After four years of trying to have children we were beginning to lose hope. At 36 and 48 years of age we knew we didn’t have unlimited time to keep trying.

Our journey began with high tech ovulation monitors, hoping for the best every 28 days. We lost faith more than once, struggling through the monthly disappointments. Eventually we went for fertility testing – sperm count and motility for him, ovary and uterine health for me. Everything looked fine. Still no results.

Next we sought out a Naturopath. More tests plus a daily regime of herbal remedies. No luck. Then we turned to our trusted OB for a round of IUI – what we affectionately called the “turkey baster”. Still no results. Next we looked to Eastern medicine and engaged an acupuncturist specializing in infertility. More herbs. Every day. No results. Finally, in the summer of 2004, we began researching Bay Area fertility clinics. We assumed it would be the last step in our journey, either way.

In September 2004 we began working with PFC and embarked on our first round of IVF. Scott learned to give shots, and Cara dutifully produced five eggs of various sizes, only two of which turned into embryos, both of very low quality. We hoped for the best but knew the chances were minimal. The pregnancy test ten days later confirmed we weren’t pregnant. It was disappointing, to say the least.

We met with Dr. Ryan and discussed what to expect for our second round. If we had a similar experience in round two, which was likely, we needed to consider the alternative of an egg donor. This was not good news. To learn that IVF may not allow us to have our own children was extremely discouraging. We took several months off to prepare for the second round. We felt it might be our “last chance” of having a baby that was biologically ours.

In January 2005 we started our second round at PFC with a modified stimulation protocol. This time Cara produced eight eggs, two of which became “viable” embryos and a third that was marginal. Even though the two viable embryos were “Grade 2” and were only six or seven cells, they were at least considered “reasonable.” We hoped, prayed, and tried to remain calm and positive.

Then the “magic” began. Within a few days of the egg retrieval Cara had a dream we would have twin babies – a girl and a boy. And a week before our first pregnancy test a close friend dreamt we were pregnant. Then his wife announced she had a premonition we were going to have twins. We stayed hopeful.

After ten days of waiting we received the results of our pregnancy test, and it was positive! Plus Cara’s hCG level was high enough to indicate there could be more than one “bun in the oven.” At our 6 week ultrasound we announced to Dr. Ryan that we had twins (before the ultrasound). When she found two embryos (7mm and 9mm long) with two happy heartbeats, it was as if we were being told something we already felt we knew.

We are now entering our 4th month of pregnancy. Every day we envision our babies being born healthy and happy. We are so grateful to Dr. Ryan, the entire PFC staff, and the many people that have supported our journey. We remain in awe of both medical technology and the magic of the universe for helping us to create two new lives.

– Cara and Scott France, Pacifica, CA

My infertility journey started when I was only 17. I was diagnosed with endometriosis and underwent my first laparoscopy. I had temporarily relief and then my symptoms returned. I tried various alternative treatments but they too offered only temporarily relief. This was not the life that I wanted to have as a young adult who wanted to have children more than anything in the world.

Surgery after surgery, specialist after specialist, my quality of life was slowly going down the drain. Initially, I told doctors that I didn’t want to have a hysterectomy but later, something had changed. I was eight surgeries into my journey and I asked my doctor if I could have just my uterus removed so I could still try and have a biological child. He said yes and I was quite relieved. After the surgery, I felt better for a while, but the pain still continued. I had to evaluate my life and decide what was important to me. I knew I wanted to live, but the pain had me in and out of the hospital and often times feeling suicidal. I had no other choice but to have my ovaries removed.

Luckily, I thought about freezing embryos and called Pacific Fertility Center. I met with Dr. Isabelle Ryan and she changed my life. My boyfriend and I knew we wanted to get married and I was on a limited time line until I had my ovaries removed. We only had one chance to do this and we were determined to do it right. We underwent one cycle of In Vitro Fertilization and froze all of our embryos. We froze our embryos at a 2PN stage* per Dr. Conaghan and Dr. Ryan’s request. This would help our chances of having them thaw better but we don’t know how they will turn out. We were willing to take that chance.

