Secondary Infertility: Olivia’s Story

Secondary Infertility. It means having trouble conceiving after you’ve already had a child or children. I didn’t know that was a thing.

Back then, I knew of two women who had experienced a miscarriage. I felt terrible for them. I also remember feeling scared of this thing I did not understand. I wanted to do something to show I cared, or help them, but I didn’t know how. They never spoke of it openly but I heard through the grapevine; a transferred embryo didn’t survive in the womb. For the other— they miscarried in the first trimester. I assumed it was a secret. I had never experienced a loss, I couldn’t relate, so I assumed I didn’t have a place to speak. I also had no idea what to say if I did say something, or if the act of mentioning it would be offensive. I wasn’t sure, so I did nothing.

Later I plotted with my friend to have our babies around the same time, in the spring. We exchanged our ovulation windows and we were determined and excited. I had never tried to get pregnant on purpose before. It had seemed a matter of allowing it to happen, a task requiring a little planning, akin to deciding when to pick up some eggs and milk at the grocery store. The success probability was high, after all, the first time I got pregnant was by accident.

My first pregnancy I entered motherhood when I was not really desiring it. It took me years to grow up a little and adjust to my new role. I was looking forward to getting pregnant exactly how and when I wanted to… I had experience under my belt, I had figured out how to emotionally steer with a new child, and I had all the gear. I really enjoyed being a mom, everyone who knew me knew that. It seemed natural and expected to have another. I knew it, my husband knew it, we even prayed and felt good about moving forward. In fact, the answer that came to our minds on separate occasions from our personal prayers were the words, “I will be with you”. Rather vague, but I’ll take that as a yes. I did a victory dance following my IUD removal. He will be with us.

I found cute onesies at a yard sale. I thought about my nursery decor. My husband and I mused over names, interspersed by debates, teasing and happily imagining details of our next, and hopefully for lots, perhaps twins. I was the one showing up at pregnancy events and winning raffles and I wasn’t even pregnant. I relished in picking the brains of my friends with a second child. I scouted out the course I wanted to take for birthing classes, and was ready to sign up as soon as I was allowed to… when I was pregnant. Birthing and breastfeeding were my favorite topics to discuss. My passion for lactation education evolved into taking some online classes and sparked some career interests. I had never before known what I wanted to do in life aside from being a mom. I felt so passionate about normalizing breastfeeding and advocating for maternal health. It all seemed to fit like a key into a lock.

Soon after a positive pregnancy test, my period came. I felt frozen, hoping there was an explanation or consolation. I went into a clinic. I soon learned I experienced a ‘chemical pregnancy’— a term describing a miscarriage so early, they don’t even call it a miscarriage. I requested further explanation. I got an earful of possible things that could be wrong with me, but the bottom line is, they didn’t know, so I was sent on my way. “I’m so sorry” You’re sorry? Joy that I felt, the future I envisioned was robbed… right out of my hands, and with no real explanation. I felt so shell-shocked walking out into the sunshine into the parking lot, getting into my car, starting the ignition in a very robotic way. I did not understand how this could be happening to me. I did not even begin to know how to deal with it. This was the worst possible news. My aunt embraced me, my husband rationally encouraged me. I felt like I was an actor in a movie, it didn’t seem real, it wasn’t fair. How? and Why?

When my friend shared that she was pregnant, I confessed that I lost mine. The world carried on without skipping a beat, when I was sure it would stop, when I wanted it to stop so I could wake up and it could start over the way it’s supposed to be. She took the birthing class I recommended. I threw her a baby shower, I came and saw the baby the day she delivered. I gave her the hat and baby sling I won from the raffle. I pushed our loss to the back of my mind. Time had softened my disappointment and I moved on the best I could, assuming my time would come. I didn’t talk about it, only in rare circumstances. I felt the less I thought of it the better. I unfollowed pregnant people on social media, I unfollowed hashtags having to do with babies or mom-ing. I dove head first into working 40-60 hours a week and studied.

It was a year since my miscarriage. I was going into my third night shift in a row, so I was pretty tired. The previous night was turbulent, watching one of my favorite residents pass away. This night had no particular stressors. Still, I couldn’t ignore strange sharp abdominal cramps persisting on my left side. I would frequently lean over, cringe, sigh and get back to work, but walk slow. When I got home, my husband assured me it was just stress. I woke 2 hours later from my rest that morning to relentless pain. I also discovered I was bleeding, but my period had finished a week ago. I immediately realized this could’ve meant another miscarriage. NO NO NO!! I sobbed over the toilet. I didn’t even know I was pregnant.

