The views and opinions expressed are those of the authors and should not be considered medical advice.
Always consult your doctor for the most appropriate treatment.
When facing fertility issues, no matter how much we hope, research, and plan—and we should do all of those things—having the knowledge, experience, and guidance of an RE (reproductive endocrinologist) can make all the difference.
When facing fertility issues, no matter how much we hope, research, and plan—and we should do all of those things—having the knowledge, experience, and guidance of an RE can make all the difference.
After dealing with 2 miscarriages by age 30—yes, pregnancy issues can happen that early—finding a fertility specialist or RE I could trust early on helped me through the most difficult and painful experience of my life.
In August of 2017, for our 2-year anniversary, my husband and I went to Italy. I was 28 years old and had been on birth control since I was 15. On that trip, my husband and I decided that I should stop taking the pill, because we wanted to start trying for a baby in January, and I had heard stories of other women not getting a regular period for a while after going off the pill.
Fast-forward to January 2018; I still had not gotten a period. I went to my OB/GYN, who is a very straightforward woman. She looked at me and said, “You can give it a full year, and you and I can sit here and have this conversation then, or you can make an appointment with an RE now.”
After dealing with some insurance issues, I found a doctor covered by my plan.
I went to an RE right away and we hit it off. He did some blood work and an ultrasound, which revealed that I had many tiny (cyst-like) follicles, and he diagnosed me with PCOS (polycystic ovary syndrome). He seemed fairly confident that this was an easy and straightforward fix, and that I’d get pregnant in no time.
My husband went for a semen analysis, and that came back perfectly normal. My RE had me take progesterone pills for a few days and then stop abruptly, which would cause a “withdrawal bleed” (AKA a period). I went for a spa weekend with a good girlfriend and both of our mothers-in-law, shook off the PCOS diagnosis, and got excited that I finally had a path forward, that I would have a baby.
At the end of the weekend, there it was—a period! I was so excited I could barely contain myself. I was cleared to start my RE’s drug protocol that evening for 5 days. The pill he prescribed would help the tiny follicles mature to the right size.
Over the next few weeks, I went in for monitoring every few days, and waited for the follicles to grow. When I had a good-sized follicle, it was time for my husband to give me a hormone injection at home to force the follicle to release into the fallopian tube so it can meet the sperm and potentially be fertilized. We opted to do our first cycle with monitoring, drugs, and timed intercourse at home—kind of the “natural way.”
We tried for 3 days in a row, as instructed, and then started the 2-week wait, which is the time between ovulation and when you can find out whether you’re pregnant. Pins-and-needles time!
The day before I was due to go back to the doctor for the pregnancy hormone (HCG) blood test, I decided to take a home pregnancy test. My husband and I stood anxiously in our bathroom over the blinking stick, waiting for an answer, and then, boom—“PREGNANT” flashed on the little screen!
My husband and I stood anxiously in our bathroom over the blinking stick, waiting for an answer, and then, boom—“PREGNANT” flashed on the little screen!
The next morning, I went back to my RE’s office and the blood work revealed that although I was pregnant, the numbers were a bit low. I returned 48 hours later to repeat the test. At this point, I didn’t really understand that there was such a thing as being “a little bit” pregnant. I figured it was just positive or negative, just like the at-home tests said. Turns out, it’s not so simple. I really was a little bit pregnant…
48 hours later, my beta (HCG) more than doubled, and the RE was happy. But my progesterone (a hormone that keeps the uterine lining from shedding) seemed a bit low, so they suggested progesterone suppositories. I followed the doctor’s orders and went about my normal life. I still traveled, went to the gym, worked, and ran errands. I was ecstatic to be pregnant. I went for weekly sonograms and blood work, and everything looked fine.
At 8 weeks, I graduated from the RE’s office back to a regular OB/GYN. I was so excited that I had made it!
But at 11.5 weeks, I was spotting so I went back to my OB/GYN. The sonogram tech slid the machine over my belly, back and forth, back and forth. She didn’t have to say anything. I knew. The baby was gone.
You’re given a choice when you’re about to lose your baby—miscarry naturally or opt for a dilation and curettage (D&C). Neither option sounds good, but I opted for the natural way since I had already started bleeding. It was utterly exhausting.
Since I trusted my fertility specialist, and he thought we could have a viable pregnancy and a baby, I went back to him to figure out our next steps. The first thing he wanted to do was to make sure my HCG went down. It’s weird how you want this number to skyrocket when you’re pregnant and then can’t wait for it to drop when the pregnancy isn’t viable. He told me we could try again when the number fell below 5. This took 3 months, which shocked me. THREE months in trying-to-conceive time is practically an eternity.
