Infertility

Thank you again for the overwhelming love and support over the past week. After opening up about the struggles that we’ve encountered in our infertility journey, I have heard similar stories from hundreds of women and couples that brought tears to my eyes. The topic of infertility and miscarriage is rarely discussed, making those going through it feel ashamed and alone. Before experiencing infertility myself, I had no idea how prevalent it really is with 1 in 6 couples diagnosed with unexplained infertility and 1 out of 4 pregnancies ending in miscarriage before the first trimester. As difficult as it is to open up about this traumatic experience, I know how reading about other women’s stories gave me the hope that didn’t let me give up on my dream, no matter how painful it was. So here’s my story…

Prior to my emergency ovarian surgery, I had a normal menstrual cycle although I did experience some hormonal symptoms such as acne, bloating that made me look 6 months pregnant at times, and extreme inflammation that looked like visible water retention throughout my face and body. Prior to the surgery, I had seeked out various doctors from Naturopaths to Women’s Hormone Specialists for 10 YEARS and not a single doctor ever cared to touch my abdomen that was the root cause of the bloating issues. In fact, after the last doctor that I seeked out - a female GP that specialized in Women’s Hormonal Health - tried to convince me that there was nothing wrong with me, she asked me to fill out a mental health questionnaire. This was my breaking point. I was starting to think that the symptoms really were just in my head since every single practitioner could not find any issues. In their eyes, I was a young, seemingly healthy woman that was well versed in exercise and nutrition and probably just overreacting about PMS symptoms. “The birth control pill should help solve your problems.” And by solve, they meant mask - the pill would mask all my problems. You can read more about the experience that led to the emergency surgery here.

I was told that the surgery went well - they removed both cysts safely from each ovary. Prior to this surgery, I hadn’t thought about having children. If you know me, you know I’m a go getter - I quit my corporate sales job to open a business with my husband at the age of 25, our CrossFit and Private Training Facility, Semiahmoo Athletic Club which is home to 300+ CrossFit Members, Private Training members, and every local Sports Team in the White Rock/South Surrey area. I opened a second nutrition coaching business shortly after which has now grown to the amazing team called the SnS Squad. I didn’t choose coaching health and fitness for the money, I am truly passionate about changing lives and I dedicate my whole heart into everything I do - I had goals that I wanted to accomplish before transitioning to motherhood. I knew that it would be an exciting but demanding new chapter in my life, and I wanted to feel content with all that I’d accomplished leading up to that moment. I wanted my child to be proud of her hard working mother that had the unique ability to touch so many lives.

However, a few months after the surgery when my menstrual cycle never returned, I started to worry. I asked for a follow up with my surgeon, and was shocked to learn that there was no follow up post op. So again, I started seeking out my own health care team. I worked with the Boucher Clinic of Naturopathic Medicine and the Pacific Centre of Reproductive Health to learn more. They had diagnosed me with unexplained infertility and told me that it was most likely stress related or a byproduct of the extreme trauma my body had went through with this emergency surgery. PCRM started running some tests and I learned that something happened during the surgery that caused my Pituitary Gland to turn off. This gland in your brain influences nearly every part of your body. The hormones it produces help regulate functions such as growth, blood pressure and reproduction. Upon an MRI of my brain, I also learned that I had a tumour growing in pituitary, although the doctors claimed it was too small to have an impact on my lack of hormonal function. They told me that I could still get pregnant, but it would have to be with the use of assisted reproductive technology. At this point I was VERY against using synthetic hormones after my terrible experience with birth control, so I started looking at every other natural option. I spent the better part of the next year using Naturopathic tinctures that would mimic a menstrual cycle, acupuncture, stopping high intensity exercise, gaining body fat, and reducing my work load to see if my natural cycle would return. In my nutrition coaching practice, I had helped hundreds of women diagnosed with Hypothalamic Amenorrhea (HA) to conceive naturally, so I knew that if this truly was the correct diagnosis, I could heal myself. After a year of reducing my stress levels, gaining a healthy amount of body fat, eating 2500+ calories per day, prioritizing sleep, and staying consistent with my natural herbs, I saw zero progress. Losing my faith in doctors, I wondered if the diagnosis was correct, or if something happened during the surgery, or if the tumour in my brain was growing.

