"Getting pregnant and having
a baby is a gift."
Those are the words of Heidi Smith, a resident of Chesterfield
who should know. Smith, 33, and her husband Randy, 40, spent
several years trying to get that very gift.
Their daughter Caroline now is almost a year old and is as healthy
as any other baby, if not healthier. But the Smiths did not get
Caroline the conventional way. Instead, they sought help from
modern medicine and conceived Caroline through
in
vitro fertilization (IVF).
The Smiths have been married for seven years. After one year
of marriage, they began trying to get pregnant. Smith said
that after six months of trying with no success, she knew something
was not right, so she consulted her obstetrician/gynecologist.
"I was put on a drug called clomid," Smith said. "It stimulates
more eggs to be released."
After three months on clomid, Smith said she began taking her
temperature every day to keep track of her cycle and when it
would be best to try to conceive. This went on for another
year. But the Smiths still had no success.
"After one year of charting my temperature, I started reading
books about infertility," Heidi Smith said. "I also found out
I had never been ovulating. I wasted so much time taking my
temperature."
Looking back, Smith said she would love for women to be able
to talk openly about what they might be going through if they
are having problems getting pregnant.
"Women who are thinking, 'I can't get pregnant,' can be educated,"
Smith said.
Smith said she knows the pain of so many women who think they
can never get pregnant.
"I couldn't go to baby showers for a few years," Smith
said.
"I couldn't talk to girlfriends who were pregnant. I couldn't
even say congratulations. I would just cry. I had one friend
who had a baby and found out a few months later she was pregnant
again and she was complaining so much and dreading it, but
she didn't know how lucky she was. The hardest part that still
makes me cry today is when a parent of my students or people
would say, 'You'd be such a great mom. Why don't you have kids?'"
It got to the point where Smith said she wrote a letter in
their Christmas card one year telling all their friends and
family they had been trying to get pregnant for years. She
wrote, 'Please don't ask us, we'll tell you.'
"Friends started
calling," Smith said. "A few were going through similar situations.
It was better to talk about it, and it
got easier the more I wrote about it in my journal."
But then Smith said she finally found some help from the book,
"
How to Get Pregnant
with the New Technology," by
Sherman
Silber,
M.D., director of the Infertility Center of St. Louis at St.
Luke's Hospital. Silber is internationally known for performing
and creating breakthrough procedures in the infertility field.
Still, Smith did not seek the help of Silber right away.
"When I read the book, I didn't know Dr. Silber was in St.
Louis," Smith said. "But my husband and I asked ourselves,
'Do we want to spend all this money?' So we went to another
doctor in the area and spent thousands."
Smith said looking back, she now considers seeing this other
specialist a waste of time and money.
"We spent around $5,000 with him," Smith said. "He wasn't very
aggressive, and I still wasn't pregnant."
Smith said she contacted Silber but still waited an entire
year before she went to see him.
She said she was not sure if she wanted to be on the fertility
drugs required, and there also was the big expense.
"Nothing is covered by insurance," Smith said. "Maybe some
of the drugs, but not the process of getting pregnant. We spent
$14,000 to 16,000 with Dr. Silber."
Smith began her treatment with Silber in July 2002, nearly
six years after she first began trying to get pregnant.
Before Smith began treatment, she was teaching elementary school.
Smith and her husband decided she would quit her job once the
treatment started so she could concentrate on getting pregnant.
"I really loved teaching," Smith said. "It was hard to quit
my job. But I didn't want to be teaching while I was on the
drugs, and I wanted to give my all to getting pregnant."
Staying at home and not having her income was a slight adjustment
to their budget, Smith said. But the Smiths said they have
no regrets about their investment.
"Now I look at the life I have and it's the best and most difficult
job I've ever had," Smith said. "We don't go to Europe twice
a year or out to dinner very much anymore. When you think about
it, all it was is money. What we do with our money now means
so much more."
The Smiths are not alone in creating a baby through the IVF
procedure.
Silber said that to date, more than 1 million IVF babies have
been born, with 100,000 IVF babies born in the United States
last year. Silber also said those numbers would be higher if
insurance companies covered treatment for infertility.
Silber said he defines an infertile couple as one that fails
to get pregnant after one year of trying. While 85 percent
of those trying to get pregnant will within one year, 80 percent
will get pregnant in the second year, Silber said.
"The population is changing," Silber said. "Women are not interested
in having a baby until later in their lives. They have their
education, career and marriage. Everybody is so healthy, so
why worry? I usually don't see them until they've been trying
for years."
Silber recommends that any woman age 35 and older not wait
to be seen by an infertility specialist if she is having trouble
getting pregnant. Silber said when he first sees a patient,
he takes a sperm count of the husband and sexual history of
the couple.
While there are several causes of infertility and several options
to get pregnant, Silber said in vitro fertilization not only
is the most effective, but the most cost effective as well.
Silber said $10,000 per IVF cycle is the average cost of treatment
across the country. silber also said IVF is the most common
form of
assisted reproductive
technology available today.
"If the fallopian tubes are damaged or the sperm is poor, it
is the only acceptable approach," Silber said. "Thus, with
such cases, the eggs must first be fertilized in our laboratory,
and the resulting embryos then are placed into the uterus two
days later. This procedure achieves remarkable pregnancies
even in women with hopelessly damaged fallopian tubes. Our
IVF
pregnancy
rate is about 50 percent per attempt, regardless
of diagnosis."