Two weeks later, I had my ovaries removed and then felt I was ready to move on with my life. My boyfriend and I got engaged and together dealt with the loss of having me carry our child. In our counseling session with Peggy Orlin, MFT at Pacific Fertility Center, we talked about what if a gestational cycle didn’t work. We knew that we would be parents no matter what and if it wasn’t our biological child we could be ok with that.

From time to time, I still grieve the loss of being pregnant, but know that I did everything that I could. Since then we have gotten married and have been offered the opportunity of a lifetime. A dear friend has said that she would like to carry our child. She has restored our faith in humanity. What an offer!

As we are working out the details, we are thankful for her commitment to us and our journey. We will transfer some of our embryos into our gestational carrier and hope for the best. Dr. Ryan and all of the staff at Pacific Fertility Center have been so supportive of us that we can’t wait to come back when we are ready to do our transfer.
Anonymous, San Francisco

* A note from Laboratory Director Joe Conaghan, PhD:
Embryos can be frozen at different stages of development, usually 1, 3 or 5 days after oocyte retrieval. In general, the earlier they are frozen, the better they tolerate the freezing process. Embryos frozen on day 1, or at the 2 pro-nuclei stage, survive freezing and thawing at a rate over 95%.

After trying “au natural” for several years, we were told to try clomid a few times… no luck. We were then told to try IUI but we decided against it. We always felt we had plenty of time but Daphne, my wife, had turned 36, and we knew we had to get serious.

Following a battery of tests, our picture went from bad to bleak. First we learned that my sperm count is lower than average, so I felt horrible. Then we learned that Daphne has endometriosis. So it was her turn to feel bad. You sort of feel like you’re letting the other one down.

Our OB/GYN decided we needed a specialized facility, and referred us to Pacific Fertility Center.

One of our toughest days was our first trip to San Francisco, a four-hour drive. We didn’t know anyone there. We went through the convolutions of testing and more testing and deciding to undergo IVF. And then minor surgery. This was in the middle of the holidays; Daphne felt sick, and we began thinking of all the expenses we had incurred just to get to that point. We felt like our lives were out of control. Standing on Pier 39, I wondered whether we could continue, and I said, “I don’t know if we can do this!” Daphne just looked haunted. She didn’t say a word.

Daphne was so meant to be a mother. At one point I started feeling desperate for her. Another mother in line at a grocery store yelled at her child, taking it all for granted. It just made us wonder why? Why them and not us? It made Daphne absolutely miserable.

During these tough times we would be comforted when we entered the doors of the center and felt a sense protection, as if people were putting their arms around us. We began to turn it around and started enjoying ourselves in the City while dealing with medication shots and appointments. We didn’t look back – and then it came time for the retrieval.

Just before Daphne was to receive the anesthesia, Dr. Schriock, with his soft-spoken mild manner came over to check in with us, and held her hand. That really touched her. If you’re going to go through something like this, you couldn’t ask for somebody more understanding. Whether they know it or not, the PFC physicians and nurses, and Joe come across as caring people before professionals, even though I know they’re experts.

We didn’t break any records; I think we barely made 10 embryos, but that gave us enough to use and freeze. Plus, they looked good.

After an agonizing wait, the news on our IVF cycle was negative.

We were disheartened, but Daphne quickly rebounded and we went right into our 2nd cycle – a frozen transfer. Again, the transfer, the waiting and again, negative.

Those were very black days. You feel part of a populace, but everyone is moving on and you’re not. You feel so alone. We were struggling so hard on an activity that should have been so natural. We were hostages to so many unknown factors.

We went on and did a 3rd try, again using our frozen embryos. We were fully prepared to be disappointed. After the transfer and the wait, the testing lab in Fresno drew her blood and by the time we got to our home close to Yosemite, the phone rang almost immediately. I was ready, standing next to my wife, forming the words that would comfort her, but instead she looked at me and gave me a thumbs-up!

From that time on, we were even more guarded than before… at least for a while. We were almost too afraid to tell people but we surprise-visited Daphne’s parents with a cake that said “We’re Pregnant!”

Tessa is now nearly two. Of course, you see children, and you know they’re considered perfect. But Tessa is the most photographed and beautiful baby, and she has a personality that just won’t stop.

