The Invisible Pain of Unexplained Infertility

I was in the bathroom stall at work realizing that my fourth round of IVF failed. After 9 months of trying, I still hadn’t achieved my dream of becoming pregnant. As the tears started to fill my eyes, the person next to me left her stall and two more women walked in. I soon discovered that all three of them were pregnant! I kid you not. It was like an extremely cruel joke. They stood there happily chatting away about their due dates and morning sickness and back pain while I hid in the stall choking back the sounds of my heartbreaking sobs at the unfairness of it all. Over the two years we were trying to conceive, this feeling of being punched in the gut with no notice was all too familiar. In that time, everyone we knew who wanted to have children did. They all had the same look of sympathy in their eyes when they ‘broke’ the good news to us. We were extremely happy for all of them. They were our closest friends and we loved them and would love their babies, but it still stung. I felt guilty that our infertility struggles were putting a shadow over someone else’s happiest moments. I felt guilty for not having the same happy news of my own to share.

I just kept thinking… “Why not me?” I was doing everything right. I wanted it so badly. I stopped drinking caffeine, was eating tons of fruits and vegetables, had acupuncture twice a week and took every natural supplement that was meant to improve fertility. I took prescriptions, gave myself injections, had my husband giving me injections at times too. I was going to the fertility specialists’ office every single morning before work to get my blood drawn. The inconclusive name of unexplained infertility was like torture. I was feeling very defeated and alone. But I knew that I wasn’t the only one struggling.

The fertility specialists’ office was jam packed with women and couples going through their own journey to achieving the dream of parenthood. I was shocked every time I went there just seeing how many people were going through the same thing and yet, no one ever seemed to talk about it in the “outside world”. Fertility struggles are something in our society that we don’t talk about openly which is understandable when you’re actually going through it. Because then, each failure to conceive is magnified by every set of hopeful eyes looking at your stomach to see if you’ve succeeded each month. It can be a very lonely and isolating thing to go through. But when you’re not in the thick of it, I think it’s so important to share our stories so those who are quietly struggling can feel less alone and possibly gain some hope or strength to continue down their path to parenthood. I never had to suffer through a miscarriage which I am very lucky and grateful for. I know so many others who have had that positive test, had the sonogram, had all the hope only for it to come crashing down when they lost it. I can’t imagine that feeling. What I am familiar with is repeatedly hearing “you’re not pregnant” and seeing negative pregnancy tests. I am extremely fortunate that my two plus years of “unexplained infertility” did end in a successful pregnancy after a very, long, long, painful (physically, mentally and emotionally) experience.

There is only ONE thing in life that I’ve ever been 100% sure of and that is that I desperately wanted to be a mother. I’ve dreamed of being pregnant, caring for babies and hugging my children since as long as I can remember. I’ve changed careers literally, and in my imagination, more times than I can count. It took me a very long time to meet someone that I wanted to share the rest of my life with (and have children). But motherhood was always something I knew I’d do. As a matter of fact, when I met my husband, I was 27 and had already started to seriously consider the possibility egg freezing for the future. The thought that I would miss my chance to be pregnant and have a child of my own was my worst nightmare. I even remember thinking about what it would be like to go through pregnancy and parenthood on my own if my dating life didn’t improve (luckily it did). I’m saying all of this in an attempt to explain how BADLY I wanted to become pregnant and how DETERMINED I was to make it happen by any means possible. I know there are so many women who have felt the same way and weren’t able to have their dream realized. I was so, very lucky to finally achieve my dream but it did come at a price (literally, physically, and emotionally).

There’s this song called “A Thousand Years” by Christina Perri that was written for the Twilight movies. It’s actually a love song about the human/vampire couple in the movie (I think, I’ve never actually seen them). Anyway, during the time that we were trying to conceive, it was on the radio a lot and every time I heard it, I just broke down sobbing. Although the lyrics are about a romantic love, they spoke directly to my aching heart just begging to finally get a baby of my own that I just knew was meant to be.