Silber said many couples have gone through other, more expensive
conventional treatments that have not worked. Once a couple
chooses to pursue IVF, they pick a target date for the IVF
procedure with Silber and then count backward, usually six
weeks. First, the woman is on hormones for two weeks to suppress
the pituitary gland. The next two weeks, the woman is stimulated
with hormones to get her ovaries to produce multiple eggs.
Silber said 15 to 20 eggs is a good number with which to start.
For Smith, she said she was surprised the drugs did not adversely
affect her. Her husband administered the shots, which she said
probably was the most uncomfortable part of the process.
"St. Luke's taught Randy how to give me the shots," Smith said.
"He still remembers exactly what drug I was taking and what
time I had to take it. The only shots that hurt were the ones
that went into my muscle, but other than that, it was OK."
Next, Silber said the IVF process goes as follows:
"The eggs are retrieved by an ultrasound-guided needle
aspiration under light sedation in the operating room. This
involves no
surgical incision and virtually no pain afterward. With IVF,
you just leave the hospital directly from the operating room,
with no pain, and come back three days later to have the embryo,
or embryos, placed very simply into the uterus through the
cervix with a tiny catheter. No incision and no anesthesia
are needed. An hour later, you are able to go home."
Silber said once the eggs are retrieved, they are cleaned off
and then under a microscope, they pick up the sperm and literally
inject it into the eggs. Then the eggs are cultured for three
days, and two to three of the "best" embryos are transferred
back to the uterus. When there is any problem regarding the
sperm, Silber said they can fertilize the eggs with
intra-cytoplasmic
sperm injection (ICSI), which actually is injecting one
sperm directly into an egg.
Silber and two other doctors developed this procedure in 1993.
Silber said in his program, he routinely uses ICSI in all cases
to guarantee against the risk of failed fertilization.
"If the embryo is genetically normal and it is transferred
delicately back to the uterus, they will get pregnant," Silber
said. "It is very important not to irritate the uterus."
Silber said 15 percent of all pregnancies end in miscarriage,
and with IVF, the number is no different. The percentage goes
up with the age of the woman. A woman 40 years old has a 35
percent chance to miscarry, Silber said.
Smith said she and her husband tried not to think that one
round was the only round.
"I could not let myself think this is all or nothing," Smith
said. "I had to put that in my head. We might have to do this
three times, but we knew three times was all we could afford."
While Smith said she had no problems during the actual IVF
procedure, five to six days later, she did begin having trouble
breathing.
"I couldn't catch my breath," Smith said. "It turned out I
had hyper-stimulation because of the fertility drugs I was
on. My ovaries kept producing a fluid, and my lungs were filling
up with the fluid."
Smith was admitted to the hospital for three weeks while the
fluid was drained from her lungs. But the surprise Smith got
from the doctors the first day she was there is something she
said she will never forget.
"They told me I was pregnant," Smith said. "I didn't even know
they could tell so early. It was such a euphoria to think that
I was pregnant. I didn't care that I was in the hospital. I
was pregnant."
While it was Silber's job to get Smith pregnant, once pregnant,
IVF patients then see a regular obstetrician (OB) for the prenatal
care and delivery.
Other than the hyper-stimulation, Smith said her pregnancy
was pretty normal. At six weeks, she said she had her first
ultrasound where two heartbeats were present, but then at eight
weeks one had disappeared.
"It's called a vanishing twin," Smith said. "It's supposedly
common, but most women don't have ultrasounds so early, so
they don't even know about the other heartbeat."
While most women dread the weight gain a pregnancy creates,
Smith said she was proud every time the scale went up, proving
she had a healthy baby on board.
Like many women who have practically reached their due date,
Smith could not wait to deliver the baby. Her due date was
April 25, and it was quickly approaching.
"I thought, 'I've got to walk this baby out,'" Smith said.
"We went walking and I had spicy food. On April 14, I had dinner
with my sister and came home and Randy was still out. She asked
if she should stay with me because I was having contractions
and was home alone. I didn't think it was time because the
contractions were still sporadic. Then I woke up around 2 or
3 in the morning and the contractions were strong. My water
broke in the car on the way to the hospital.
"When we got tot the hospital, Randy dropped me off at the
main doors and we found out they were locked. So here I am,
in labor, walking around the hospital in the middle of the
night down to the ER. But the whole time I was laughing and
having a good time."
Smith said the delivery of their daugher is the best thing
that has ever happened to her. And Smith did not have any drugs
during the delivery, not even an epidural.
"The happiness took all the pain away," Smith said. "We never
thought we would have a baby. She's here because of Dr. Silber
and she's beautiful. We named her Caroline. When they (the
delivery team) found out her name, the all started singing
'Sweet Caroline.' I'll never forget it. I appreciate every
pain."
After all she went through to get pregnant the first time,
Smith said she is ready to do it again.
"People who get pregnant and have babies so easily have no
idea," Smith said. "Before Caroline, we had gotten to the point
where we thought there was no way we would ever have a baby."
The Smiths said they could not be happier with Caroline or
more grateful to Silber. She also said she still wants every
couple who is trying to get pregnant to know they are not alone
and options are available if they need help.
Cover Story - West Newsmagazine,
March 10, 2004