• Getting Pregnant and Staying Pregnant: Infertility and the High-Risk Pregnancy

• Infertility to Pregnancy: Resolve to Hope

Getting Pregnant and Staying Pregnant: Infertility and the High-Risk Pregnancy

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by Norlisa Keffer

Getting pregnant is something that shouldn't be that hard, right? For those of us who have suffered from infertility, the journey to pregnancy can be one of the most devastating. With my husband Gordon and myself, it was three years of medications, surgeries, negative pregnancy tests, tears, and broken hearts while everyone around us was getting pregnant. We were hurt and embarrassed by questions such as: "Don’t you know how to 'do it?' No baby yet? What’s wrong with you?" When you're trying to get pregnant, the only thing you think about is getting pregnant, and you only see the obstacles that prevent you from achieving your dream.

When Gordon and I got married in August 1999, we wanted a honeymoon baby. However, the pregnancy didn't happen, and our long road to conception began. I was not ovulating. Gordon’s sperm count and motility were extremely low, and much of his sperm had abnormal morphology. Surgeries and oral medications failed. Gordon and I were at our lowest, suffered a crisis of faith and almost gave up hope. Our only chance of attaining pregnancy, Gordon's urologist told us, was to undergo in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

As we went forward with the IVF, we were losing hope again: I developed an ovarian cyst, was diagnosed with chronic hypertension, and was told by an infertility specialist that my eggs looked "old" after egg retrieval.

Praying for a miracle and hoping against hope, our prayers were answered.
It still brings my husband and me to tears when we remember the phone call telling us our pregnancy test was positive. To this day, we are thankful beyond words.

Now came the worries of staying pregnant. Gordon and I were scared about anything going wrong, and I barely moved, afraid that I would make my baby "fall out." Seven and a half weeks into the pregnancy we had our last visit with the infertility doctor, where we were thrilled and pleasantly surprised by the news of a twin pregnancy. It was the most beautiful sight we had seen in our entire lives up to that point when we saw our babies and their heartbeats for the first time via ultrasound.

The difficult journey of infertility had ended and another had begun: that of a high-risk pregnancy. Having suffered through infertility beforehand makes you even more scared of having anything go wrong, because you have that fear that you may never get pregnant again. Going into a twin pregnancy with hypertension makes you high risk. Fears and "What if's?" dominate your thoughts. Although we were high-risk, a lot of the peace of mind that my husband and I got came from having the best maternal-fetal specialist available.

Transitioning to maternal-fetal medicine
Gordon and I loved Dr. Moore, my reproductive endocrinologist at the University of Washington Medical Center, but he didn't specialize in "keeping" me pregnant. Since we felt that we had the best infertility care with Dr. Moore, and since he knew how anxious we were about our pregnancy, we asked him whom he would go to in our position. He referred us to a colleague of his, also at the U, Dr. Easterling. We figured that our best way to achieve success was to pray a lot and listen to Dr. E. Going to a high-risk OB is crucial to maintain that peace of mind throughout your pregnancy. I would highly recommend getting referrals from the infertility doctor whom you already trust, and researching which perinatologist is best for you. There are different ones out there to deal with different problems: genetic disorders, autoimmune disease, diabetes, and hypertension, to name a few. How fortunate for us to have found Dr. E, because he is an expert in hypertensive pregnancies and prevented me from getting preeclampsia while I was pregnant. Other tips:

• Connecting with your doctor is crucial. Make sure that he or she understands how difficult the road of infertility was, and how fearful you are that something may go wrong. Be able to speak with your doctor and trust him or her with all of your gut to ensure the healthiest outcome possible, and be sure to know what signs and symptoms to look out for and when to call in. Remember, that you’re putting your life and your unborn child's life into this doctor's hands, and you should be satisfied with your monitoring and care. . Fortunately for us, Dr. E is not only an extraordinary doctor, but also a devoted family man and husband, and we knew that he wanted us to have what he has—our own family to love.
• Be able to ask questions and get peace of mind. When you're in that exam room, you should be able to ask your doctor anything, and nothing is trivial. As an infertility patient, with a lot of fears, at first I was afraid that I was asking too many questions. But Dr. E understood and took the time, and Gordon and I were able to ask him anything. He always took the time to answer each and every question to our satisfaction, and made us feel like we were the only patients in the world. He never let us leave his clinic without that precious gift of peace of mind.
• Have a list of specific questions, and make sure that when you leave, you have no unanswered questions and all concerns are put to rest.
• Be specific when telling your doctor things. There is a huge difference between telling your doctor that your have a stomachache or feel big and heavy, as opposed to I feel like someone is stabbing me with a knife underneath my right ribs and I feel like my baby is sinking to the bottom of my birth canal. This helps your doctor know how to treat you.