My husband ran me a bath, I practiced deep breathing. Still, the pain didn’t stop. I called my doctor father. He usually doesn’t raise an eyebrow at ailments, but he was very concerned about this. He wanted me to go to get checked out, he thought it was ectopic. I wasn’t largely convinced but considered it while driving a couple blocks to pick up my son from preschool. Sitting felt strange. I cringed on the edge of my seat. When we headed home, I passed the house, straight for the insta-care, narrating to my son, who was full of questions. Approaching the building, I noticed the sign didn’t say ‘emergency’. “You need to go to the hospital,” I thought. So I didn’t go to urgent care, I made a U-turn. I wondered if I was overreacting, still I gathered my husband and insisted he take me right away. We were on our way. The relief was sweet. Deciding what to do was the hardest part.

I was urine tested, blood tested, prodded, poked and questioned. I was patient, but my toddler was not. A tantrum unfolded despite my husband’s vending machine fruit snack efforts. They had to leave me, but he said he’d come back. I was wheeled through many winding hallways for an ultrasound, in my scanty hospital gown. As visitors and staff passed by I felt exposed. Time in the ultrasound room felt like an eternity, wondering what all the click-click-clicking and little explanations were for. The trans-vaginal ultrasound was excruciatingly painful, because they were pushing on that spot that was hurting me, agitating it more. I was trying to be brave but I moaned and sobbed in pain. I stopped caring if I had it all together. All I could think is how I wished my mother was with me. I didn’t try to make logic out of anything. Nothing made sense. The dialogue swirling around me continued to contradict. “There were hCG levels detected, did you know you were pregnant?” they said, “That rules out ectopic.” Irritated, I thought, “I’m not pregnant anymore.” The muttering continued, “Oh, there’s the mass” (MASS??) then, “The doctor will talk to you soon.” I got wheeled out again, this time staring up at the moving ceiling and less concerned about my outfit.

There was nothing (aside from morphine) more comforting than my OBGYN, who was called in from another location, he came to be at my bedside to tenderly explain the implications of what had transpired. Finally, he did confirm that I did have an ectopic pregnancy. An ectopic pregnancy is a fertilized egg that grows outside of the uterus, usually the fallopian tube. It’s potentially life threatening if not removed surgically or stopped with medication, because the pregnancy will burst the sphere and cause internal bleeding. As for me, my tube had long ruptured and I was internally bleeding. I went on to have a VERY deserved nap (I went into surgery).

My left fallopian tube was removed that day. Recovery was rough. The first night at home I would wake up through the night and cry and feel really stiff, waking my husband for more pain medication. I could not walk to the bathroom without him to lean on. I began to feel better and was touched by the friendly visitors, flowers and meals, so I decided to open up and share my story on facebook. This out-of-the-blue life threatening episode that ended well, but with one tube short. Something surprised me. I had dozens of random friends and acquaintances comment or message me expressing they also went through an ectopic pregnancy, too! People I hadn’t spoken to in years, both old and young shared something in common; they went on to have kids following the event. This was consoling. I was hopeful that this small setback would also not affect my fertility. A few days after recovering from surgery and the shock of it all, I felt quite optimistic that I would get pregnant again.

It was only 5 months later that I did.

My husband and I considered this an answer to prayers, and as happy as we were, I also felt something was wrong. I would compare it to walking in the dark and not knowing if the next step will be the edge of a cliff. My husband, over the moon, told my parents right away and they cancelled their trip to Australia to be there when the baby came. Concerns appeared at 6 weeks, when I had some bleeding. I went in to be seen and the news was not good, but I didn’t want to believe it could go wrong again. After a week and a half of tests and waiting, my other fallopian tube ruptured in the clinic.

I came to know this after I booked an appointment for a valid concern considering my ectopic history; I was having spotting. I knew spotting could be normal, or at least I hoped it would be. The ultrasound technician looked grave. There was no pregnancy in my uterus. “You said you had an ectopic on which side?” Then after some further investigation, she warned me that it does look ectopic. I went in to see the doctor. It was possibly so early on that a pregnancy could be hard to even see, if there was one. He gave me a choice. We could terminate the pregnancy… or… if this is a “highly desired pregnancy,”we can wait it out.

