Michelle was still nursing her daughter, born through in vitro fertilization, when she found out she was pregnant again. It was entirely unexpected -- she wasn't using any fertility drugs.
Several years earlier, the Indiana mother found herself so determined to have her first child, she resorted to using donor eggs. She and her husband made the decision following a string of devastating failures: Michelle suffered two miscarriages and gave birth to a stillborn baby at 20 weeks. She tried three failed rounds of intrauterine insemination -- a procedure in which her husband's sperm were placed directly in her uterus using a catheter. Then she moved onto IVF, which involves joining an egg and sperm together in a laboratory dish, and placing the fertilized egg into a woman's uterus. Michelle tried one round using her own eggs.
That failed, too.
In early 2003, at the of age 42, Michelle, who asked that only her first name be used for this article, made the difficult decision to place another woman's fertilized egg in her body. She gave birth to a daughter, whom she lovingly describes as bright, daring and, at 8 years old, "all girl --pink and purple and sparkly." Initially, she worried about using donor eggs and giving up a genetic link to her daughter. But now she cannot believe she ever, even fleetingly, doubted her ability to love a child who wasn't genetically hers. That feeling was re-confirmed when she give birth to her second child, her biological son, now 7. Both feel entirely hers, she said, and both feel miraculous.
"Sometimes my husband and I hear them playing in the other room and we look at each other and say, 'Can you believe how lucky we are?' " Michelle said.
Lucky, perhaps, but not alone.
Though few studies track how often a spontaneous pregnancy after use of assisted reproductive technology occurs, those that do suggest it is not uncommon. Most recently, a French paper published this summer in the journal Fertility and Sterility found that 17 percent of women who gave birth after IVF became pregnant again within six years — this time on their own. Among couples whose IVF failed, the rate of spontaneous pregnancy was even higher: 24 percent of the women became pregnant in the years after treatment. A 2008 German study found that 20 percent of couples who conceived a child by intracytoplasmic sperm injection — a form of IVF in which a single sperm is injected directly into an egg — and who subsequently tried to get pregnant naturally, succeeded. Estimates suggest that normal, healthy women have around a 20 to 25 percent chance of getting pregnant per menstrual cycle.
Many fertility doctors say the findings bear out, at least anecdotally. “I tell my [IVF] patients, ‘You know, after you have your baby, your OB is going to come to discharge you and tell you to use birth control if you don’t want to get pregnant,” said Alice Domar, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and executive director of the Domar Center for Mind/Body Health. “And my patients look at me and say, ‘You’ve gotta be kidding me. I’ve had 18 cycles of IVF.’ And then they get pregnant.”
Though no expert has ever offered her a definitive explanation, Michelle believes her first pregnancy somehow healed her body.
“With my boy, it’s like I had one golden egg in there. I don’t know how to explain it,” she said. “But I don’t think it would have happened without my daughter. It’s like she taught my body what to do.”
Scientific theories do support Michelle’s hunch, particularly for women with certain conditions. For example, about 50 percent of women with endometriosis, which causes the tissue that normally lines the uterus to grow elsewhere, have problems getting pregnant. Whether induced or natural, pregnancy “suppresses” the condition, Domar explained.
“For somebody who has a history of endometriosis, if she manages to get pregnant, those nine months of pregnancy are very healing to her pelvis,” she said. “It would make more sense that she would be able to get pregnant after.”
An underweight woman faces a similar prospect, as long as her weight is a reason for ovulation problems. If she manages to get pregnant, even a window of several months to lose the baby weight may be long enough for her to become pregnant naturally with a second child.
AN INEXACT SCIENCE
An even simpler explanation is that some women are rushing into assisted reproductive technology and that given more time, they might have gotten pregnant on their own. Much about infertility and its roots is still a mystery, and to have a baby, the complex processes of ovulation and fertilization need to go just so. Around one-third of infertility cases are traced to female problems, such as ovulation disorders and structural complications; one-third stem from male problems like deficiencies in sperm count and ability to swim; and one-third are due to both partners, or are unexplained.