I returned to PCRM for more testing, and again, I learned that there was no progress - my hormone levels were non existent and when they retested my AMH level (a test that is used to assess a women’s ovarian reserve or egg count), the already low number had rapidly declined in less than a year. As a healthy 27 year old (when I had the surgery), I never thought that fertility was something that I should be concerned about, however, I was once again shocked to learn that the surgery had wiped out my egg count. Women are born with all of the eggs they will ever have in their life (approximately 1-2 million at birth). Throughout their lifespan, starting at the first menstrual cycle, the body recruits a group of follicles (each with a small immature egg inside) that have the potential to respond to hormones, grow and ovulate. Usually, a woman will ovulate one egg per month, the eggs that do not get selected to ovulate will dissolve and the process repeats itself if a woman is not pregnant that month. This is why fertility declines as we age. Since our eggs are located on the outside of our ovaries, when the surgeon removed the cysts, I ended up losing a large portion of my healthy eggs to the point where I was diagnosed with diminished ovarian reserve (DOR). All this new information, combined with the plummeting stats of successful IVF and natural conception after the age of 30, scared me into trying my first round of IVF.

Since I don’t touch pharmaceutical medications like cough syrup or pain meds, the thought of injecting myself with hormones made me sick. However, the fear of having the decision of motherhood stripped away from forced me to sacrifice my values for my desire to start a family with my husband. Our first round of IVF resulted in 5 viable embryos (12 eggs, 6 fertilized, and 3 made it to day 5 for transfer). We chose to transfer 1 embryo this time. Upon the HCG test (the pregnancy hormone that the embryo creates after implantation) 10 days later, we learned that it had implanted and I was pregnant, however the HCG levels were very low and they warned me not to get my hopes up. The levels are supposed to double by the 2nd test conducted 2 days later - mine increased but they still weren’t great. They sent me back for a 3rd test after another 2 days and the levels started to decline, which meant it was a chemical pregnancy that would result in an early miscarriage. On the next transfer we tried the remaining 2 embryos and they both failed to implant. I tried another round of IVF almost immediately after with similar results. We transfer another 2 embryos, of which one implanted and resulted in another early miscarriage. I had one frozen embryo left to try but the emotions of miscarriage and failed transfers became too much pain to cope with and I found myself spiralling into depression. I had been living the better half of the year as a countdown to the next injection, the next egg retrieval, the next embryo transfer, the next 2 week wait, the next HCG test. It was sucking the life out of me. So I decided to focus on myself - I would be turning 30 in 6 months and I wanted to stop feeling like shit and get back to being me. So we left the frozen embryo to have a great summer and coincidentally, COVID hit us around this time. With all the impact the pandemic had on our business, I’m glad I decided to push pause on the fertility treatments as I do strongly believe that our perception of stress plays a crucial role in the ability to conceive, whether that’s naturally or through ART, hormones play a powerful role.

We spent the next 8 months pivoting our business strategy to fight to stay operating throughout the pandemic, and when things calmed down a little, I decided I was ready to try again. I didn’t want to get my hopes up this time, but it was hard not to as this was our last embryo. I started on the medications again and we booked a relaxing trip to Banff to distract me during the 2 week wait. We had the car packed up and were scheduled to leave for our trip immediately after the transfer. On the way to the clinic, I received a call that the embryo didn’t survive the thawing process and my transfer was cancelled.

After coping with that heart breaking news, we decided that we had to give ourselves one last shot at IVF. We weren’t ready to give up yet, but we wanted more answers. Dr Caitlin Dunne explained that while most females my age have 50% healthy eggs, mine were likely closer to 25% since the surgery diminished most of my egg reserve. She was hopeful that I could get pregnant because of the previous embryos that had implanted, but it may just take more cycles to find that healthy embryo. Since most early miscarriages are the result of genetic abnormalities that do not allow the embryo to grow and develop, she suggested I do PGT testing to screen the embryos for genetic abnormalities so that I wouldn’t have to go through the pain of failed transfers. This is something I wish was discussed prior to starting my first IVF cycle, as the cost is minuscule in the grand scheme of an IVF cycle and would have saved me a lot of time and tears. Although like with any test, it’s not 100% accurate, this test would give me the answers I was really looking for to understand if it was my egg quality resulting in all these failed implantations.

We both decided this would be our last shot at IVF before exploring other avenues such as egg donors and adoption, so I spent the better half of the year really prioritizing my health. I had taken a huge step back with work stress - I expanded my Nutrition Coaching business with support staff employees, and I no longer trained clients or taught classes at Semiahmoo Athletic Club. I stopped most forms of high intensity exercise and focused on strength training and walking for movement. I continued to eat 2600+ cals/day even though my activity level dropped dramatically as I was very lean and wanted to put on extra body fat to support the hormone production that would hopefully help me get pregnant. I supplemented with Prenatals, CoQ10 and DHEA for over a year, which studies had shown to help improve egg quality in menopausal women (which was basically where I was at with my hormones/egg levels). After a solid year of prioritizing my health, although my period never returned, my AMH levels actually increased slightly, which they say should only decline overtime. This news had me excited and optimistic for our final round. Our 3rd round of IVF produced 5 viable embryos for transfer and we sent them all off for genetic testing. We were disappointed to learn that 4 out of 5 embryos had come back genetically abnormal and one embryo produced no result, which apparently happens 50% of the time. They asked us if we wanted to go ahead with the no result embryo or send it back for more testing. Although the risk of thawing and re-biopsying the frozen embryo could harm it, we needed the answer to determine our next steps if this didn’t pan out. So even though the doctors did not sound hopeful and we were also starting to lose hope, we pushed for further testing.