We’re hoping to give Tessa a sibling soon with our remaining frozen embryos.

I now look back and see it kind of empirically – Tessa was one of the strongest embryos, and since being born, she hasn’t had any problems: no sniffles, no flu, not even a hiccup. So we didn’t just get a baby, she really is one of those babies!

– Randy Cohlan

My story has a very happy ending. And I’ll start with the ending first. My husband and I have a beautiful girl who will turn two in September and are pregnant with our second child who is due late this year. We feel that this would not have been possible without the expertise of a fertility specialist and, specifically, Dr. Givens.

Four years ago my husband and I decided that we were finally ready to have children. We had been together for over ten years. When we decided to start to try to get pregnant and I stopped taking the pill, we anticipated it might take a few months for my period to start and my cycle to become regular. After many months, I had not had my period and was still not pregnant. Still, we optimistically had sex, thinking that I might get pregnant even without having my period. We had heard and read that it was possible. More months went by. I spoke to my gynecologist who said that it might take a while. Still more months went by.

After almost a year, I went back to my gynecologist to try to uncover what was going on. She advised that I could start taking Clomid to assist with the pregnancy. My understanding was that I would not be able to take Clomid indefinitely until I got pregnant, and I wanted to understand the underlying problem and diagnose it before I started taking drugs. Luckily for us, I had a family member who was able to advise us to seek help from a fertility specialist and even found out the names of the top specialists in San Francisco. I then found out that before I could see one, I would need to jump through a series of hoops. The first one was to try to get my doctor to identify the right tests I would need to take to get the referral to the specialists. After many phone calls to my doctor’s office and insurance company, I was finally able to identify and take the right tests. This took a couple of more months, after which I was diagnosed with polycystic ovarian syndrome.

The diagnosis was frightening to me at first. As it turned out, I had a mild case, and it did not interfere with my ability to get pregnant. Rather, Dr. Givens identified a very simple but elegant way to help me. She prescribed Clomid and monitored my ovulation. I was not able to detect ovulation with a home test, but Dr. Givens could see the egg maturing with ultrasounds. At the critical point, when I was about to ovulate, Dr. Givens prescribed a shot of HCG and said that my husband and I could have intercourse in the next 48 hours. It worked. This same approach worked with both pregnancies on the first cycle. We are fortunate to have found an excellent doctor and cannot underestimate the power of the expertise of Dr. Givens.

– LK (name withheld upon author’s request)

Once women with polycystic ovarian syndrome are successfully induced to ovulate with medications such as Clomid, it is likely that pregnancy will follow, if all else is normal. Sometimes Clomid alone will not work and ultrasound monitoring and appropriate timing of hCG injections will complete the ovulatory process. My patient, LK, is young and she only needed a little extra help to ovulate. She was very fortunate to conceive on the first try with both of her pregnancies. It is more typical that it may take 3-6 cycles of ovulation induction to achieve a pregnancy. Nonetheless, we are delighted that LK was able to have her family with a relatively low-tech approach.

– Carolyn Givens, MD

After three failed IVF attempts, my partner, whom I’ll call “Sam”, and I decided to go the egg donor route. The choice actually reduced the degree of frenetic attention we had been paying to our “baby project”. All along, we had been racing against my biological clock as I went from age 38 to 41 with only disappointing results, including one early miscarriage. Curiously, our decision to use a donor evoked a peculiar calmness as I realized that as long as we chose a young egg donor, I could be almost any age!

We then spent some time looking at the various donor databases, yet weren’t truly happy with any of the candidates. Not that we could define the perfect donor profile, but none of the women felt just right. So I let our “baby project” sit on the back burner as life moved on, thinking autumn would be a good time to resume.

Given that the entire process can take up to three months, this past July, without too much expectation, I casually made a 2nd appointment to view PFC’s binders, which contain photos and essays of each egg donor. I was fully prepared to go through the motions and leave without finding the “right one” but one particular donor’s profile just leapt out.

Her photographs revealed a woman who just beamed with exuberance and yet seemed grounded. Other positive indicators included a completed college degree and a job in a field that interests me. Her intelligence, focus and motivation were good signals. I also noticed we shared the same favorite color, and had both played the flute and piano at one point.