Enjoy being pregnant
After my fourth month, I was on some form of bed rest at home. Bed rest is hard--you won't hear an argument from me there. But you will never have this opportunity again to enjoy these babies inside of you. Holding my belly, feeling my babies move, kick, and hiccup, and hearing their heartbeats during my clinic appointments kept me going. I knew that I was doing this for them, and that these five months of bed rest were nothing in the big scheme of things. The years I spent being infertile, fearful that I would never be pregnant and longing to feel these babies inside of me put these few months into perspective.

Our Miracle Pregnancy and Birth
Our pregnancy had many high-risk factors: chronic hypertension, multiple gestation, group beta strep, and gestational diabetes, but Dr. E made the pregnancy complication-free. Eight and a half months after almost losing hope, and having prayers answered, we were about to have them answered again. When my pregnancy hit 38 2/7 weeks, I was induced, and our twins entered the world healthy with loud cries. Our family had become a reality; words are inadequate to describe our joy.

Getting support at every stage, from the moment you suffer from infertility, to the moment you hold your baby in your arms, is crucial. Infertility support is just as important as high-risk support. What we did and what we recommend is to find support in others who have gone through the infertility and high-risk process, to help you hold onto your hopes and chase your dreams of having a family. It helps you and your husband realize that you’re not alone. Infertility will affect you for the rest of your life, even after you do get pregnant and give birth. You’ll always wish that you were that woman who got pregnant easily and found out “peeing on a stick” vs. doctors calling you after they put your child back into your uterus. In the large population of pregnant and expectant families, the previously infertile and high-risk pregnancies are a small community. But we’re large enough to make a difference, in supporting each other and helping others achieve good outcomes. Empower yourself: reading this magazine is a good start, look at the Sidelines website, talk to your Sidelines buddy to get the support you need.

The pain that you suffer with infertility and high-risk pregnancy make the joys of having your children just that much sweeter. It is much easier to count my blessings, enjoy my twins, and realize that their hugs, touches, and “I love you, mamas” are true miracles and gifts. Before when I would ask God “Why?” today I say “Thank you!” I am thankful for having gone through infertility and my high-risk pregnancy. It has made me a stronger person and more appreciative, and I’ve grown closer to my husband, met some of my life’s most wonderful friends, and have become what I wanted to be my whole life, “mommy.” May you have a healthy pregnancy, and know that we are here on the Sidelines cheering you on.

Norlisa Keffer is a stay at home mom to twins, Frankie and Sammy. She volunteers with Sidelines and on behalf of University of Washington Medicine's Division of Maternal-Fetal Medicine, and is on the Board for RESOLVE (National Infertility Association) of Washington State.

Are You Ready To Start Trying Again?

by Ann Douglas

It takes courage to try again when your previous pregnancy has ended in miscarriage, stillbirth, or the death of an infant. You know that there's a chance that you may experience another loss, but you're willing to risk it all for a shot at the ultimate prize: a healthy baby that you can call your own.

As committed as you may be to having another baby, it's perfectly normal to feel a bit nervous about planning another pregnancy. After all, you already know that not all pregnancies result in picture-perfect happy endings. Like it or not, the innocence that you enjoyed when you found yourself pregnant for the very first time is gone forever. You can't get it back.

Don't be surprised if you find yourself experiencing a smorgasbord of different emotions when you first make the decision to start trying to conceive - everything from joy to worry to outright panic. Some days, you may feel convinced that becoming pregnant again is the only thing that will bring joy back into your life. At other times, you may wonder if you're crazy to even think about exposing yourself to the possibility of heartbreak again.