Knowing how much time to give biology to work is an inexact science that changes from couple to couple and from situation to situation. The most commonly agreed-upon definition of primary infertility is when a woman has tried to get pregnant, and failed, for at least 12 months, and of the 15 states in the U.S. that provide some form of coverage for IVF, most stipulate that a woman must have been trying to get pregnant for at least that long before enlisting help. But groups like the American Society of Reproductive Medicine stress that earlier evaluation and treatment is warranted for women over 35. Indeed, for someone like Michelle who was 40 when she began trying to have a child, a viable pregnancy is that much less likely.
“It’s all statistical. So long as a couple doesn’t have any of the absolutes — completely blocked tubes, no sperm — as long as you have some chance each month, then statistically you will find that some couples will get pregnant on their own,” said Dr. Robert Oates, president of the Society for Male Reproduction and Urology. “We have to hold back our enthusiasm for getting to interventions like IVF too quickly and need to give biology some time to work when there’s a sense that it might.”
Nearly 12 percent of American women between the ages of 15 and 44 have sought some form of fertility assistance and, though only a small percent pursue the most aggressive options, more than 146,000 cycles of assisted reproductive technology — namely IVF — were performed in the U.S. in 2010. The Centers for Disease Control and Prevention estimates that 1 percent of babies born each year are now conceived using some form of assisted reproductive technology.
“Because IVF is so successful now, I think some people are probably getting it who don’t really need it,” said Courtney Lynch, an assistant professor of obstetrics and gynecology, epidemiology and pediatrics at the Ohio State University Wexner Medical Center, whose research centers on risk factors for fertility problems. Lynch said there is something of a don’t ask, don’t tell policy with reproductive endocrinologists and their patients. Rather than pressing for details on how often they have been having intercourse and how carefully they have been timing it, doctors take their patients at their word that they are good candidates for fertility treatment.
But IVF is a grueling, logistically challenging process, not a quick fix. Women are given drugs to boost their egg production, often hormones that must be injected daily. During that time, patients must undergo pelvic ultrasounds and blood tests to check their ovaries and hormone levels. Next their eggs are retrieved, an outpatient procedure that usually involves some form of sedation. That is followed by insemination, or the mixing of the sperm and egg in a lab. When a fertilized egg divides, it becomes an embryo which is monitored and, given that everything looks okay, transferred into a woman’s womb several days later.
The process is expensive — in the U.S., the average cost per cycle is at least $12,400 — and not without risks. There is a small chance of ovarian hyperstimulation and pelvic infection, as well as the possibility of multiple pregnancies if more than one embryo is transferred to a woman’s uterus. According to the American Society of Reproductive Medicine, babies conceived by IVF have a slightly higher risk of birth defects — between 2.6 and 3.9 percent, compared to just to 2 to 3 percent in babies born naturally.
And then there is the enormous emotional toll of treatment.
“Those years were the low point in my life,” said Cortney Carroll, a bubbly 34-year-old with a wide, pretty smile who recently moved from Ohio to Virginia. “They were the saddest. I was crying constantly — every day, it was this up and down. You’d get excited, you’d think, ‘These numbers are good! Yay!’ And then you’d just crash.”
Cortney grew up wanting to be two things: a dancer and a mom. After a stress fracture in college ended her Broadway dreams, Cortney eventually ended up working in pharmaceutical sales. In 2001, she married her husband in front of 200 guests and the
pair started trying for a baby in September 2004, when Cortney was 26.
“I thought it would be easy,” she said. “That was a dumb assumption.”
After about six months of trying, Cortney went to an OBGYN who preached patience — women under 35 are generally not considered infertile until they have attempted to get pregnant for one year. A few months later, she saw a different OBGYN who found a blocked fallopian tube, not necessarily enough of a hindrance to make pregnancy impossible, but enough for Cortney to be put on Clomid, a pill that induces ovulation. She tried two rounds of the medication; neither worked.
