An all-out effort to conceive Christopher

Susan and Christopher Weigen, pictured above, became Mom and son only after a long journey through a perilous maze to overcome infertility.

Susan and Christopher Weigen, pictured above, became Mom and son only after a long journey through a perilous maze to overcome infertility.

Susan L. Weigen, RDH, BS

After working several years in a general practice, I met and married my husband, Ed. We decided to begin the family we both had dreamed about. But the road turned out to be rocky, complete with potholes and detours. My first conception in 1990 resulted in a life-threatening tubal pregnancy. This occurs when the fetus implants and grows outside the uterus.

The conception occurred and proliferated in my right fallopian tube. When it ruptured, it caused extensive internal bleeding. Due to the amount of blood lost, major surgery was required to excise the ruptured portion of my tube, followed by eight weeks of recuperation to regain my strength.

My gynecologist told me that I should be able to conceive again normally, because my left fallopian tube appeared to be healthy. So, as soon as I regained my health, I returned to work at a periodontal office close to where I lived.

Life resumed its usual pace - or so I thought - but the roller-coaster ride had just begun.

Infertility frequently is referred to as a "roller coaster," because the emotional highs and lows are so dramatic and extreme. The endless charting of menstrual cycles, temperature-taking, and the purchasing of expensive ovulation tests don`t hold a candle to the emotional drain of the disappointment of a failed attempt at pregnancy.

It is a natural phenomenon to become absorbed in the quest for a baby, since maternal instincts are extremely powerful and cannot be underestimated. Month by month, our determination and desire to become parents increased. Ed and I pursued our careers, took many vacations, cared for our home and animals, and continued to hope and pray for a child. I made it a priority to research and read as much as I could about endometriosis, ectopic pregnancies, and infertility.

At work, I found myself sharing infertility information with patients, and they shared what they knew with me. I networked through my position as a periodontal dental hygienist with patients, co-workers and employers. It was therapeutic and rewarding to lend a compassionate ear when a patient revealed his or her medical history, and I found out it included Lupron or Metrodin fertility drugs or surgery to increase a poor chance of having a baby. My personal tragedy had a silver lining that allowed me to counsel, educate, and befriend many of my patients on a whole new level.

Infertility is defined as the inability to achieve pregnancy after 12 cycles or months of attempted conception. It is a major problem in the United States, as well as around the world. Even in India, with severe overpopulation and poverty problems, the most common reason for a visit to a doctor is infertility. One in every six couples in the U.S. alone will undergo some type of infertility treatment, and more than 25 percent of couples in their 30s worldwide are considered infertile. These statistics make infertility our nation`s most prevalent, major health problem.

Even so, the business of infertility is young and has milestones to go before federal regulations. Although infertility is vastly widespread, it is not considered life-threatening. As a result, the infertility industry is operating independently of governmental guidelines in most states. Lack of regulation makes treatment a huge gamble, since clinics may or may not report accurate information regarding statistics and birth rates. They also may or may not perform appropriate techniques and/or treatments.

Since the fees for treatment are not restricted, the cost of infertility treatment can make it inaccessible for many, not to mention the fact that there are no guarantees of a baby or quality of care. Most insurance companies consider infertility treatment elective and do not cover most infertility procedures. Regulation would protect the safety of the infertile patient, as well as force insurance companies to provide benefits. Over $1 billion is spent annually on infertility treatments in this country alone, most of which is paid for by the patient out-of-pocket.

Some causes of female infertility include failure to ovulate, damage to fallopian tubes, endometriosis, congenital abnormalities, and abnormal mucus in the cervix. Treatments can include medications, surgery, and in-vitro fertilization.

Male infertility usually is related to the quality and quantity of his semen. Male infertility is much harder to treat. Treatment is limited, but can include drugs and/or surgery. Great strides are being made with manipulated sperm-injection techniques and the outlook for this treatment is very promising. Many infertility clinics around the country are microscopically selecting a single sperm out of billions and injecting that sperm into a single female egg to achieve fertilization. This new technique has resulted in thousands of pregnancies to date.

While pursuing a pregnancy, I decided to attend night school to complete my bachelor`s degree. This had been a personal goal since graduating from dental hygiene school. I felt that going back to school would be a good diversion from my disappointing quest for parenthood. With the flexibility and financial benefits my employment offered, I earned a bachelor of general studies degree from the University of Connecticut while continuing to work full time.

Month after month, I continued to work and study ... and pray for a baby. We started to doubt the prognosis we had been given following my surgery. We began to suspect that my left fallopian tube wasn`t functioning after all.

Treatment begins

We were even more frustrated as we watched our friends have second and third babies, while we had yet to conceive one. We decided to change gynecologists, opting for one that incorporated a wide range of testing and treatments as a part of his practice. We felt it was time to become more aggressive, since it had been almost two years since my first and last pregnancy.

