Reminding Us Of Our Purpose
Mark P. Trolice, M.D., FACOG, FACS
Board Certified, Reproductive Endocrinology and Infertility
Director, Fertility C.A.R.E.
Stephanie and Joseph had tried for many years to realize their goal of a biologically related healthy child. They had already adopted two children several years ago. But as Stephanie approached 43, she wanted one more attempt at child bearing. After being told by many fertility specialists she would not be successful, Stephanie presented to me for a consultation.
We learned her challenges were not only advanced reproductive age but a congenital absence of both the left portion of her uterus (a unicornuate uterus) and left ovary, a multiple fibroid uterus (benign tumors of the uterus), and Joseph's severe low sperm count. Nevertheless, she realized her goal and her beautiful daughter Brielle resulted from In-vitro Fertilization (IVF) as Stephanie became the oldest patient I had been successful in assisting.
Two years later, Stephanie returned to add another child to her family. Respectively denying her biologic ovarian aging, she experienced several unsuccessful IVF attempts. Her sustained resilience and determination were uplifting and we began to share our personal fertility challenges.
During this time, I was also in the midst of pursuing my child through adoption after 10 years of my own struggle with fertility. When my wife and I received our angel daughter, my life became even more focused. I was determined to assist any fertility patient with closure of their near-perpetual struggle despite the statistics but based on their wishes and understanding of their prognosis.
Stephanie was not interested in egg donation, so she began her final IVF cycle at age 46. If successful, she would again become the oldest patient I had assisted. From the start of the cycle, Stephanie experienced her best response to medication while Joseph, uncharacteristically, demonstrated a normal sperm count. When her pregnancy test returned positive, we all realized the significance biologically and emotionally.
For the first several weeks of her pregnancy, Stephanie's hormone levels appeared consistent with normal progression. However, at an estimated gestational age of seven weeks, her ultrasound revealed a several week delay. The pregnancy did not continue past measuring six weeks. Truly devastated, this loving couple elected to undergo a procedure to remove the nonviable pregnancy from her uterus.
On the days preceding her D&C procedure, Stephanie was very anxious and placed many calls to our office for answers to her main question of "why." She finally decided to have the embryo analyzed genetically to determine the cause. The morning of the procedure, her final questions were answered and she seems assured of her decision and comforted by the closure.
I met Stephanie in the pre-operative area and when I pulled back the curtain in her cubicle, I immediately felt her pain. She held my hand and gestured for all the other personnel to leave the area and close the curtain. Stephanie was shaking and crying from her perception of the staff behaving in an impersonal way. All I could do was continue to hold her hand and listen intently. We shared that moment and I excused myself to bring her husband into her area to she could be comforted while I prepared for her surgery.
Although her uterus was abnormally large from her fibroids, the procedure was without difficulty. Usually I visit the patient right after the procedure to assess their pain and explain the procedure if they are awake. I approached her stretcher and placed my hands on the guard rail. Without speaking, Stephanie slowly reached down to my hand and bent over to kiss it - my right hand. The hand that was just used to remove her and Joseph's dream from her uterus. I reassured her she was fine then walked away.
I recall that day on a daily basis, particularly when times become hectic or troubling. Stephanie and Joseph have moved on with their lives. Ironically, as I assisted them in healing they guided me toward my own purpose - to relieve suffering.