A second woman, with a closer ethnic background also emerged as a good candidate. At age 21 she already had a child but no college whatsoever. I decided to return home with both profiles so that Sam could have some buy-in on our choice, although I had quietly decided on my favorite.

When Sam wholeheartedly chose my favorite, I felt an enormous wave of relief. The process started feeling less like an abstraction and I posted her portraits on my bulletin board and looked at her face on a daily basis. Her smile was actually encouraging and I grew increasingly comfortable with the notion of using her eggs and having her genetic material in my body and baby. After all, I am in a sense fusing with her.

We then had to decide whether to meet our donor. Sam opted out but I reluctantly decided yes. No doubt, the meeting would be awkward and my biggest fear was that I might change my mind after discovering an undesirable trait!

But the mediated 45-minute meeting went well and felt relatively natural even though there was a drastic limitation to our conversation. Imagine making small talk and not being able to say much about work, home and so forth! Her quiet and reserved demeanor offset my nervous energy, and she just let me babble on. I enjoyed hearing her mention a few anecdotal points about her own childhood, giving me a good sense of her family past. We agreed that it would be a good idea to meet again at some far-off point, if a child indeed developed. I definitely got the impression that she would respect boundaries and she affirmed this.

Soon we’ll know if our donor relationship is truly successful and results in a pregnancy. Sam and I have high expectations. He likes the favorable odds and I like the donor, so we hope for the best.

– JMT / San Francisco (name withheld upon author’s request)

We are the parents of a little boy with a rare, life-threatening, enzymatic disorder. He inherited this condition through genetic mutations passed along to him by us. Caused by a recessive genetic defect, neither of us is affected in anyway as we are simply “carriers” of this disease. Once we were determined to be carriers, however, we learned that should we conceive another child naturally, there is a 25-percent chance that we will have another affected child.

It had always been our plan to have more than one child. However, as we began to discuss the possibility of having a second baby, we both realized that given the physical, emotional and financial costs of being affected by this disorder, we were not comfortable with consciously bringing another child into the world without doing everything we possibly could do to avoid this for any other child.

Embryo Biopsy

After two years of extensive pre-conception counseling, we decided in-vitro fertilization (IVF) with pre-implantation genetic diagnosis (PGD) through Pacific Fertility Center would give us the best possible chance of giving birth to an unaffected child.

A medical technique whereby embryos can be screened for specific genetic defects prior to transfer to the womb, PGD has been performed for over 10 years and has proven to be a most effective method of diagnosing embryos for known genetic mutations. To-date there have been over 2500 PGDs performed around the world resulting in over 1600 children born without the disease for which they were screened. The error rate for PGD is less than two-percent; therefore, PGD would reduce our chance of having an affected child from 25% to less than 2%.

A little over a year ago we began our IVF with PGD Embryo Biopsy cycle. On Day 3 after retrieval, when our embryos were eight-cells or so in size, a single cell was biopsied from each embryo. These cells then were sent to a lab where the single cell from each embryo was tested for the genetic defect in question. We then transferred two embryos pre-determined to be unaffected by the disorder. In October of last year, we welcomed to the world our miraculous bundle of joy, an – unaffected – little boy.

– Name withheld upon request

After my husband and I learned that we had no chance to become pregnant by natural means, we began to investigate IVF/TESE (sperm obtained by biopsy of the testes) with ICSI (Intracytoplasmic sperm injection) as a way to realize our dream of starting a family. We expected the procedures to be challenging to our bodies, minds, and finances.

We were also concerned about the frequency of twin and triplet births with IVF. As much as we hoped to have a child, we wanted to do everything we could to provide the best start for our child-to-be. We wanted to optimize our chances for a healthy full-term singleton pregnancy, natural childbirth, and breastfeeding, if we could become pregnant.

Dr. Carolyn Givens patiently answered our many questions about IVF and embryo cryopreservation and supported us when we made a choice that was quite unusual at the time: we requested that only one embryo be placed in my uterus during the IVF cycle and that any remaining embryos be frozen. I was 34 at the time and had never been pregnant.