Our Fertility Journey Begins

My husband and I got married in October of 2013 when I was almost 33 years old and immediately started trying to conceive after the wedding. I went to my OBGYN before the wedding just to ensure that everything was up to snub for us to start trying. My bloodwork indicated that I did not have an abundance of eggs (which for some reason I expected due to my age) but otherwise everything came back good to go. If I wasn’t worried about having morning sickness or other symptoms of pregnancy at our wedding, we would’ve tried sooner. We went to a reproductive specialist the May after our wedding and even though the fertility doctor thought we should wait until we tried for a full year, I was just convinced that it wasn’t going to happen for us so I insisted that we start fertility treatment with IUI (intrauterine insemination) as soon as possible.

Starting with IUI

We started out with natural IUI (Intrauterine Insemination) where we followed my regular cycle and just timed the insemination around when I was most likely to ovulate. We did this once with no success. My husband then had to get his sperm tested to ensure that his side of things was going as it should. His results came out great - sperm quality, sperm count and motility all checked out so we moved on to medicated intrauterine insemination. Then I had a test performed called an HSG which was an x-ray of my uterus and fallopian tubes to make sure I didn’t have any uterine conditions, blocked tubes or endometriosis. This test was described to me by my male doctor as “uncomfortable” and “like cramps”. I can tell you that this experience was NOT like cramps. I was squeezing the nurse’s hand so hard I think her fingers turned purple. It was just one of the many painful things I had to go through that I wasn’t prepared for and made this all feel like a punishment…for what? I’m not sure.

“I have died every day waiting for you”

— Christina Perri, A Thousand Years

I took medication (Clomid) to help more eggs to mature and improve the chances of one of them fertilizing. I also used progesterone after the iui procedure to improve chances of implantation. The progesterone impacted my mood very negatively and also made me gain significant weight. I was not a fan, to say the least. I spent hours researching "What to eat before iui", "keys to a successful iui", "iui success stories" - anything to make me feel more in control. Those first two attempts were unsuccessful and since the doctor continued to be adamant that we had great chances to become pregnant on our own, we stopped treatments for 4 months when we tried on our own. I used at home ovulation monitors and an app to track every part of my cycle. I took multiple pregnancy tests and would be in denial at the onset of every menstrual cycle telling myself it could be “implantation bleeding” …but it never was. We returned to the reproductive specialist’s office in late November 2014 when we were unsuccessful.

In December 2014, we did two IUs while I took Clomid again. I didn’t agree to progesterone for those attempts because I couldn’t bear to think about dealing with those side effects again. Both times I did not ovulate when expected but we were able to do two inseminations over two days to improve the odds, unfortunately it didn’t work. In February 2014 we did a clomid IUI with progesterone oil injections that my husband had to give me in my butt cheek. These injections were painful, but the idea was that the side effects would be more tolerable. They were, but only mildly. So, after four rounds of IUI and four negative pregnancy tests, I was extremely stressed out and getting more scared about the chances of my dream becoming a reality. Although it was expensive and intense, we figured IVF (in vitro fertilization) would just have to be the route we took to get to parenthood (thank God for science, right?!).

On to IVF

Before we started the IVF process, I was on Google daily trying to figure out what was wrong with me and what I could do to finally get pregnant. I started taking natural fertility enhancing supplements, drinking smoothies with tons of “fertility boosting” produce and maca powder, exercising and going to therapy to handle the stress.

The One with Three

In March 2015 I started taking birth control pills to start our first In-Vitro Fertilization cycle. In April, after weeks of giving myself injections and taking pills, although the sonogram showed at least 8 potential eggs developing, only four were retrieved and three developed into embryos. We transferred two of the day 3 embryos in an uneventful procedure and froze the third. After two hopeful weeks of progesterone and many tearful prayers, I had my blood drawn for a pregnancy test and got the familiar phone call from a kind nurse telling me I was not pregnant, and I could stop taking the progesterone. Then, as I always did, I still maintained hope that the blood test was wrong and I would actually discover that I was pregnant after all…of course, that never happened.

