Abdominal Cerclage and IVF: How We Overcame Recurrent Pregnancy Loss
Amanda and Paul’s journey to parenthood was anything but simple. In this blog post, Amanda shares her six-year journey through IVF, pregnancy loss, abdominal cerclage and finally, the joy of welcoming her son Dimitri.
Our Dream of Starting a Family
My husband, Paul, and I always knew we wanted kids. We always talked about having two but were open to the idea of three. I never suspected anything was wrong because my cycles were pretty regular, and I had no signs or symptoms of any issues.
We got married in the summer of 2018 and were anxious to start trying. After several months of negative tests, I talked to my OBGYN, and he put me on Clomid. I took Clomid for about six months, and after that didn’t work, we started to explore other options and began working with a fertility clinic. We started the IVF process in November 2019 and finally had our first retrieval in March 2020. When the lockdown mandate was ordered, we were too far into the cycle to cancel, so we were able to proceed with the retrieval.
By the fall of 2020, we were ready for our first transfer. It worked—or so we thought. The embryo stopped growing and resulted in a loss. We decided to move forward with another transfer toward the end of 2020. That one also worked, and I was released from my IVF clinic at six weeks. A few weeks later, I went in for an ultrasound and was told there was no longer a heartbeat. Because we were still in the midst of COVID, I was alone. The ultrasound tech was the only person in the room. She was so kind—she hugged me and cried with me. It was something I’ll never forget. I had my first D&C right before Christmas.
Finding Dr. Miller and a New Plan
After talking to a friend who was already with Dr. Miller, she recommended that I switch doctors. The one I was with didn’t want to change anything in my protocol, and it was time for a change. We started the process of switching over to Dr. Miller and moved our remaining embryos. I had a phone consultation with him in early 2021, and we began the necessary genetic testing for both my husband and me. Everything came back completely normal, so we were still at a loss as to why we couldn’t get pregnant.
We had our first transfer with Dr. Miller at the end of July 2021. We got pregnant! Everything looked good—until it didn’t. This pregnancy also ended in a loss and required another surgery. We had another consultation with Dr. Miller, and he suggested a trial cycle. We started it and had to push the transfer date back one day. I also had some inflammation due to endometriosis. Around that time, Dr. Miller spoke to Dr. Jubiz, who suggested I have an endometrial scratch before the next transfer.
An endometrial scratch is created when a small catheter is inserted into the uterus, then moved back and forth and rotated in order to cause some disruption to the uterine lining. It may be helpful in women with recurrent implantation failure by increasing endometrial receptivity. Once I got the all-clear from Dr. Miller, we prepped for the next transfer. I had the endometrial scratch in the cycle prior, and the transfer was done on April 29, 2022.
This transfer would prove to be both the most successful and the most gut-wrenching. After all the surgeries, retrievals, and losses, I wasn’t hopeful. My husband remained positive and supportive—my rock. I tried to stay open-minded, but after almost two years of heartbreak, I was losing hope. To my surprise, this transfer worked! My beta numbers were the highest they’d ever been, and we made it to another OB ultrasound. Our baby boy was growing and developing perfectly! It was surreal to finally start believing I was truly pregnant. We relaxed a little and began dreaming of the day we’d bring our baby home.
Everything was going perfectly. We finally got to announce our pregnancy on July 20, 2022—our fourth wedding anniversary. He was healthy and growing beautifully. Then my husband and I both got COVID.
We scheduled our gender reveal for August 6, 2022. It was hot, and our cake melted—but it was a perfect day. Our family found out we were having a boy. We had known from genetic testing, but we still wanted to share the moment with them.
A few days later, I noticed more discharge than normal. Research suggested it was fine, so I didn’t worry. But on August 13th, I went to the bathroom, pushed, and heard a loud pop. It sounded like a gasket breaking. I checked but saw nothing unusual. Later, as I turned on the couch, I felt a gush of liquid. I ran to the kitchen, and it was pouring out of me. I called my husband—he was in disbelief. I called my OBGYN, who suggested I lie down and elevate my feet since I wasn’t bleeding. Moments after I hung up, I started gushing blood. I got into the bathtub, and my husband rushed home. We went to the ER.
After hours of waiting, we were told my water had broken. While the baby still had a heartbeat, he wouldn’t survive. I was 18 weeks pregnant. We were given the option to go to a hospital equipped for babies born at 18 weeks, but the outcome would be the same. We went home, and I prayed harder than I ever had that he would make it to 22 weeks. I played lullabies and told him I loved him.