Eight-cell embryo

We had the exceptional fortune that our first IVF/ICSI cycle in August of 1997 produced 13 beautiful embryos, and our transfer of a single fresh 3-day-old embryo during that cycle resulted in the birth of our son Benjamin nine months later.

I was still breastfeeding Ben in 2001 when we decided to try for a second pregnancy. Dr. Givens transferred a single 8-cell frozen embryo during an unmedicated natural cycle. We had explained to Ben that there was a little, little baby in Mommy’s tummy that we hoped might grow to be his brother or sister. About a week after the transfer, Ben said, “Mommy, the little, little baby in your tummy is crying.” A few days later, my period began, and I felt like crying too.

The next month, Dr. Givens transferred another frozen embryo, also without medication. Ben thought this embryo was happy, and he was right: she grew to be his sister Charlotte.

When we were considering the choice to have our embryos transferred one at a time, we were glad to learn that the expense of frozen embryo transfers was only a small fraction of that for the IVF/ICSI procedures. I found embryo transfers performed by Dr. Givens to be gentle and comfortable. Dr. Givens’ respect for our individual preferences made our infertility treatments a very positive experience. Our children have brought us unimaginable happiness.

– Camille, Redwood City

Most couples going through IVF or frozen embryo transfer choose to transfer at least two embryos in order to improve the chances of conception with any one embryo transfer procedure. As Camille’s story indicates, however, in younger patients with nice embryo quality and overall good chances for success, electing to transfer a single embryo is a viable option to avoid the risks of multiple gestation pregnancy. It also illustrates the benefits of embryo cryopreservation for having more than one child with a single IVF stimulation cycle.

– Carolyn Givens, MD

Our 7 year old daughter sneers when we joke about why she is a fanatic about ice cream: “Because you were a frozen embryo for 9 months.” To our 4 year old twin boys, also conceived by ICSI/IVF, we sometimes say, “double trouble – we wanted one more boy, and we got two!” They, along with our adopted Korean son, don’t realize that they are true miracles, particularly since the most recent IVF attempt was given a 2-5% chance of success by Dr. Schriock, because “age was an issue,” and to our dismay Emily’s FSH level had tripled since our prior successful IVF cycle.

Never as a couple did we predict that we would be challenged with unexplained infertility. Emily took for granted that she would some day have children, having put career and studying as a top priority throughout her second decade. But as a pediatrician and geneticist, we too became part of the Bay Area epidemic of infertility as we struggled to start a family. Each day at work Emily became ever-so-more aware of the challenge as she counseled pregnant women about genetic testing. I myself, a psychiatrist, became concerned about the emotional roller coaster, because Emily seemed obsessed with the goal of having a child.

Despite the lack of control we felt, now that we have completed our quest to be parents, we are truly appreciative of the expertise, wisdom, and compassion of PFC doctors and staff.

We feel blessed by what we have learned:

1. We never take our children for granted;
2. Each child, no matter how he/she came into the family, is loved equally for the joy each one brings – adoption is just as much of a gift as a pregnancy;
3. There are some advantages to raising twins;
4. Our lives are enriched from the relationships we formed with health care providers and friends;
5. Life is precious – we more deeply cherish our own lives and value friendships, hobbies, nature, family time;
6. We have more sensitivity towards others who have similar struggles.

We are also compelled to share what we learned:

1. Don’t hesitate to ask questions or seek multiple consultations;
2. It is useful to record all notes in a journal to help think of questions, and to feel more knowledgeable and in control;
3. Take advantage of scientific journals on infertility, RESOLVE and their resources;
4. Start therapy and counseling if needed;
5. Use the internet to research and read the many available books, but also keep in mind that some information is not substantiated by good, sound data;
6. The field of infertility advances quickly, and given new choices – there is always hope;
7. Look into other options, even though at times it may seem there is no light at the end of the tunnel. Adoption does not have to be a last resort;

Don’t forget, after the challenge of infertility, there is perhaps an even greater challenge – parenting!!!!

