Patient Spotlight: Christina and Allen
I met my husband, Allen, in 2009, as I was entering graduate school. After I graduated and started my career in the healthcare industry, we spent our time traveling our hearts out and enjoying our lives together. We got married in 2017 and we felt ready to grow our family. I had always had very normal cycles with no complications, so I thought this would be no problem for us. Ha – boy was I wrong!
Towards the end of 2017, we quickly became pregnant and we were over the moon! We started buying cute little clothes and fun things for a nursery, totally naive that things could go wrong. Our world was shattered at our first OBGYN appointment in early 2018, when the ultrasound showed that our baby had stopped growing around 5-6 weeks and there was no heartbeat to be found. Our doctor assured us we were still young(ish) and this was likely just an issue of chromosomal abnormalities. She said this was common and we still had a very good chance of having a normal pregnancy the next time around. Later that year, we would become pregnant again, but ended up miscarrying a blighted ovum (an empty gestational sac) followed by a chemical pregnancy (HCG levels dropped before we had an ultrasound).
At this point, we were referred to our first Reproductive Endocrinologist (RE). The recurrent pregnancy loss panel showed that I had positive antiphospholipid antibodies and this doctor concluded that if I started baby aspirin coupled with Lovenox, this would likely “solve” our issues of recurrent pregnancy losses. Despite adding these new medications, we would have another chemical pregnancy followed by another missed miscarriage.
Emotionally, we were exhausted. After what felt like powering through these 5 pregnancy losses, we both agreed we needed to seek some community with others for support. We attended a support group at our church and I met a girl who had also suffered recurrent miscarriages. Our stories were so similar and she directed me to her doctor, who treated immunology issues. We went through a multitude of immunology testing, which showed I also had elevated natural killer cells. This doctor advised us to add intralipids to our protocol to help suppress these natural killer cells. We went through several monitored cycles and IUIs and surprisingly under the care of this doctor, we were unable to get pregnant. At the end of 2019, we decided to stop treatments for a few months just to give ourselves a breather from all the stress of fertility treatment. We become pregnant again, only to find out on Christmas Day that the 2 pink lines had disappeared quickly and we were having another chemical pregnancy.
At the start of 2020, we switched doctors again due to insurance and financial reasons. We decided to undergo one more IUI with a stronger injectable medication for “a better quality egg.” This would be our last ditch effort before potentially shifting over to IVF. We became pregnant and saw a beautiful heartbeat on the ultrasound at 6 weeks, and the doctor assured us that our miscarriage chances were very low at that point. A week later, a pandemic would hit the world and shut everything down. Our next ultrasound showed that our baby had stopped growing and the heart had stopped beating. We met with a different doctor that day, who very crassly said “there’s a chance you may never be able to carry a baby to term.” This completely broke us.
With that doctor crushing our very last ounce of hope, we needed to leave and go elsewhere. We started researching the internet across the country for doctors that had a lot of experience with complicated cases. My gut told me there was still an immunology component to these losses and we wanted a doctor who would address this. I connected via Instagram with a woman who had suffered 13 miscarriages but went on successfully to have 3 kids, and spoke to her about her experience. Unfortunately, traveling across the country during a world pandemic was not possible. Little did I know, there was a sister clinic right in the heart of Dallas. We immediately set up a tele-health appointment with Dr. Saleh, who right off the bat, was very empathetic. He was the first doctor to be genuinely compassionate and feel the heaviness in our hearts from the last 2+ years of recurrent losses. He looked at our thick medical records and said “I really think I can help you.” Given our history of losses, he suggested we do IVF to control all the variables involved with our medical history – antiphospholipid syndrome, low AMH/possible egg quality issues, elevated natural killer cells. We listened to his rationale and we were on board.
In the summer of 2020, we nervously started the entire process of IVF with PGS testing. We knew IVF was not a sure shot for giving us the baby we so desperately wanted. Yet, we knew it would be a really good chance. If we were to yield viable embryos, it would assure us genetically normal embryos, allow for the perfect timing for intralipids/dexamethasone to suppress my immune system effectively, allow us to start Lovenox at the right time to help properly lay a good foundation for spiral arteries, etc. So, we optimistically went in to our first transfer, praying this would finally work for us. Sure enough, we got the phone call – “your HCG level is rising” – but we were oh so cautious because the first number, although over the threshold of being positive, was still on the low side. Unfortunately, this pregnancy ended in a chemical pregnancy. We regrouped with Dr. Saleh, who was left scratching his head. He explained, there was one more test we could try and we will have exhausted all testing. He explained that for an embryo to implant successfully, there needs to be “good fertilizer” aka progesterone in the uterine lining. An ERA test would be able to tell us if the ground work for my lining had enough progesterone to successfully sustain a pregnancy. This made perfect sense – a seed cannot grow in poor quality soil like an embryo cannot grow without proper nutrients/progesterone. This was truly our last ditch effort and we decided to do an ERA. Good thing we did because results came back that I needed over a day’s worth of extra progesterone. We were shocked! This was starting to make a lot of sense. At the end of 2020, we moved forward with our second transfer and it ended up a complete success!
After 3+ years of recurrent losses, feeling completely hopeless, and not being sure we would ever be able to carry a baby to term, we have now made it to the halfway point (20 weeks)! 8 losses later, this pregnancy still does not feel real. Unfortunately, becoming pregnant does not take away the anxiety and PTSD of pregnancy loss and infertility. However, we take it one day at a time, one doppler and ultrasound at a time, and try to live every moment appreciating that this baby has continued to thrive! Infertility and pregnancy loss is hard. We had to learn to advocate for ourselves, become educated about this process and what the options are, and learn to walk away when your gut tells you something is not right. Through this experience, we have also found that doing it alone is very difficult. It makes a world of difference to find the right doctor who fights for your best interest and a community to walk alongside you through this journey – to carry you through the rough waters and to celebrate the victories!