You may also find that your partner has mixed feelings about trying again, whether or not he's actually willing to express these emotions to you. After all, he's not just worried about the well being of any future babies you may conceive: he's also worried about the impact of any subsequent losses on you. If you're having difficulty deciding whether or not the two of you are actually ready to embark on another pregnancy, you might find it helpful to consider the following questions:

• Have you had a chance to work through some of your grief for the baby or babies who died? Grief can be an exhausting emotion - one that demands far more of your time and attention that you want to give it. If your baby died recently, you may still be going through a very rough time emotionally and you may not be able to embark on another pregnancy just yet.
• How would you cope if you were to experience fertility problems? If you don't think you'd be able to weather the emotional highs and lows that couples typically experience when they are having trouble conceiving, you might want to postpone your baby making plans a little while longer. While the fact that you managed to conceive in the past means that you have an excellent chance of conceiving again this time around, you have, at best, a 20% chance of conceiving in any given menstrual cycle. That means the odds of being disappointed during the first month or two of trying is extremely high. Are you emotionally strong enough to cope with that disappointment?
• How would you cope if you were to experience the death of another baby? While you may not want to even consider this possibility, it's important to go into your subsequent pregnancy with your eyes wide open. If you're still feeling emotionally fragile, it may be too soon to jump back into the fire again.
• How would you cope with the stress of a subsequent pregnancy? The worry doesn't end when you manage to conceive. If anything, it's just beginning. That's why it's important to be sure that you're up to coping with the stress of what could very well be the most nerve-wracking 40 weeks of your life.
• Are you expecting too much of your subsequent pregnancy? If you expect a new pregnancy to wipe away the grief you are feeling for the baby or babies you lost, you are setting your expectations too high. No other baby can possibly take the place of that other baby in your heart.

While there are a lot of factors to weigh in deciding whether or not you're ready to start trying to conceive again, your best bet is to listen to your heart. Most couples instinctively know whether they're ready again or not. Consider these words of wisdom from Cynthia, 35, who experienced a series of miscarriages before giving birth to her second living child last year: "If you have to consciously decide, then it's probably the wrong time. It's kind of like being in love. You always wondered how you would know when you were, but when you were, you just knew it. I think it's the same. When you're ready to try, you'll want to try. It's really that simple."

Ann Douglas is the co-author of Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss (Taylor Publishing, October 2000) and The Unofficial Guide to Having A Baby (IDG Books, 1999). She is the mother of four living children as well as Laura, who was stillborn in October of 1996 as the result of an umbilical cord knot. She can be contacted via her web site at http://www.having-a-baby.com.

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Infertility to Pregnancy: Resolve to Hope

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by Candace Hurley

Many of you dealing with a high-risk pregnancy are also those who endured years of often costly and painful medical intervention to become pregnant. I was one of those women. I found support and encouragement from a wonderful national support group called Resolve. I don’t know what I would have done without these amazing women who knew exactly how I felt while the rest of my world was seemingly “perfectly” pregnant.

The majority of my friends in Resolve built their families through adoption. Infertility treatments had a much lower success rate at that time. After four years of treatments, tests, surgeries, and heartache, I became pregnant. I began spotting almost immediately and spent the next 7 weeks on bed rest. I miscarried on Mother’s Day.

I was beyond devastated, but the very next month I once again began fertility treatments. It was the only way I could stay sane. Those who knew just what to say and exactly how to encourage me were predominantly the friends I had made through Resolve. They had been there. Nine months later, I became pregnant again. I got through my first trimester and started to relax, allowed myself to hope, and began to feel “normal”.

When I reached 20 weeks and started having vague, inconsistent “twinges” I thought, “Stop yourself. Quit being paranoid!” I asked my co-workers if I should call my doctor but they assured me that everything was fine and encouraged me to relax. However a friend from Resolve told me to follow my instincts, call my doctor, and get checked out. Luckily I had chosen a high-risk OB (perinatologist) who got right on the phone and said, “Nobody knows her body better than an infertility patient. If you think something might be wrong, come to my office immediately”.