When fall came, it was time to try again. I did get pregnant, but at 7.5 weeks I miscarried again. This time I opted for a D&C, which was performed by my RE in his office a day later. The D&C was quick and painless (they put me under general anesthesia). The whole thing took about 20 minutes, then I was home resting for the remainder of the day.
This time, the RE suggested we run a “repeated pregnancy loss” (RPL) panel. They took about 15 vials of blood. Over the next several weeks, as the HCG levels dropped, he performed more tests: an HSG to make sure my tubes were open; a water sonogram to make sure my uterus was the correct shape and didn’t have any fibroids or other unwanted matter in it; a hysteroscopy, which inserted a camera into the uterus to make sure everything looked right inside; and finally an endometrial biopsy to check for infections and for a luteal phase defect (when your lining sheds too soon, so the egg can’t implant properly).
All of the blood work came back normal. The fetus tested normal—no chromosomal abnormalities. Both my husband and I tested negative for chromosomal abnormalities. I had slightly elevated antiphospholipid IGM levels, and my thyroid was a touch high. The RE suggested I change prenatal vitamins. None of these seemed like a direct cause, but any one of them could have been a contributing factor.
I was plagued by disappointment, but I pressed ahead. It was helpful that my RE felt we could get to the bottom of this. He was eager to figure out the problem and determined to give us a solution.
It was helpful that my RE felt we could get to the bottom of this. He was eager to figure out the problem and determined to give us a solution.
Finally, a day after my endometrial biopsy, my RE called me. He had what he finally thought was the answer. The biopsy showed that my lining was way thinner than it should be, perhaps making it difficult for the embryo to implant properly. Again, a seemingly easy fix. We increased the suppositories to 3 times a day, we incorporated progesterone in oil shots once daily, and started this regimen 2 days after ovulation rather than after confirming a positive pregnancy test. We also used an injectable hormone, in addition to the pills, to create a stronger corpus luteum (which is supposed to secrete progesterone in the beginning of pregnancy, before the placenta forms and takes over). I felt such a sense of relief.
I went back for monitoring every single day on the injectables because with PCOS, I risked hyperstimulation. This cycle was mentally more trying than either of the others both because we had experienced 2 miscarriages and also because there was this idea of growing follicles, but not too many.
I was glad to be in the right hands. Ovulation happened at day 18 and we were told again to do the deed and wait. (I learned to be so patient!)
I was glad to be in the right hands.
The Thursday before I was supposed to go for the HCG test at the RE’s office, I took a home pregnancy test. This time, at last, again—“PREGNANT” flashed across the screen. My only symptom was a constant, slight cramping. Less pain than period cramps. That Saturday my RE had me come in for a beta test. Sure enough, both the progesterone and HCG levels were nice and strong. We were back in business.
Where are we now? Our baby boy is due this November. I go to my RE almost every other day, and acupuncture twice a week. I spend almost all of my free time researching plausible possibilities for what might or might not happen in my pregnancy. I look at statistics for women who have miscarried twice before. I look up the odds of miscarrying after seeing a heartbeat. I research the proper size of the baby on each weekly scan. I cannot stop researching. (This is a side effect of having fertility issues, for sure.)
But I’m also counting my blessings now. Sometimes the only way out of a problem is through it. I know I’m more resilient because of what I had to handle, and I’ve learned so much from my path to having a baby.
When you’re going through fertility challenges, I cannot stress enough the importance of a support system. Know whom you can vent to and share with and who is in your corner. My husband is a saint. He never lost faith, despite my continued worry and insistence that things were going wrong. I’m also grateful to my dad, who stomached the daily “the sky is falling” phone calls from me. He spent the first 12 weeks of my pregnancy talking me off the ledge almost daily and kept me strong.
My support system definitely includes my RE, who never made me feel crazy or annoying like “just another number”—he was the most patient, kind doctor I have ever dealt with. He responded to daily emails from me and never lost hope or patience. I’m grateful I listened to my instinct to book an appointment with him, instead of waiting and waiting for a pregnancy to happen.
My support system definitely includes my RE, who never made me feel crazy or annoying like “just another number.”
I am fortunate that I wasn’t alone through this process. Some of us just need more help to make a baby, and in many ways, it makes us strong.