Recurrent Pregnancy Loss? It Could Be An Immune Disorder

Recurrent Pregnancy Loss? It Could Be An Immune Disorder

This is our story of the journey to twins. Let me start from the beginning, which was 2010. I met my husband the year before in roller derby and we had an instant connection. At this time I was a single mother to my 12 year old daughter. I wasn’t looking for a relationship and was pretty content on where I was in life. Already being in my early 30s I had given up on the idea of having more children. Boy things sure do change. My husband and I dated and were engaged within a year. He didn’t have any children and really wanted a family. Of course so did I, but I won’t lie, I was worried about my age and thought we would have problems.

Of course for the first 3 months we tried on our own and nothing. I decided to make an appointment with my general practitioner. He suggested I was just trying too hard and stressing out so he put me on anxiety meds — more like tranquilizers. Completely dumbfounded, I decided I better start seeing an OB. She suggested a few months of the fertility drug Clomid with timed intercourse. Nothing. I then decided to move to another OB to get a second opinion. I think finding her was meant to be and it started our journey of getting pregnant.

Toni and her husband

Toni and her husband

She did all the blood work on us and decided to try a few more months on Clomid. Meanwhile, she wanted me to make an appointment with her husband who happened to be an RE (Reproductive Endocrinologist, aka infertility doctor). It took a few months to get in to see him and during this time we still weren’t having luck on getting pregnant. I was sure he would fix whatever was wrong and we would be pregnant within the next few months.

I remember our first appointment with the RE. I sat in the waiting room looking at all these couples. They all looked so defeated and angry. I, on the other hand, was new to all of this and so full of excitement and hope. He ran tests on both my husband and I. All the tests came back normal. According to him I was suffering from secondary unexplained infertility. To me, this was great news. He explained they had a study going on for woman with unexplained infertility and we could get four IUIs (aka “artificial insemination”) completely paid for. This was wonderful news because, in Oklahoma, businesses are not mandated to offer infertility coverage to their employees and we had zero infertility insurance coverage. I just knew the first one would work and if it didn’t, we had three more tries left. I was put on Menopur injections to stimulate my ovaries and had great turn outs every time. Out of the four IUIs, I got pregnant once and it was a chemical pregnancy. It was time for step two.

Our RE thought moving on to IVF (in-vitro fertilization) would be the best option at this point. We took some time to figure out the finances and after a few weeks we decided to go with the Attain Multiple Cycle Program. It was $15,000 (without any medications + some extra charges) and we were able to get two fresh cycles and two frozen cycles. At this point I just knew the first cycle would work and, if not, we had three more. We jumped in head first and we were so excited for the possibilities. My first cycle went so quickly. I responded almost too well to the medications and we ended up retrieving 23 eggs — 17 were mature and 15 fertilized. I thought, “Of course I will have eggs to freeze.” WRONG. We ended up with two “good” quality embryos for a 5-day IVF transfer and the rest were destroyed because the quality just wasn’t there. Two weeks later I got the call that IVF #1 didn’t work. I was told it was due to possible bad egg quality because of my age. We took a three month break and during that time just used Clomid.

IVF infertilityIVF #2 was a little different. This time they lowered my medications and I was able to take my time. I guess this time was “slow and grow”. This time we ended up with 9 eggs — 8 matured and 7 fertilized. My doctor ended up transferring (3) good quality 3 day embryos. We got pregnant!! A week or so into the pregnancy we realized it was ectopic and had to end the pregnancy. By this time I was starting to understand all those sad faces I talked about earlier in the waiting room of my RE office.

I was starting to feel defeated, but I was still determined to keep moving forward. I ended up having a few surgeries, two hysteroscopies and one laproscopy to clean out fibroids and adhesions. We took a small break for a month or so. I decided to go forward with IUI #5 and it worked! Pregnant again (third time). Of course it had to work this time, right? The first few blood draws showed I was pregnant. The numbers were good and my HCG levels rose like they were supposed to — and then they just dropped. Another chemical pregnancy. The doctor told me again he thought it was due to bad egg quality and wanted us to go to the Colorado Center for Reproductive Medicine (regarded as the best infertility clinic in the US) to have IVF done with PGD genetic testing. That was totally off the table for us. We just couldn’t afford it. So we decided to keep moving forward with IUIs.

I did take a short break from IUIs and we decided to start with Femara (another drug to stimulate the ovaries) and timed intercourse. I was pregnant again! The blood work was looking good; on the low side but always doubling. At the first ultrasound we saw a yolk sac! Second ultrasound we see a heartbeat. I knew this was it! Third ultrasound…no heartbeat. The baby died right after the second ultrasound.

Where do you go from here? I was feeling so lost and at the same time so determined to find a treatment that worked.

I started researching other doctors on the internet and came across a doctor in Chicago, Dr. Joanne Kwak-Kim, who specializes in treatment for women that have had several pregnancy losses. She is a Reproductive Immunologist. I called her office to see about insurance and what they needed from me. Thank goodness their work was filed under miscarriage treatment and 80% of the blood work, tests, etc. was covered by our insurance.

We flew to Chicago and had all the testing done. I came to find out I did have many things wrong with me that was never found by my other doctors. I will not sit here and put blame anywhere, because I do feel that from day one everyone did the best job they were capable of. I was diagnosed with APS (Antiphospholipid Syndrome) along with TH/1 TH/2, Factor XIII, PA-1, MTHFR. These are all immune issues that affect the embryo implanting and getting what they need. Basically my body is attacking itself and the embryos.

We were devastated at first and couldn’t believe all of the information in front of us. She recommended starting us on Lovenox injections, steroids, Metformin, and many other vitamins. She also suggested IVIG, which is an infusion of donor human plasma. I wasn’t sure we could afford all of this treatment and didn’t know what to do. We went back home to Oklahoma and contacted my insurance company. Luckily I was able to do all of the recommended treatments and I started immediately with my RE, under Dr. Kwak-Kim’s direction.

immunityWe didn’t get pregnant for 6 months after this new treatment started. We finally broke down and decided to do one last IUI. I think this was #7 and it was lucky #7. We got pregnant again. My blood work was really high! The numbers continued to double and double. At ultrasound #1 we saw two sacs and two heartbeats! TWINS! Since then, our girls have continued to grow and grow. Today I sit here and proudly declare that I am 25 weeks pregnant with twin girls.

There were so many times I wanted to give up and just sit in a corner feeling sorry for myself. I couldn’t do that. I knew I wanted to be a mother again and I had to fight with everything I had for this to become my reality. I don’t regret one single thing we went through. I also know that if I hadn’t listened to my gut, we might still be trying the same things over and over. I firmly believe that Dr. Kwak-Kim is a miracle worker and there aren’t words to describe how blessed I feel right now.

ToniUPDATE! Lilah Grace and Olivia June were born in September 2014 at 30 weeks gestation and are doing well!

Tonisha Rapp lives in Oklahoma City with her husband Al, and daughter Cierra. She has two dogs, two cats and is employed with an oil company as a landman. You can follow her blog here

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