The next day, I began cramping. We rushed to the hospital. Everything escalated quickly. Our son was born sleeping about 45 minutes after we arrived. It was the hardest moment of my life. The hospital staff gave us as much time as we needed with him before saying goodbye.
Discovering the Need for an Abdominal Cerclage
When we were ready, I called Dr. Miller to get back on the schedule. About a month later, we created a new plan. Dr. Miller was kind and compassionate. I asked him not to give up on us, and he promised he wouldn’t. We also met with a Maternal Fetal Medicine doctor and discussed a cerclage This is a small stitch to close the cervix. Initially, I thought a vaginal cerclage was best, but Dr. Miller strongly recommended an abdominal cerclage.
An abdominal cerclage is a surgical procedure where a strong stitch is placed around the cervix through the abdomen to help keep it closed during pregnancy. It’s most often recommended for women with cervical insufficiency, a condition where the cervix opens too early, which can cause pregnancy loss or preterm birth. By reinforcing the cervix, the cerclage gives the pregnancy a better chance to continue safely.
When an abdominal cerclage is placed prior to pregnancy, it avoids the risks associated with a vaginal cerclage, such as infection or an inability to place the cerclage due to cervical thinning. It has a success rate of about 98%. Paul and I knew this was the right choice. We had it placed in early 2023.
We did another endometrial scratch, this time two cycles before the next transfer. That transfer didn’t take. I started spiraling, truly believing I might never be pregnant again.
Hope After Heartache: A Successful Transfer
We still had four embryos left. We proceeded with another scratch the month before our next transfer in August 2023. I wasn’t hopeful. But we were pregnant again. Instead of joy, I felt dread. Our first beta was decent, not great, but it continued to rise. We made it to another OB ultrasound at the Naperville office. I couldn’t bring myself to get excited. My heart was guarded. I told myself that if we lost this one, at least I wouldn’t be attached.
But another week passed, and the baby was thriving—already a day ahead in growth. The heartbeat was strong. We graduated and saw my OBGYN that same week. We agreed I’d see him or the MFM every other week to ease my anxiety. At 18 weeks, the anxiety was intense, but thankfully, I had an appointment. Our son was growing, moving, and the cerclage was holding strong. We passed 18 weeks, then 20 weeks, then reached viability. I felt a wave of relief. Before I knew it, it was time for my baby shower. I was 37 weeks—the cerclage had done its job.
Because I have an abdominal cerclage, I could only deliver via C-section unless it was removed. To protect the stitch, my OBGYN scheduled a C-section at exactly 38 weeks: May 1st.
But our son had other plans.
Welcoming Our Rainbow Baby
On Sunday, April 28, 2024, after dinner, I started having contractions. After about 12 in an hour, I called my doctor. He said, “That’s it—we’re having a baby.”
Our beautiful baby boy, Demetrios Bartho, was born at 37 weeks and 5 days, weighing 9 lbs 1 oz and measuring 22 inches long, on April 29, 2024, at 4:38 a.m. What we had prayed for and hoped for over nearly six years was finally a reality. He was—and is—absolutely perfect.
We recently celebrated his first birthday and are now beginning a sibling cycle.
A Message to Others Facing Loss
Without Dr. Miller’s knowledge, persistence, and innovative care, we probably would not have our beautiful son today. If you’ve experienced loss due to an incompetent cervix, I highly recommend finding a qualified doctor capable of placing an abdominal cerclage. It was—and is—a life saver.
We will be forever grateful to Dr. Miller and his staff, my OBGYN Dr. Tom Kazmierczak, and the MFM doctors at Duly.
-Paul, Amanda, and Demetrios (Dimitri)
Patient Story- Kasi: Endometriosis, Infertility and the Path to Motherhood
As Endometriosis Awareness Month comes to a close, we wanted to share Kasi’s journey. It’s one of strength, resilience and hope. Kasi endured years of pain from endometriosis, multiple surgeries and several IVF cycles. Through every challenge, she never gave up on her dream of becoming a mother. Today she holds that dream in her arms- her beautiful son, Koah.
He has brown russet-colored eyes that are full of depth. They sparkle when he laughs and when he looks at me. He has his father’s hair and my jawline. His latte-colored skin comes straight from me. He is the light of my life and for many dark years, I wondered if he’d ever be here.
