought we had fixed the problems with Rex, but we were going to have to dig deeper. We let things settle for the rest of the summer. We grieved together and just tried our best to fill our time with other things and thoughts. 
Eventually we created a new game plan.  We both had an interest in getting a second opinion on our fertility outlook. We had heard about others seeing doctors at the University of Utah and had heard very good things. So, I scheduled a phone consult and since Utah is 6 ½ hours away we wanted to feel it out over the phone first. We spoke with Dr. P and instantly I knew he was someone we could trust. He had a few good suggestions of where to start and instantly had someone call us to set us up as part of a study. This study would require Rex to take a vitamin daily and it would possibly improve his sperm count and function so long as we did not get the placebo, which was a 50/50 chance.  However, regardless of whether it was the placebo or the real deal, we would get paid for our trips to Utah every other month for six months. We also would get free testing, which we desperately needed. Rex did a DNA fragmentation test and the results came back that he had sperm DNA fragmentation. They then requested he get ultrasounds to see if there was a varicocele that could possibly be causing the fragmentation. We found that he had a bilateral varicocele. This means he actually has two varicoceles. They strongly recommended surgery to fix the problem and a few months later we returned to Utah for surgery to remove the varicoceles. This leads us to our current situation. We are currently waiting three months before we have another appointment in Utah to see if the surgery was a success and to, once again, find out what direction we will be pointing our sails in. 
                  A quote that I have read many times says, “Never give up on something that you can’t go a day without thinking about.”  I think about having a family daily and I will not give up. It has been three years now since we started this crazy journey. I will be the first to tell you that infertility is not easy. It is the hardest thing I have ever been through. It is truly a roller coaster. We have had many twists and turns and ups and downs. However, I do know that having a sweet little family of our own will be worth every expense, heartache, tear, disappointment and bad day. It will all be worth it in the end. Winston Church Hill once said, “Success is not final, failure is not fatal: it is the courage to continue that counts.” I believe that everything happens for a reason. We may not understand the struggle we are going through now, but someday it will all make sense. I do not know when things will turn out for Rex and I, but I know that if we keep walking in the direction of our dreams we will eventually get there. This has been a character building experience for me. When things get hard you find out what you are really made of. Rex and I have been knocked down a lot in the last few years but as a result we are closer and we are learning how to support each other and be there for each other through the really hard stuff. I have been able to reach out to people and connect on a deeper level. I am more sympathetic and compassionate towards others. We may not get our family the way we originally planned and certainly not within the time frame we had planned but things will change for the better. We also have been able to look around us and take inventory of the many blessings we do have. We have wonderful family and friends. We have our health. We have each other. We also have been able to see God’s hand and tender mercies all through this journey. We really are so blessed.

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