The One With Too Much Pee

We were devastated, again, but since it was only our first try at the magical science of in vitro fertilization, we just put our heads down and kept pushing forward. I was just determined and impatient and getting more and more terrified that I’d never get to achieve my dream. Since we only had one embryo frozen, we opted to go through another round of drugs to do another egg retrieval. It was May 2015, we tried adding more, different drugs to the process to see if it would induce more egg production. We saw at least 8 oocytes (eggs) on the pre-retrieval ultrasound which wasn’t as much as we were hoping for, but it was something. They retrieved 7 oocytes, 6 of them were manually fertilized using a method called ‘ICSI’, 4 of them successfully turned into embryos. We transferred two of the day 3 embryos and froze the other two. Next, in preparation for the embryo transfer, you must make sure you have a full bladder. I took this very seriously and drank a ton of water only to find that the doctors were running behind schedule. I asked nurses and other doctors if I could just go to the bathroom and then start drinking water again and they said if I did, I’d have to move to a later appointment which I did not want to do. By the time it was my appointment, I was in tears from my bladder being so full. One of the doctors took sympathy on me and said I could go to the bathroom to try to release some of the urine. Unfortunately, I must’ve released more than I should have because the doctor that was doing the transfer was extremely annoyed and impatient about my bladder being not full enough. He gave the option of going back to the waiting room and starting over again or using a catheter to fill my bladder. I opted for the catheter since I just wanted to get it over with and it was another painful experience. The doctor was not kind or gentle about it at all and I was so uncomfortable I cried once more. I ate pineapple core and kept my hips elevated for hours afterwards all in an attempt to help with implantation. BUT…. once again, no luck. I received the “you’re not pregnant” call again, while at work, and I wanted to die.

“I have died every day waiting for you…

Darling, don’t be afraid, I have loved you for a thousand years

I’ll love you for a thousand more…”

-Christina Perri, A Thousand Years

In June of that year, we had a family wedding to attend out of state which was not going to allow us to do another round of IVF. We took that month off and just tried the “old fashioned way” but of course that didn’t work.

The One With One

We got back down to business in July which was one of our saddest experiences. I remember being away for a few days with my husband to decompress and enjoy the fourth of July. In our hotel room refrigerator were my drugs and I had to inject myself every day which was just an awful reminder of what we were going through (not that we needed one). We had our pre-retrieval ultrasound where we saw 8 eggs ready to go. I was told to give myself an HCG shot to trigger ovulation at a specific time which I did (in the middle of a Broadway show in the bathroom). I had a very kind, gentle male doctor doing this retrieval which I was very thankful for after the last experience. So, I went under anesthesia (for the third time) and when I woke up, the doctor’s face looked very sad. He apologized and said he didn’t know how it happened, but there was only ONE egg. After those weeks of so many drugs, supplements, smoothies, exercise, group therapy….ONE. What my body was already capable of doing on its own. It was awful. Thank God, the egg fertilized, and I was sure to have a full bladder for the embryo transfer procedure and managed to time my water intake more efficiently than the time before (obviously, that lesson was learned the HARD way). So, they transferred the one embryo and we waited…again. Everyone just kept telling me “It only takes one…that’s all you need to get pregnant” so that’s what I kept reminding myself. I was just praying that this time would FINALLY be it.

In the meantime, we had been living with my parents since December and spending every single weekend looking for a house to buy. To say this was a challenge would definitely be an understatement. Buying a house for the first time is usually stressful, but buying one for the children that you may not ever have is way worse. It was so hard debating things like how many bedrooms did we actually need and what we would do with the playset in the backyard. I think that’s what made it take us so long to finally find our home. The one we still live in today. Right around the time when I got “the call” – the one where they told me I was still not pregnant, we found our home and started the process to buy it.

“Every doubt
Every hour has come to this
One step closer...”