Well, maybe it was the way he phrased it, but if there was a margin of doubt, I wanted to run with it. I chose to wait and see. I mean, there’s no way I’m going to give this chance up! I would get my blood tested periodically to see if my hormone levels continue to rise, signaling a growing pregnancy, or not. The notes read, “This must be considered a pregnancy of undetermined location. Therefore, until proven otherwise, maintain a high degree of suspicion for an ectopic pregnancy” He also noted, “moderate cellular fluid in the pelvis.” Looking back, this sort of bothers me that their response was not more urgent.

Five days later was my ultrasound. Five days is a long time when you have an ectopic problem, but here we are. I was excited for my ultrasound, but I had some doubt weighing on me. The blood tests revealed some trouble, as the hCG levels were stagnant, and that signified an ectopic pregnancy.

A myriad of miscommunication made this process interesting. There were a few factors that hindered me. First, my records had not yet been sent over from out of state where my last ectopic episode took place several months earlier. I had requested them but there was a technicality problem. I insisted the staff gather it over the phone that day, immediately, and it eventually got done. Secondly, I was confused which tube had been removed last time, I thought it was the right, which didn’t help the context of my pain location being on the right. Third, I was also reluctant to face the possibility that my chance to be pregnant was soon to be ruined. In this state of cognitive dissonance, I was grabbing at any explanation that this could still pan out for the best.

The wait times stretched on between results from tests and images, and it took longer than normal for the doctor (a different one from days before) to come back. I was told that the women’s clinic was very busy that day. I was told that I would be getting methotrexate to end the pregnancy that day. But while waiting for this to take place, all of a sudden, the discomfort which had been hinting at me started to surge into intense pain. It was on just one side, the right, and all too familiar. The pain was increasing and no one was coming, so I stepped out into the hallway and motioned to the student doctor to relay my message. Warranting investigation, I got the OK for an ultrasound, and made my way down the hall to the ultrasound waiting room to sign in. My pain proved that by this time my severed tube had burst causing me to bleed internally from my right fallopian tube. #1 I should not have been walking. #2 I should not have been waiting. I basically just folded over and winced in my chair…really glad I had only two fallopian tubes so hopefully this was the last time I had to do this. When the ultrasound finished up, it took time before the doctor could get back to me. During this time, I was visited by some medical assistants— for it was time for methotrexate to terminate the pregnancy. Not sure who would be terminated first, though, the pregnancy or me, because this ectopic rupture was relentless.

Laying on the recliner, I covered my face and sobbed. Tears streamed down my face, and I consented to long needle injections into my thigh. The staff person noticed my tears and voiced her sympathies about how sad and difficult it is to lose a pregnancy, and that it was almost over and soon I would go home. “Don’t send me home!” I thought. They were missing the point. No one was getting it, no one was believing me that this is serious. Looking up at the ceiling, I knew I was going to have to keep fighting for myself even though I was in pain, if I was going to make it. I had to fight for myself. I sat up and expounded, “Listen, I am in a lot of pain.” Looking them head on, I told them I need the doctor to come in and I think my tube has ruptured, I need surgery, I have been through this before. The two women in excessive gowns and masks shuffled out of the door after finishing up, and I promptly was visited by the doctor, who shared my view after seeing the ultrasound, so surgery was happening. Finally. Surgery was happening. What sweet words. The next thing I knew I was being hooked up to IV and given morphine, and my parents and husband were there.

Do you remember last time, all I could wish for is my mom to be with me? Well, some decisions had to be made at this point, and everyone (my mom, my Dad, my husband) had an opinion. “Do you want us to save the tube if it’s salvageable, or just remove it?” Some choices are better left not given. Especially if you’re internally bleeding and your husband and father are at odds. I decided I wanted the tube removed. This was following explanations from the doctor about how another ectopic pregnancy would be much more likely if the tube is damaged as it must be. My sweet hubby came in shocked not only by the turn of events of our pregnancy terminating, which was news to him, but also hearing talk of permanently halting our chance to conceive naturally. It was distressing for him. It was also distressing for me, but it was literally torturing me, I just wanted it out! To never feel this feeling again. The emotional tension was stressful for me surrounding the reactions my family was having. I was relieved to get wheeled away by the nicest obstetrician ever, who took care to make me laugh and put me at ease. The surgeon received me commenting that I must be the most cheerful looking patient who had a ruptured tube. He wasn’t sure he had the right person. I laughed that I was just glad to be here.