It turned out that something was very wrong indeed. At only 20 weeks my cervix had thinned 80% and I was having numerous silent contractions per hour. I was in big trouble. My Perinatologist not only told me how he would combat my preterm labor and cervical incompetence, but that he would have a former patient call me who had been there, done that, and had a good pregnancy outcome.

Kathleen’s call was the beginning of hope for me. After I became pregnant, I felt uncomfortable asking for support from friends who were still struggling to become pregnant. I knew that when you are in the middle of infertility all you look towards is a positive pregnancy test. Giving birth to a healthy baby is so far in the future and so inconceivable that you literally can’t imagine it.

I had a roller coaster ride pregnancy, which is pretty consistent with many high-risk pregnancies. I made trips to the hospital and took loads of medications and dealt with constant terror, depression, and guilt. But Kathleen had gone through nearly every experience I had, and certainly every feeling I felt. She became the natural extension of the support that my friends at Resolve had given me during those dark years of longing and hopelessness.

I was blessed with two healthy sons after equally frightening, tenuous, but well-managed pregnancies. And that’s what I want to talk to you about. What to expect when you’re expecting after having been an infertility patient.

Find an OB or perinatologist who is used to dealing with complications. Discuss his/her plan of care. How often will you be seen? What diagnostic tests will be done? What kinds of complications are more likely in your pregnancy?

Educate yourself. It’s great to read “Girlfriends Guide to Pregnancy” or “What to Expect When You’re Expecting”, but I’d also like to see you read “When Pregnancy Isn’t Perfect” or our online magazine “Left Side Lines”. It will not jinx your pregnancy to know the signs and symptoms of preterm labor, hypertension, and other complications that can arise. More infertility patients end up having complicated pregnancies for a variety of reasons. It’s a fact. But it doesn’t mean that we can’t have good outcomes. It does mean that vigilance pays off, that getting to your doctor with a vague symptom or simply an uneasy feeling may be the difference in your doctor’s ability to intervene and treat you successfully.

Report symptoms clearly and don’t ignore them. If you do indeed feel that something is wrong, verbalize it in clear and simple language. One patient feeling heaviness in her cervical area reported, “I feel heavy” to her doctor. He answered simply, “Well, at 6 months along, everyone feels heavy!” She should have clarified, “as if the baby is falling out”, because the doctor thought she meant that she felt “fat”. Unfortunately her physician may have been able to avoid her pregnancy’s poor outcome with clearer language from the patient and timely medical intervention.

Bring a notebook. Write down your non-emergency questions in between appointments and ask them at the beginning of the appointment. Write down the answers. This is an ongoing education for you, just as your infertility has been. (And don’t hesitate to call day or night if you feel it might be an emergency. Remember, Obstetrics is not a “convenient” specialty and your doctor knew that in medical school.)

Contact Sidelines. Sidelines was my way of honoring Resolve by carrying their support model to complicated pregnancies. Sidelines began in 1992 and since that time we have worked directly with tens of thousands of families, received a citation from The President’s Volunteer Action Awards, as well as being the first group ever to enlist cyber-volunteers. Sidelines’ goal is to educate and support women so that they can have the best possible pregnancy outcomes. Many of us in Sidelines began with ties to Resolve. Whenever I speak to a high-risk mom and find out that she had first been an infertility patient, I can’t help but give her just a little more TLC.

Nothing taught me more than my infertility. It truly was the most difficult thing I’d ever endured. There were times I thought I’d go crazy asking “Why me?” I’d never been sadder, madder, or felt emptier inside. Infertility took so much. Yet, every devastating event I experienced during those years has made me a better friend, a more centered person, and certainly a more grateful mother.

If you are pregnant following infertility, please remember what I’ve told you about vigilance. It is a small thing to do for your unborn child and it can have life-long consequences. Ignore the overwhelming desire you’ll have to finally be “normal” and disregard signs and symptoms of potential complications. And use your experiences to reach out and help someone else. Every hurt I ever faced miraculously melted away when I reached out to help others. You’ll see…

Candace Hurley is the founder and Co-Executive Director of Sidelines High-Risk Pregnancy Support Network. She lives in Southern CA with her husband Brian. Adult sons Kelan and Braeden are leading healthy and productive lives and make their mama proud.

©2015 Sidelines National Support Network

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