Years of Pain Without Answers
I had a plan for my life as many women do. The plan was to finish graduate school, get married, buy a house, and then start a family. My early twenties had their own hardships that centered around midterms and quarter-life crises. I also had unusually painful periods that most doctors dismissed with instructions to start taking ibuprofen a couple days before my period would start. But the pain would still leave me curled in a ball in the middle of my bed every few months. A doctor at the health services recommended taking birth control pills to help regulate my periods and reduce the pain. It worked for several years. When my husband and I turned 30 years old, we decided that we wanted to start our family. That required me to stop taking the birth control pills and to begin planning the next part of our lives. We planned on 2 or 3 children. We talked about the types of parents we would be, and we made plans around their impending arrival. But the arrival seemed stalled.
The pain was back. Sometimes it would be debilitating, and it would cause me to miss work. I was also having digestive issues that would cause chronic constipation and discomfort. I started a new job that could be stressful, so I thought it was all stress related. In the winter of 2012, the holidays were rough. After Christmas, I found myself in significant pain. I recently switched doctors and decided to see my new doctor to find out what was going on.
The Diagnosis That Changed Everything
Dr. Melissa Kwak was the first doctor who listened to me when I told her about all the pain I was having. She ordered an MRI that started me on my journey. The MRI found a fibroid the size of a grapefruit on my uterus. She sent me for further testing with Dr. Brett Cassidy and he recommended that I have surgery to have the fibroid removed in February 2013. I was 32 years old. I remember feeling so frustrated that my body could betray me in that way. I know the depth of the betrayal.
The surgery was meant to be laparoscopic. They explained that I would have tiny keyhole incisions made in my abdomen and another in my belly button so that the machine could excise the fibroid without them having to open me up with a lateral incision. They expected everything to go easily and after recovery, we could begin trying to have a baby again. When I woke up from anesthesia, I was in overwhelming pain. I began screaming and the nurses rushed to me. I heard one say, “We need to manage her pain!” I knew immediately that something went wrong. I kept asking over and over what happened, but no one answered me.
“You have endometriosis,” my doctor later explained to me. They had to abandon the laparoscopic surgery as soon as they could see what they were dealing with. They had to open me up laterally (like a c-section). I had adhesions all over and this was the reason for my extreme pain during menstruation. With endometriosis, endometrial tissue is found in other areas of the pelvis. When the body menstruates, the tissue in these other areas, outside the uterus, bleed as well. The body treats these areas as internal bleeding and rushes to heal it and create scar tissue around it. These are called adhesions. My doctor was able to save my reproductive system and remove the adhesions. He gave us the green light to begin trying to have a baby again. He explained that being on birth control was unknowingly treating the endometriosis. But to start our family, I could not take medication for the condition. The instructions were to get pregnant fast since there was no cure for endometriosis and the adhesions can return. We were optimistic, but another year passed without a baby.
IVF and the Emotional Toll of Infertility
We realized that it was time to talk to a fertility specialist to assist us. Dr. Cassidy recommended that we see Dr. Charles Miller in Naperville, IL to assist us. However, our insurance didn’t cover Dr. Miler. So, in 2014 we began working with another fertility clinic. The doctor with this center, decided quickly that IVF would be the best option. We were 33 years old, so the odds were in our favor.
At this clinic, we ran into more complications. They had trouble with egg retrieval. They sent me back to Dr. Cassidy for another laparoscopic surgery to remove more endometrial adhesions. We finally got 10 embryos but only 4 survived. They transferred 2 embryos in December 2014. We would have to wait 2 weeks to find out if the embryos took and if we were going to be parents. During that 2-week wait, my father-in-law passed away from heart disease and we were mourning. I look back on that period with a lot of pain. I often wonder if the grief and the negative emotions I felt made my body inhospitable for those little babies. We found out that the embryos didn’t take a couple days before the funeral, so we grieved my husband’s father, and the loss of the embryos. I fell into a mild depression after that. I admitted this to my doctor, and she suggested that I begin seeing a therapist. I was dealing with a lot of guilt and grief over my father-in-law passing. I felt like I was selfish in his last days because I was so focused on the embryo transfer, but I also felt that I was a terrible mother to those embryos because I did not provide a positive environment where they could grow.
