I have always enjoyed gynecology because it allows me the privilege of locking arms with women to help them build families in the midst of adversity. Too often I see them despair over their infertility, often to the point of giving up on their dreams. Fortunately, early in my career, a 15-year-old girl taught me the value of living on purpose.
As a well-trained, board-certified fertility specialist, I had a large referral base for laparoscopic surgery, done through the belly button and an emerging field in the 1990s. Most well-trained laparoscopic surgeons at that time were infertility physicians. In my early days at Wake Forest, I was the person doing the aggressive surgery through the belly button, and many gynecologists sent me patients for this very reason.
I received a call from a colleague about a young girl with a pelvic infection. Katy, only 15, had been diagnosed with a bilateral tubal abscess. I took her to the operating room where she underwent a laparoscopy to determine the scope of the problem and repair her damaged tubes. While not surprised, I was distraught at the extent of her disease. Both tubes were filled with fluid, extremely dilated, and blocked. As a fertility physician, I quickly realized that her chance for a natural conception was extremely low. While not zero, it was close. Usually, with today’s technology, we would remove the tubes and do IVF. But she was only 15 years old. And besides, IVF at that time was not very successful.
I took a deep breath, put on some music, often Ella Fitzgerald or Dire Straits, and went to work trying to repair her tubes. I cut the scar tissue, opened the tubes, and created new openings at the end of the tube near the ovaries. But a tube has a delicate end called the fimbria, the mechanism whereby an egg from the ovary is pulled into the tube in preparation for fertilization. Without fimbria, the chance of a natural conception is almost zero. And there were no fimbria present in either of Katy’s tubes. But I persisted since the thought of telling a 15-year-old she cannot conceive naturally was too much for even me to bear.
After the surgery, I met with the family. They were full of optimism and thanked me for the work I performed. They didn’t worry about Katy’s fertility since their focus was on her health. That was the kind of love they had. Depriving Katy of a family was never in their thought process. Never did they despair, and I’m sure they took the same attitude around Katy.
As a gynecologist, I’m not typically working with parents, but this was refreshing in one way because they were a supportive family. Katy’s ability to bear children did not change their love for her or their ability to parent her. But it was challenging since they were now facing the fact that Katy’s life would be forever changed. Would she despair and turn toward an unfulfilled life? Would she ever rebound from this major life event? Would she find a partner who would love her purely for herself? Would infertility destroy her relationships? I knew all these potential pitfalls, but Katy’s parents seemed to not focus on these outcomes. They simply loved her.
I lost touch with Katy and her family for about 15 years. I never really knew how they approached her infertility, but I bet they loved her unconditionally and kept encouraging her. I bet they assured her of her worth, even though she might not be able to have a child. I bet they spoke of her purpose and told her to seize life for all it has to offer. I can say that now, and here’s why.
I was having a typical day seeing new patients when my nurse brought me a chart on a 30-year-old woman named Katy. I walked in the room to find a delightful young woman with a smile spread across her face. She spoke of the surgery 15 years earlier and went on to explain that both of her tubes had been removed in a later operation. She understood that her only chance of a successful pregnancy was through IVF. She approached the conversation with confidence and a demeanor that exuded self-worth.
She was spunky, the kind of attitude that had grown from a base of self-confidence. I learned that she was a successful lawyer, had a great marriage to Kevin, and was part of a church that gathered around and supported infertility couples. Becoming a lawyer seemed perfect for her, and I knew I would not like to face her in court unless she were on my side.
Her church also seemed special. They gathered around and supported infertile couples in their congregation. No condemnation. No judgment. No pointing fingers at perceived sins. Just love and support. This is rare but is a hallmark of a good church. Many in churches look for causes of an illness, quick to point a finger and encourage repentance, but not this church. They loved instead.
Katy was not only living life, but she was also embracing it fully, not willing to let anything deter her from her destiny. I found myself encouraged simply being in her presence. She was a victor, regardless of her circumstances.
We embarked on her IVF journey. Unfortunately, a blood test revealed her egg quality was diminished, which meant that the success rate of IVF was markedly lowered. We also learned that her insurance company was not going to pay for the cycle. But even in the face of these two significant disappointments, she was not deterred. She moved forward with optimism.
Her husband, Kevin, was perfect for her. He was always happy and managed to cheer us up during some of the difficult conversations. He also had faith, never doubting their eventual outcome. They would banter back and forth in a way that seemed perfect. I could never tell which one was really in charge—perhaps neither. But it was fun and a delight to watch.
Her IVF cycle had the typical ups and downs—the emotional roller coaster of IVF. After multiple daily shots, several mature eggs developed, and she underwent an uneventful egg retrieval. But we only got six eggs. Again, she handled the disappointment well. After fertilization, we were delighted to have five good embryos, and one was placed in her uterus five days after the egg retrieval. One of the remaining embryos did not develop to the freezing stage, and three were frozen for later use. Now we were all expectant of a good outcome. Eight days later, her pregnancy test came back positive.