By then Cortney was moving along a treatment trajectory familiar to many of the 7.4 million women in the U.S. who have used some form of infertility services in their lives. She was referred to a reproductive endocrinologist and tried three rounds of IUI, all failures. In November 2005, Cortney began preparing for her first round of IVF. Cortney found out she was pregnant on December 21, but seven days later her hormone levels had dropped.
“At that point, in doctor’s-speak, it’s called a ‘chemical pregnancy,’” she said flatly. “But it’s a miscarriage.”
Cortney’s next two rounds of IVF were also unsuccessful. One was canceled because there weren’t enough ovarian follicles to retrieve, the next because none of her eggs had fertilized. Her fertility doctor said there was nothing more he could do and suggested she try a more pioneering out-of-state clinic. At that point, she had spent more than $12,000 out of pocket on co-pays, medications and anything her insurance didn’t cover.
In September 2006, Cortney took a medical leave from her job and flew to Las Vegas where she spent three weeks shuttling between various hotels and the Sher Clinic, part of one of the largest networks of infertility clinics in the U.S. She left Las Vegas hopped up on her highest dose of medication yet and the maximum number of embryos Sher’s doctors were able to transfer. She was certain she was pregnant. She was not.
A month after returning from the failed trip, Matt and Cortney started pre-adoption parenting classes at their local hospital. They planned to return to Las Vegas in January for another IVF cycle, the final one that would be covered by insurance (her company’s plan covered a portion of her treatments), but they were beginning to wonder if conception was even an option for them.
The adoption classes were almost over when, on a November day in 2006, Cortney took a home pregnancy test. She watched the line start to grow, tossed the test on her bathroom counter and got in the shower.
“At that point I was so used to negatives, it was like ‘Whatever,’” Cortney said.
A few minutes later she stepped out, looked at the test and called her husband in tears. A blood test hastily scheduled for that afternoon confirmed what the home kit had told her: Cortney was finally pregnant, all on her own. And two and a half years later, she gave birth to a second child who was also conceived naturally, this time a girl.
“It was just up and down, up and down,” Cortney said, “and all the time trying to just have hope that it could happen.” Though the ordeal strengthened her marriage — Cortney and her husband began going to church together and praying together every night — she confessed there were times when she felt desperate and completely alone.
‘JUST ADOPT, IT’LL HAPPEN.’
Those feelings of fear and anxiety are the basis for another popular explanation for these unexpected pregnancies, which hinges on the role that stress plays in women’s efforts to become pregnant. Research on the relationship between stress and fertility is far from conclusive, in part because of the chicken and egg challenges of mapping a woman’s stress. Does stress lead to her infertility, or is infertility the source of her stress?
These complexities help explain why recent scientific evidence tends to contradicts itself. A 2011 study in the journal Fertility and Sterility (on which Lynch was an author) used saliva tests to measure certain stress biomarkers in 274 women who were trying to get pregnant. Stress appeared to significantly reduce the probability of conception, and at least one small study has found emotional stress can hurt sperm quality. But a review published in the venerable British Medical Journal in 2011 found that a woman’s stress levels do not appear to affect her chances of getting pregnant after a single cycle of assisted reproductive technology.
“At this time, there has not been a clear link between stress, depression, anxiety and successful outcomes in infertility treatment,” said Dr. Marlene Freeman, an associate professor of psychiatry at Harvard Medical School and director of the perinatal and reproductive psychiatry program at Massachusetts General Hospital in Cambridge.
Nonetheless, the connection flourishes in the public imagination. Ask a handful of women who have dealt with infertility and they’ll roll their eyes over the number of times they heard some version of: “Just relax. If you stop stressing out, it’ll happen.”
