One couple\'s triumph over infertility
by Elissa Sonnenberg
One couple's triumph over fertility Doctors always told Jackie Jacobs that her
irregular periods were "no big deal." She believed them�until, at age 25, she
wanted to get pregnant.
After a year of trying, Jacobs sought help from her obstetrician, who prescribed
hormone pills. She felt like she had bad PMS every day, not to mention hot
flashes, bloating and extreme mood swings when she took the pills.
After a few unsuccessful, painful months, Jacobs switched obstetricians and both
she and her husband underwent fertility testing. Male infertility was ruled out,
and her second doctor found multiple cysts on her ovaries. She was referred to a
fertility specialist�a reproductive endocrinologist (RE)�and began cycles of
fertility shots, daily monitoring and artificial insemination.
Rough on the marriage
"It breaks your heart," says Jacobs, an emergency room nurse from Cincinnati.
"You don't think you'll ever have kids, then you go through these treatments
that totally mess your hormones up. You gain weight, you feel bad, and then you
still don't get pregnant."
The devastation Jacobs felt each time she started her period, along with the
hormone-induced mood changes, took a toll on her marriage. "I can't say we were
actually going to get divorced," says her husband Eric. "But we weren't getting
along very well."
"If we had stopped trying, our marriage would have been in really big trouble,"
adds Jacobs. "I would have always felt inadequate."
Risky business
Conception, which finally happened after a successful artificial
insemination, was not the magic cure Jacobs hoped for. She developed diabetes
and had to take four insulin shots a day; her blood pressure rose dangerously
high. She was hospitalized and put on bed rest for the last 12 weeks of her
pregnancy, which ended early with a Cesarean section.
Two years later, the nightmare had faded enough so that Jacobs underwent
fertility shots and artificial insemination once again. When the techniques
didn't work after three months, her RE recommended in vitro fertilization (IVF).
Though Jacobs didn't rule the expensive option out, she wanted a second opinion.
What she discovered next might well have saved her life.
The cause of Jackie\s infertility
The next RE she consulted saw the ring of cysts around her ovaries and diagnosed her with polycystic ovary syndrome (PCOS), a condition that can pose serious health hazards, including increased rates of type 2 diabetes, heart attacks and strokes. Some doctors believe PCOS may also be one of the single largest causes of female infertility. At the recommendation of her RE, Jacobs tried fertility shots again, coupled with a technique to thicken the lining of her uterus to increase her chances of conceiving. Jacobs became pregnant after the first try, then miscarried.
Help for women with PCOS
Tired of the efforts and the pain, Jacobs and her husband decided to stop
seeing fertility doctors, to stop worrying and to start living. Then Jacobs saw
a news story about a local researcher working with PCOS patients. Charles
Glueck, MD, director of The Cholesterol Center at Jewish Hospital was treating
PCOS patients with Metformin, a diabetes drug he said would make them healthier,
regulate their ovulation cycles, and improve their fertility.
Jacobs met with Dr. Glueck and started taking Metformin. The first month she
took the drug, she ovulated and became pregnant. Against the initial advice of
her obstetrician and RE, she continued to take Metformin. Though the drug's use
during pregnancy is considered very controversial, Jacobs believes it helped
keep her stable and healthy while she carried her daughter Audrey to term.
The waiting game
Like millions of couples each year, the Jacobses learned how emotionally and
financially draining infertility can be. Between 10% and 15% of couples are
infertile, according to Steven Nakajima, MD, an RE at the University of
Louisville. They spend billions of dollars trying to conceive, and often suffer
heartbreaking setbacks. He says that couples shouldn't necessarily wait a full
year before consulting a specialist.
Those who should seek early fertility help include:
- Women aged 35 or older with no children
- Women who smoke, regardless of age
- Women who have had previous reproductive surgery
- Women who have irregular menstrual cycles
"What's important is to start early," Dr. Nakajima says.
Jackie Jacobs, who was told countless times that taking a relaxing vacation
would help her get pregnant, agrees. "When you have a medical condition causing
infertility, you can go on a relaxing vacation every weekend for the rest of
your life, but you're still not going to get pregnant," she says.
Who is infertile?
Many doctors recommend that men be tested for fertility either before or at the same time as their female partners, in part because male testing is not as invasive as female testing, and in part because male-factor infertility is as common as female-factor.
About 30% of the women who can't conceive without the help of assisted reproductive technology (ART) don't ovulate, according to Dr. Nakajima. Others have blocked fallopian tubes or tubal damage from endometriosis. A few have causes that cannot be identified.
Medicine and technology
Thanks to technological and medical advances, most infertile couples today can eventually conceive. Men whose sperm won't naturally penetrate an egg can have it injected there. Women whose eggs can't develop into embryos can carry fertilized donor eggs to term. Men who produce very little sperm can have sperm extracted from testicular tissue and injected directly into a partner's egg. Although much attention has been paid to IVF techniques and test-tube babies, some fertility specialists find noninvasive medical breakthroughs just as exciting as their high-tech ART counterparts.
\"We're getting away from patchwork approaches to look at the underlying abnormality,\" explains Mark Perloe, MD, who pioneered treating PCOS patients with diabetes drugs to increase their fertility and improve their quality of life. Dr. Perloe maintains that only a thorough evaluation of both partners can determine the most appropriate, and least risky, line of treatment.
Pregnancy at any cost
For patients struggling with the emotional highs and lows of infertility
treatments, understanding is also essential. "It's important for the people who
are providing infertility care to realize that they're helping couples build
families, not destroying the family that's already there," says Dr. Perloe. His
center offers counseling and online support for all couples to help them focus
on their child�not their pregnancy�as the ultimate goal.
Jackie Jacobs knows that after she started down the slippery slope of high-tech
treatments, she would have stopped at nothing to have her first child, even if
it meant spending tens of thousands of dollars on IVF or traveling around the
world in search of special care. "You get in the mindset that if you stopped,
you would be giving up...and psychologically that would be telling yourself that
you didn't even deserve kids."
Family first
Though they're still paying bills from their infertility treatments and joke that they've spent their son's college tuition on home pregnancy tests, the Jacobses think the hardships of infertility helped them discover the depth of their commitment to each other.