— Christina Perri, A Thousand Years

The Fourth and Final IVF

Now it was August 2015 more than a year since our first IUI in June 2014 and almost two years since our October 2013 wedding when we first started trying. We had three day 3 embryos frozen from the previous cycles and after some debate decided to transfer all 3 and pray one of them stuck. Before the procedure, I had a biopsy of the lining of my uterus which had been shown to improve chances of implantation. We also opted for “embryo glue” that was applied to them before the transfer for the same reason. Once again, we waited. I did not have much faith in the process anymore and was still pretty upset after the last two cycles and everything that happened with them. Luckily, we also closed on the house at the same time and were moving in, painting, cleaning, and taking care of a lot of wonderfully distracting things. I was kind of hoping that since I was not obsessing over it that it would magically work this time.

But – it didn’t.

Hormonal Hiatus

We decided to take a break for a bit. I detoxed my body from the past 6 months of nonstop cycles. My stomach was covered in bruises from the injections, my skin was broken out, I was a bloated, hormonal mess. In the meantime, I did extensive research on the reproductive specialists in my area. I was NOT going to give up. Especially now that we had our home with plenty of room for kids to run around. In October, we decided that we needed someone to take care of. Someone else we could focus our attention on and that could bring us some much-needed joy. We decided to adopt our amazing dog, Tank. He was a 10-week-old Pitbull mix and we were just in love. He brought so much joy and warmth into our new home, and we were very focused on him instead of ourselves and our fertility journey.

Re-Starting Fresh

During that time, I created a detailed spreadsheet and used the information I gathered to make a list in priority order of who we would go to next. We had initial appointments scheduled with three different specialists, but we really loved the first one we met and ended up going with him. He was very personable, empathetic of everything we had been through, gave me an email address where I could reach him at any time (and he responded very quickly every time). He said despite everything we’d been through, he still thought we could be successful with an IUI (which I didn’t buy but went along with it) so he asked us if we would consider doing just one with a different mix of medications than we used before. In my mind, he was an expert in his field and, I knew better than to expect an IUI to do anything. This was just a step we had to go through to get to the next IVF round, so we said yes and moved forward with the process.

The Phone Call

It was Saturday, November 21st, 2015, when my husband was outside mowing the front lawn and my cell phone rang. I saw the doctor’s office was calling and thought “Ugh, here we go again” and just braced myself for the all too familiar call. The nurse on the other line said “Kim, you are pregnant.” I couldn’t speak or move. I eventually said “No, this is Kim Seftel, are you sure you’re looking at the right results?”. She said “Yes, Kim, I know who you are and yes, these are your results.” I started stumbling to the front door to tell my husband. I was smiling and crying at the same time and couldn’t get any words out. The nurse continued to say, “Your HCG levels are fairly high which can sometime indicate multiples but at this point, we can’t know for sure.” I thought immediately “It’s twins. I just know it.” We eventually got off the phone and my husband and I just hugged and cried and just kept saying “I can’t believe it! I can’t believe it!”. We immediately called our parents who also all cried and screamed and just lost it. It was the most unbelievable moment of my life up until that point. Of course, there were still so so many things that could go wrong and I was so afraid to be too hopeful too soon but just knowing that I could in fact even get pregnant at all after exactly TWO YEARS of trying, was a goddamn miracle!

“All along I believed I would find you
Time has brought your heart to me”

— Christina Perri, A Thousand Years

Our Girls

In July 2016, our precious, miracle fraternal twin daughters were born at full term, healthy, thriving and ready to take on the world. I have never felt such love (and relief) as I felt when I held them to my skin for the first time. There is just nothing like it. I just knew they were mine and they were meant to be. They were supposed to come exactly when they did and exactly how they did. Would I have preferred to done things the “easy” way? Probably. But I learned a lot about myself, my husband, our relationship and our amazingly supportive families and friends. If we could make it through that long, long journey to this moment, we could do anything together.