“People say all those things that they think are helpful,” said Tracy Birkinbine, 40. “I heard them all the time: ‘Just adopt, it’ll happen.’”
Tracy started trying to have a baby in 1996 at 24 and taking Clomid soon thereafter. Earlier in her 20s she was diagnosed with polycystic ovary syndrome, a hormonal disorder that can make it harder to have children, but everything else looked good. Her doctors checked her tubes for blockage and analyzed her husband’s sperm.
By 26, Tracy was referred to a reproductive endocrinologist, who suggested she move on to IVF. She dove into three cycles, carrying around a fishing tackle box with needles to give herself injections of the fertility drugs needed to stimulate egg development. The medicines made her “not very nice” to her husband, she said.
Tracy, like many women in this situation, was so driven to birth a baby that she felt inadequate when she could not. “I would say really stupid things, like, ‘You need to just divorce me and find somebody else who can give you a baby,’” Tracy said. “Or I would get really angry and say mean things that were not true and were hurtful. I knew it when I was saying it, but I couldn’t stop. I almost felt like a different person.”
But the most fraught period was the stretch known in infertility-speak as “the two-week wait,” the time between the end of treatment and before the pregnancy test.
“It’s excruciating,” Tracy said. “Every move I made, I was afraid I was going to push [the embryos] out. I was crazy. We lived in an old house, and I went to open the windows and used my abdominal muscles. I was like, ‘Oh my gosh! I strained when I did that!’”
Harder still was trying to keep herself from seeing everything as a sign of pregnancy. “You start having the, ‘Oh, am I going to the bathroom a little more? Are my breasts starting to ache?’”
During Tracy’s second IVF cycle, the answers to those leading questions became “yes.” She was pregnant. Then three days later, her hormone levels dropped and it became clear it was only a chemical pregnancy. Altogether, Tracy underwent three cycles of IVF before she and her husband decided to adopt a child through foster care, and soon took in a 3½-year-old girl. Four months after the adoption was finalized, Tracy discovered she was pregnant with a girl. Just over a year later, she was pregnant again, this time with a boy.
“I wasn’t adopting, thinking, ‘If I adopt, I’ll get pregnant,’” Tracy said, acknowledging that she followed the exact pattern people told her she would.
None of her doctors ever gave her an explanation for her infertility, nor did they give her a reason why she was able to have children after failing with IVF and adopting.
The lack of clear answers can make it extremely difficult for women to know what to make of their bodies throughout the infertility process, particularly when, after years of pipe dreams and treatments, they suddenly have a baby on their own.
Should they feel betrayed? Elated? Can they muster any sense of trust in their own reproductive systems?
Kari Harris, 29, took ovulation drugs for three years and had multiple IUIs — having her husband’s sperm injected into her uterus — as well as two miscarriages before she gave birth to her son. Now 2, he was conceived during her second cycle of IVF. As she and her husband were preparing to start another cycle to try for a second child, Kari found out she was pregnant, naturally. She is due in December.
Her reaction to the news surprised her. “My first feeling was that I was angry. I was angry that this was happening after everything we had been through,” Kari said. “My feeling was, ‘We’re going to end up having a miscarriage.’ I was like, ‘This isn’t fair. How is this happening?’”
When she got pregnant with her son, Kari was already on several medications to help prevent miscarriage; this time she was not. Though she and her husband are “over the moon” and “beyond excited” about the prospect of having another baby, that joy is tempered by the fear that her body will fail her, as well as the guilt she feels about being able to have a second baby
naturally when so many women cannot.
As an alum of the IVF world, her feelings about pregnancy — natural or otherwise — are defined by the turmoil of the process. “I just wanted to have a pregnancy I could enjoy, a normal pregnancy where I wasn’t scared all the time,” Kari said. “This was supposed to be that pregnancy for me, but it hasn’t been. I’m still in complete shock and disbelief that this is really happening.”
This story originally appeared in Huffington, in the iTunes App store.
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