It’s hard to imagine the emotions she must have felt. Since the age of 15, she had faced the fact that getting pregnant would not be easy. One of the most important moments of a person’s life—the birth of a child—should not be accompanied by heartache. But isn’t it true that dreams are often realized after long journeys through peaks and valleys? She spent 15 years wondering about her fertility, and now she was pregnant. Some would say that 15 years as a young woman, wondering every day if she would be able to become a mother, must have seemed painfully slow. For Katy, I wonder if the years flew by because she chose to keep living.
I always repeat the pregnancy test one week later to make sure the level is rising normally. When the nurse told me the level had dropped, my heart sank. Katy was going to have a miscarriage. While I understood that her miscarriage was unrelated to her pelvic infection as a young girl, I worried that she would try to link the two. But she didn’t. While I’m sure there were some private moments of grief, her public persona was upbeat.
She took a break for a while. Both she and her husband took new jobs. I’m sure they felt the need to do something to regain control of this most important part of their young marriage. I knew that control is ultimately an illusion, but I’m sure it helped them to reboot their lives.
Not much later, she came back for another try, and we placed two thawed embryos into her uterus. When the pregnancy test came back positive, we were all happy but a bit more hesitant than the first time. Guarded optimism is much more common after a prior miscarriage. Once again, much to our sorrow, she miscarried. While I became more concerned about this young couple’s emotional state, Katy and Kevin remained upbeat.
After another break, she came back for one final try with her only remaining frozen embryo. She was honest—this would be her very last try. As a more seasoned infertility doctor, I was better able to handle this than I would have earlier in my practice. But I was still a young man. The pressure of the “last try” was intense. We prepared her uterus and synchronized it to the age of the embryo. The embryo was thawed and transferred into her uterus. Eight days later, once again we found a positive pregnancy test. The emotions were guarded, and we all began the long waiting game.
One week later, the levels looked great. We remained guarded but hopeful. How must Katy be feeling? I wish I could understand better how women feel during this time of waiting. Guarded optimism? Hopeful pessimism? Happily nervous? I bet all women are a little different.
But I do know how it feels to be denied the one thing a heart desires. When that happened in my life, it made me feel small. It made me feel unqualified. It made me feel like there was nothing special in me. It made me feel like I had no purpose on this earth. It made me feel unloved in a grand sort of way. Did Katy also have these feelings? If she did, they were kept in the recesses of her heart.
All these emotions are very normal, but I’ve seen too many women get stuck in despair and lose hope. If I could be given a special superpower, it might be to share this with each one of them: You are unique, you are blessed, you are loved, you have a purpose on this earth. I have always believed that to be the truth, no matter the circumstances of a seemingly hopeless existence.
Katy showed up two weeks later for her ultrasound, and there on that tiny black and white screen for all to see was a fetus and a healthy heartbeat. Katy was going to be a mother! Kevin was going to be a father! The enormity of the past 15 years began to settle in. I had prepared Katy for a possible adoption or child-free living, so I knew she would be okay regardless of the outcome. That is always part of my job—to shepherd a couple’s emotions through this tumultuous season as they journey toward a family.
Of course, Katy wanted a child, but her life was not defined by this single blessing. She knew who she was and what she was worth. While challenging, she would have handled the loss of her dream for a pregnancy. This one dream did not define her. There were many others. I will always credit her family and her husband for believing in her. It’s impossible to develop this type of self-worth in isolation.
We are all here for a purpose, but it’s very easy to get derailed and off track in life. When you’re hit with something difficult, does it redefine your life? Or is it merely a boulder in the road along the journey, something you just need to go around, something that causes a minor detour? Don’t let a major disappointment or trial get you off track. You have a purpose. Stay on the journey.
The enormity of treating her as a 15-year-old and then coming full circle to help her have a child began to settle into a physician’s heart. I have learned to face and handle great adversity, and I’ve also learned to celebrate on the pinnacle of success. And this felt like Mount Everest.
Some dreams come true within moments of dreaming. Others can take 15 years or longer, like the birth of this precious boy. Try to find the balance, keep dreaming, and keep living your life, even during the seasons of suffering. Try to grow, like Katy, during the waiting.
Even though this one little girl’s hopes and dreams took many years to come true, holding and raising Samuel made all the waiting worth it. So many years is a long time to wait, but it’s a great celebration when waiting becomes life.
Dr. Deaton’s Prescription:
Here is your prescription. It is to be taken daily, even hourly, without fail. I am writing this prescription to help keep you living in times of despair, to help you keep dreaming when it seems there is only darkness, to help you know there is so much more to who you are than you can even imagine.
I want you to embrace hope. It may be all that gets you out of bed and keeps you going. Never let go. No matter your disappointments, no matter your fears or failures, never let go. You are special. You are blessed. You are loved. And you do have a great purpose in this life.
If you’re having a tough time, think of someone who has brought hope into your life. Call or write to them. Thank them and see if they can do it again.
How will you follow this prescription?