Recovery was physically easy. I had so much support. My mother fed me and helped me bathe and dress and slept by my side. It was her wedding anniversary the day it happened and she had family coming into town that day for the holidays, but she was there 100% and without reservation. My siblings hung out with me and comforted me. Recovery was emotionally not easy at all. My mental health dipped lower than it’s ever been. It felt like sitting in a room with the lights turned off and waiting for them to come back on and they never do. Christmas brought happy moments, but I couldn’t feel happy like I normally would. My siblings would go out to go shopping or sledding but I turned down the invitation to join them. My mother in law called to comfort me and say that “this is something you go on from.” She always knows what to say, and I didn’t know I could get stuck, like a pebble wedged on the edge of a rushing stream. Numbness felt more comfortable than emotion. Long past my physical body healed, my emotions simply did not heal as easily. I thought I was the happy positive one, that’s what I identified with. But, an inner sadness took residence in my body and said hello on and off for months. It was my first time experiencing grief reaction, or reactive depression. Throughout my life, people have commented that I am an optimistic person. This experience absolutely broke me.

It was emotionally distressing in a different way than the first. There was less fear surrounding the unknown, the sensation of pelvic pain was all too familiar. Even the shock of it being life-threatening was old hat. At the same time, this rupture redefined my fertility forever, and in a way took my remaining hope and turned my world upside down.

All that time in my turbulence I was holding onto that rope of normalcy, even if it was sort of being yanked away little by little, I still had some threads to hold onto. My second ectopic took away that rope, if you will, completely out of my hands. Taking into account here, not only the years previous hoping to conceive, but grieving things you wouldn’t normally think about. Like getting pregnant by having sex…that couldn’t happen anymore. ‘Choosing’ to have more kids, deciding how to space them out. The notion in my head of having one baby after another, the way it was spoken of from a young age, you understand that normally that’s something people have control over.

My world narrowed in quickly and suddenly. The doctor’s words felt very cold reassuring me of IVF. “At least you know you can do IVF” and later on loved ones saying “At least you have a son!” It’s not that I am ungrateful to have a child, nor that I had anything against IVF. But I was losing an organ, a very essential one because I had just lost the other one. And it didn’t matter how enthusiastically the doctors spoke of me being the perfect candidate for IVF! That didn’t restore my hope or world view for how my life was to play out.

So a few months following my second surgery, my Dad encouraged me to try IVF. Circumstances seemed favorable financially and circumstantially, so my husband and I decided to go ahead with it. We tried twice, and early on the drug combinations weren’t working for my body. I happened to join a research study that involved meeting periodically with a support group, and after it ended, we all chose to keep in contact afterward. I attribute a lot of my healing journey to going through this with four other women. IVF can feel so isolating, so this was a light in the dark, I know for all of us it was. One of these friends said, “One day, we’ll get 5 babies out of this”..and we can’t wait for that day. All of those women got pregnant, except for me.

I was termed a perfect candidate for IVF. I didn’t meet any risk factors for ectopic. I was perfectly healthy. I conceived and birthed a child before with literally no complications. I thought if I could get pregnant by accident, how hard would it be to get pregnant on purpose? Well, it was hard.

Guilt came in another form, as I wanted the pregnancy out. When all you want is to be pregnant and that pregnancy is literally killing you, it’s such a contradiction. My brief experiences as pregnant a second time were killing me. All I could wish for was the pain to stop, for the problem to be eradicated. This problem being the embryo of my child. By happenstance with no explanation or reason, just an unfortunate placement— luck! It was in the wrong place at the wrong time. But it happened TWICE. Preceded by a miscarriage and followed by two failed IVF attempts. You wonder, I wonder, how could you bear it? Why have hope?

What if you try and fail over, over and over again? I’m at the point now wondering, what now? And lately, the answer has been… embrace what I’ve got and focus on what else I can do.

It’s a miracle how time can offer healing and pain evolves like changing seasons. I had a hard time writing my story, which prompted me to ask why? Since I know many other women might also have a hard time or feel alone, I created a page on facebook, Ectopic Pregnancy Awareness, to share stories and spread awareness, so that if this happens to you or a loved one, you can recognize it, and we can lower death rates. I know I’m alive for a reason, and I’m grateful for another chance to live. Thank you for hearing my story, Let’s end the stigma around infant loss!

XOXO Renee Reina

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Secondary Infertility: Olivia’s Story