– John and Emily, San Francisco

Several years ago I received a call that would change my life forever. My mother was diagnosed with Huntington’s Disease, an inherited neuropsychiatric disease that affects mind and body – (imagine Parkinson’s and Alzheimer’s combined). The chances of passing on the disease are 50/50, and symptoms usually appear between ages 35 and 50. Because there is no cure, many “at risk” for the disease choose not to learn if they have inherited the HD gene.

Living at risk with HD has altered my life completely. Every choice I make is influenced by the possibility I have inherited the HD gene. And no choice is more affected than that of bringing a child into the world.

As I grappled with my mother’s news, two facts became certain: I wanted children and I did not want to know if I would someday get HD. Given this, my husband and I sought advice on how to have a healthy baby. Our genetics counselor outlined two viable options: Once pregnant I could have a “non-disclosing” CVS that would indicate if the fetus had inherited the chromosome from either my mother or my father, thereby not revealing if I had HD. The second option was a cutting-edge process through IVF called pre-implantation genetic diagnosis (PGD). This involves testing each embryo for the HD gene at the cellular level when the blastocyst is only 5 days old. Only healthy embryos are implanted.

After having experienced a failed pregnancy, CVS had no appeal. That left IVF/PGD. Yet in order to maintain my status as a non-disclosing patient, I arranged NOT to be told any details throughout the IVF cycle. Even knowing how many eggs were harvested or how many embryos were implanted; I could surmise my status. (Imagine: if none of the embryos were healthy, my doctors would stage a fake embryo transfer so I wouldn’t suspect anything.) As such, it was important for all PFC doctors and staff not to reveal any information to me. Doing this meant putting total trust in everyone.

Trying to get pregnant through IVF is a costly endeavor: emotionally, physically and financially. I believed it would be easy because I had gotten pregnant so quickly before. Consequently, I was devastated when our first two attempts failed. In retrospect, I am amazed at how my husband and I endured, despite days when I had almost given up all hope.

After an exhausting six months and three attempts, I was finally pregnant. While overjoyed, I was still hesitant to believe it would go to term. Furthermore, I was required to have an amnio to ensure no errors were made, although given my non-disclosing status, I would not learn the results of that testing. It was only after my fifth month into pregnancy, that I believed I would have a healthy baby.

Our son is a miracle and my husband and I cherish him beyond belief. We are eternally grateful to the people who supported our choice to conceive a healthy baby using PGD.

–Patient’s name withheld upon request

I have learned that things in life do not always turn out the way you might have thought that they would. What seems to be the “standard” life may not be so easy to attain. I just turned 45 years old and have just found out that I am pregnant for the second time since working with Dr. Chenette. We have a four year old son who we conceived the “old-fashioned” way after Dr. Chenette removed a polyp from my uterus. We wanted a second child, and somehow I thought that if we did it once, we could do it again. I have of lost track of the cycles, but over several years, we have done IVF at least 3 times with several incomplete cycles and hysteroscopies in between. After failing the 2nd IVF, egg donation came up in our meeting with Dr. Chenette. My husband was ready to do it the next day because the odds were much better. I was more hesitant and felt that I needed to try a 3rd IVF cycle with “my eggs” first. In the meantime, we entered counseling and I joined a donor support group. The counselor was wonderful and so was the support group. The idea of egg donation grew comfortable for me as an option. After our 3rd cycle failed, we started looking for a donor. Although a strange process, something became clear. The look, the height, the intelligence etc., were not as important as just finding a nice, happy person who seemed to approach life the way that I do.

I looked for “nice eyes”- for I believe they tell you about a person. We found a donor and I really like her. Now, everyone probably works through this process in their own way, and that is the point. To find what you and your partner are comfortable with, and to take it one day at a time. I try not to worry – it’s easier and more fun to be positive. I envisioned myself at this point in my life to be like a Mrs. Cleaver with a couple of kids and a fancy hairdo like a grown-up. But I met my husband later in life (and learned a lot up until then…). I still feel young. I am healthy and we all really want a second child. We are hoping that it is meant to be, and we are grateful to Dr. Chenette, the special nurses (Sue, Ann, Pat, Carol and the rest), and the nice staff at PFC for their services and their support.

–A.W. in Oakland