Fertility treatment began with a test called a "hysterosalpingogram." This is an essential test to determine if there are occlusions and/or barriers preventing the egg and sperm from coming into contact with the fallopian tubes. During this procedure, dye is injected directly into the female uterine cavity and fallopian tubes to observe them under fluoroscopy X-ray. Although it is an uncomfortable test, it reveals a great deal of information and is an essential tool in the treatment of infertility.

There is a significant increase in pregnancy rates following this test as well. The reason for this is that the high-pressure dye that is forced up through the fallopian tubes can diminish small adhesions that are blocking the tubes. Because many women now are deferring motherhood into their thirties and forties, endometriosis and adhesions developing in the fallopian tubes is quite common. When the hysterosalpingogram opens previously sealed tubes, pregnancy rates surge.

My hysterosalpingogram revealed that the tubes had not processed the dye easily or directly. This indicated that the probability of a normal conception without future treatment was unlikely. The next step would require a surgical-exploratory laproscopy.

But first, it was necessary for my husband to have a semen analysis to determine if the male factor was normal before proceeding with the risks of a surgical procedure. Finally, some good news! Ed`s semen analysis revealed a very high count and quality. We didn`t realize at the time just how fortunate we were to receive that report. But, not long after that, we became acutely aware of how salient it really was!

The exploratory laproscopy was performed in the hospital and treated as an outpatient procedure. It is a relatively common surgery, using a microscope that is inserted into the navel for visual magnification of the reproductive organs. Laproscopic surgery presently is used in all facets of medical surgery, because it allows the surgeon to avoid making a large incision and thus reduces the patient`s recuperation time significantly.

The laproscopy is used in infertility treatment to reveal pathology of the ovaries, uterus and fallopian tubes and frequently is used in conjunction with laser treatment for female infertility. Lasers are used to excise endometriosis lesions and ovarian tumors.

In my case, the news wasn`t good. My previous ectopic pregnancy and rupture, along with advanced endometriosis, had caused an extensive amount of scar tissue and damage. When scar tissue forms on a woman`s reproductive organs, the function of the organs is severely compromised. Our doctor informed us that the extent of damage visible with the exploratory-laproscopic surgery was great and that the chances of an intrauterine pregnancy would only be about 10 percent through natural means.

My gynecologists said that in-vitro fertilization probably was an option for us and might be our only hope. He also warned us that the stakes were high and the kitty low with the petre dish process. He recommended that we see an infertility specialist to discuss more advanced technological treatments available.

Another heartbreak, then Marylou

Determined to fight the odds, we continued our pursuit until one day I became pregnant! I did it naturally without any drugs or other means of intervention. But my elation was short-lived when this pregnancy, too, proved to be another heartbreaking pregnancy. We were frustrated and sad ... very sad.

After the second ectopic pregnancy, we discussed adoption, but felt we needed to exhaust all of our biological options first before exploring other alternatives for parenthood. We researched as much as possible on the subject of in-vitro fertilization and tried to focus on the positive. Even with all the discouraging requirements and the low success rates, something inside me knew we could do it. I felt it was the challenge of a lifetime to conquer infertility. I would do anything to conceive a child.

Ed was skeptical of the in-vitro fertilization process and was uncomfortable with the financial burden it proposed and the unconventional method of conception. It seemed so foreign, scientific, and risky. The cost alone - without any guarantees - is enough to sabotage any couple`s decision. The fact that a couple could go through four or five treatments at a cost of nearly $50,000 and still go home with nothing but bills to show for it is a turn-off. This was especially true for my husband, Ed, who is a grounded, pragmatic and conservative person. This was a long-shot gamble, but it had the potential to become our most valuable investment.

All of our major reservations and fears changed when I was introduced to a hygienist named Marylou. She was a schoolmate of a hygienist who worked in our office. Marylou and her husband, Sandy, had undergone years of infertility treatment that finally led them to in-vitro fertilization.

Marylou and I spent a great deal of time on the telephone before we actually met. When we finally got together, I met the daughter Marylou and her husband conceived through in-vitro fertilization ... and it was love at first sight! There she was - this little girl named Amanda - perfect in every way. After meeting her, all of the reluctance for this seemingly unnatural process melted away. It no longer mattered what method we used to create life when this would be the outcome.

Marylou became a confidant, counselor, and treasured friend. It all seemed to make sense for some reason. We had to go through infertility to meet these wonderful people - another silver lining!

In-vitro fertilization was looking more and more like our only option for biological parenthood. Both my husband and I were petrified by what it involved. First, we needed to come up with $10,000, then find a good clinic, and, most importantly, arrange both our schedules to accommodate the grueling process. We also had to find the strength to deal with the probable disappointment.

How it works

In-vitro fertilization is a process in which ripened eggs are extracted from a woman and fertilized in a petre dish using her husband`s sperm. Once fertilized, up to five embryos are placed back in the woman`s uterus for implantation and, ultimately, pregnancy. The procedure is extremely delicate and has many variables. It requires potent drugs to make harvesting the female eggs possible, most of which are given at home with long inter-muscular needles. The process also involves numerous trips to the doctor for blood tests and sonograms. The kicker is that at the time we underwent the process, the "live baby" success rate averaged only 20 percent per cycle nationwide.