It was around this time that we started researching donor eggs and adoption. We even went as far as registering on all the donor sites and choosing a candidate. At this point in our journey, we learned not to put all our eggs in one basket so that we wouldn’t be heartbroken at the results. Mentally, I needed a back up plan to have something positive to focus on just in case. I will never forget the call with the genetic counsellor. It was late on a Friday night, I was aimlessly strolling the aisles of Nature’s Fare wondering what to make for dinner when my phone rang. I had the PCRM phone number memorized at this point, so I braced myself for the probably disappointing news she was about to share as I headed to the chocolate aisle to decide how I was going to drown my sorrows this time…

“The test result for the embryo came back… It’s… normal.”

I swear she sounded as shocked as I was when I dropped the chocolate bar on the ground. Dr Caitlin Dunne was right, I COULD produce a genetically normal embryo on my own, but it just took a lot longer to get there. Now, a genetically normal embryo doesn’t mean it will 100% lead to implantation and a viable pregnancy, but considering that the early miscarriages were more than likely a result of a genetically abnormal embryo, this was really, really great news.

Since we had already decided before this cycle that it was going to be my last, and I only produced one egg worth transferring, I decided to be over the top with giving my body EVERY shot at a successful pregnancy. I didn’t workout from the day of the transfer to my early ultrasound at 7 weeks. Although there is NO research correlating exercise to miscarriage, since there is no research on how the stress of IVF, essentially a surgical procedure, can impact your pregnancy, I wanted to reduce as much stress on my body as possible to give it the best chance to receive that healthy egg. My only physical activity was walking, but I still continued to eat 2500+ cals/day. At this point, weight gain didn’t phase me. In hopes that excess body fat could help produce the necessary hormones to carry this pregnancy to term, I actively tried to gain 10lbs prior to the transfer (which wasn’t hard with being on the highest dose of hormones). I was quite lean leading up to the transfer, so this decision gave me peace of mind that I was supporting this pregnancy in every way possible. I also continued to take on a reduced stress load with work and prioritized sleep as much as possible. Again, none of these things have been PROVEN to help the embryo implant or lead to a viable pregnancy. However, I have spent years studying and working with women who have conceived through their natural cycles, as well as women who have used IUI/IVF, so I used everything that I knew had worked for my SNS clients on myself.

The 2 week wait was usually the time where I (and most women) would go crazy googling how every single possible twinge could be a sign of implantation or going down the rabbit hole of message boards to compare your day by day experience to those who had a successful HCG test. However, I learned NOT to compare my journey to others. Just like some women experience all the nausea, fatigue, pain and others do not, neither the presence of lack of these symptoms make you more or less pregnant. In addition to that, I had been on the HIGHEST dose of hormones on and off for the past 3 years, so I knew that a lot of the symptoms could be attributed to the medications. I stayed away from Dr Google as much as possible to help reduce my mental stress. I didn’t experience any implantation bleeding (usually light spotting), nausea, fatigue, sore boobs, etc so I had nothing to google anyway… so 10 days later I was shocked to learn that my HCG test came back at 78, the highest it had ever been! The PCRM nurse called me to inform me and send me a requisition for another test in 2 days. The tone of voice was completely different with this call - she was congratulating me and sounded positive, which was very different from the other 2 calls with a low HCG that ended in miscarriage. Apparently a score over 50 is “good” and as long as it increases by 70% at the second test, it is progressing well. The 2nd test came back at 168 - more than double! After this, there was no testing until the 7 week early ultrasound.

If this was a regular pregnancy, I probably would have resumed my normal activities. However, this rainbow baby was made with 3 years of heartache and a hefty bill, so I didn’t want to risk anything. I continued with my daily walks and because of the current pandemic situation and the unknown risk of COVID on pregnancy/miscarriage, I isolated as much as possible. When ultrasound day FINALLY came, I was ecstatic to learn that I had a healthy little fetus growing in there with a 150bpm heart rate. I finally got to breathe a sigh of relief, and started to resume some of normal activities like easing back into my exercise routine. More on that in the next post recapping the first trimester!