An IVF cycle starts with ovarian hyperstimulation. This is required for retrieval of the eggs. In nature, a woman develops one egg per monthly cycle. For IVF, many eggs growing inside follicles are stimulated to develop at the same time. Hyperovulation is accomplished with two main drugs - Lupron and Metrodin - given by injection. The Lupron is used for pituitary suppression, followed by Metrodin for stimulation, for about 10 days, depending on the response of the patient. Ultrasound and blood-hormone levels that are taken repeatedly monitor a patient`s response to the medication. When the eggs have matured enough to extract, an injection of Human Chronic Gonadotropin is given and the retrieval procedure is scheduled for approximately 35 hours later.

Performing the injections and religiously sticking to the necessary schedule as if your life depended on it is crucial - because life does depend on it. In most cases, the husband delivers the medications. But for some patients, a visiting nurse or other arrangement can be made as well. For most couples, it is a team effort that literally consumes them emotionally and physically. Most clinics provide a crash course on injection techniques and also have a psychologist on staff to help couples handle the emotional stress.

Egg retrieval is performed under anesthesia using a transvaginal ultrasound-guided technique. A needle, guided by an ultrasound image, is passed through the vaginal wall and into the follicles containing the eggs. The follicle fluid is aspirated with the needle and delivered to the embryologist for analysis. The procedure takes approximately 30 minutes. Most clinics use light sedation and the patient remains awake during the procedure. There is a significant amount of discomfort during the procedure, but very little pain post-retrieval.

On the same day as the egg-retrieval procedure is performed, the male provides the semen for fertilization. Some clinics require a semen sample to be produced and frozen ahead of time as well as a backup. This ensures that the male factor will be available, even in the event of a problem, because of the enormous amount of stress involved.

Moving to embryo status

About six to eight hours after the eggs are retrieved, the sperm is mixed with the eggs in an attempt to achieve fertilization. Nature is left to perform its miracles for 24 hours and then the results are evaluated under a microscope. If fertilization is achieved at this time, the combined eggs and semen now are called embryos. Some patients will have no fertilization, while others will have up to 15 or even 20, depending on how many eggs were available at retrieval. Once the determination is made on embryo creation, the couple, along with the doctor, must decide how many embryos will be transferred and whether or not to freeze the remaining ones for a later cycle.

Most couples do preserve the culture for a future attempt. Another 24 hours is allotted to the prospective transfers, which are held in a culture to allow cell division. A hopeful embryo will divide anywhere from two to eight cells prior to transfer, which is an easy, painless procedure very similar to an insemination technique. The patient then is sent home to rest and will know if pregnancy has occurred within two weeks. Progesterone and estrogen are given daily following egg retrieval to prepare the uterus for a possible implantation and, if all goes well, to support a pregnancy.

Because I worked in a periodontal practice with three other hygienists, the office was very accommodating when I needed to take time off from work to see infertility specialists to have the necessary testing. The profession of dental hygiene, for the most part, allows a more flexible schedule than a corporate setting, but you don`t appreciate this until you need to institute a creative schedule to pursue a life-altering process like IVF, caring for a sick loved one, or obtaining a higher education. One of the reasons I chose dental hygiene was because I felt the flexibility would accommodate the family I planned to have. The irony was that it was now facilitating and enabling me to create a family when it might otherwise have not been possible.

Dental hygiene school taught me to question studies and to look at all the variables. It taught me that tenacity and diligence does pay off. All of these things were key factors in our "baby-chase crusade." We needed to be scientific. We needed to be analytical. But most of all, we needed to be determined.

We researched to find the best clinics in the country and interviewed three, one of which was the clinic at Yale in New Haven. This was the same clinic where our friend, Marylou, had conceived her daughter. I was fortunate enough to attend a dinner as a guest of Marylou`s with the in-vitro team from Yale.

The purpose of the dinner was to discuss how they could improve the marketing and image of their program. I was very impressed by their philosophy, and I sensed that there was an ethical integrity among the staff members. So, for these reasons, along with their slightly higher success rate, we chose Yale for our in-vitro fertilization procedure.

I believe that everything in life has a purpose and, for me, being a dental hygienist provided me with the tools to tackle the challenges of conceiving our child.

Thirteen eggs were harvested at my retrieval, 12 of which fertilized. Five embryos were transferred, resulting in a single, healthy pregnancy. Through technology unheard of just 20 years ago, our dream came true when I received the news I was pregnant!

On December 17, 1993, I became pregnant at Yale New Haven Hospital...

On September 3, 1994, Christopher Martin Weigen was born...

Susan Weigen, RDH, BS, lives and practices in South Windsor, Conn.

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