Infertility can be a lonely thing. Even though I was surrounded by doctors and nurses and friends and family who encouraged me, I still felt alone. I felt profound shame and inadequacy. I didn’t think that I was worthy to be a mother and maybe somehow God had ordained it to be this way. I received confirmation of my own perceived condemnation when a second embryo transfer did not yield a pregnancy. I needed time off. For a year, I didn’t want to think about fertility or trying to have a baby. But during this time off, the endometriosis did not leave me. The pain became severe again and I knew that I’d need to address it and decide if we’d want to try to be parents again. Through this time, we switched to a new insurance. I went to see Dr. Cassidy to ask about another surgery for the endometriosis. He asked us again if we thought about Dr. Charles Miller. He said he was one of the leading specialists in the area for endometriosis and he could do the surgery. We investigated our insurance coverage, and we were happy to find that Dr. Miller was covered.
Finding the Right Specialist
When we first met with Dr. Charles Miller, it was on a Sunday. He was dressed in a beautiful suit. He looked outstanding. He immediately helped us feel at ease. He tailored the treatment plan to me and my unique circumstances. That was refreshing, because our last doctor wanted to use the same protocol with me that she used for every woman she treated, regardless of the diagnosis. We were 35 years old and desperate to make things work. The fertility world talks about age 35 as the gateway into geriatric pregnancy. The percentages of successful live births begin to go down at this point and risks of birth defects and other issues increase. We were anxious to get started. I had 4 or 5 surgeries, numerous egg retrievals and 3 embryo transfers with Dr. Miller. I remember, after a disappointing cycle, we sat in Dr. Miller’s office with him. He was quiet after explaining what happened and we were quiet. I remember asking him not to give up on me. I remember he took my hand and told me that he was willing to fight along with us for as long as we were willing to fight.
In January 2020, I needed another surgery for endometriosis. I was 39 years old and desperate to try again before I turned 40. We had one frozen embryo left from the previous cycle. The plan was to have the surgery, do a few more egg retrievals so we could transfer more than one embryo. The odds are always better when you have more than one embryo to transfer. By the summer of 2020 I went for tests, that showed that I wasn’t ovulating after the last surgery and there wasn’t much hope of getting more embryos. Dr. Miller talked to us about donor eggs, but my husband and I didn’t want to give up on the dream of having a child that was a little bit of both of us. So, we decided to transfer the one embryo we had. We decided we were done with the whole IVF process. We started looking into foster care and adoption. It took another 6 months to get insurance and all other circumstances to line up.
One Last Chance at Motherhood
In February 2021, a few months after I turned 40-years-old, I came into the office to transfer the last embryo we had frozen. We were in the thick of COVID protocols so my husband couldn’t come in with me. When the doctor came in, I tearfully told him about the amazing impact he had on my life. I told him that no matter the outcome, I was just so grateful that I had the opportunity to reach for my dream when so many other women didn’t even get the chance to try. We both cried and he told me that he had a great feeling about that transfer. I had a sense of peace after that last cycle. In the past I did acupuncture after the embryo transfers to increase the odds of the embryo taking. But this last time, we chose to go to my father’s house and pray. My husband, my father, and I joined hands and prayed the most beautiful prayer about gratitude and joy regardless of the outcome.
The Call That Changed Everything
On the morning of my blood test after the 2-week-wait, I felt hopeful and peaceful. I knew this was going to be my last time going through the process and maybe knowing this gave me peace that day. Normally, the results of the pregnancy tests came to us on a portal app on my cell phone. I thought that I wouldn’t hear anything until the afternoon. During my morning break from work, I decided to lay down and take a nap. Before I could fall asleep, my phone started ringing and it was Dr. Miller’s office. They never called before on pregnancy test day, so my heart was in my throat when I answered the phone. The nurses in the office had me on speaker phone. The phlebotomist, the ultrasound tech, and two of the nurses were gathered around the phone. They asked me if I was sitting down. When I told them I was, one of the girls screamed, “You’re pregnant!” I immediately fell on my knees. I cried on the phone with them for what felt like an hour. I could hear a few ladies crying with me and I heard them yelling “Congratulations!’ I couldn’t even speak. It was 10 years of waiting. 10 years of crying. 10 years of wondering what I had done wrong, 10 years of disappointments. The emotion that flowed through my body in that moment was pure joy.
A Dream Come True
My pregnancy went forward without any complications. We were blessed because I was healthy, and the baby was healthy. I gave birth to a beautiful baby boy named Koah. I am certain that I just gazed at him for hours. I still love to look at him. We had waited so long for him, and he had waited for us as a frozen embryo. He was the very last to be transferred, but he was destined to make it into our arms. Koah is our only child, but our hearts remain open and excited about this beautiful life we will have with our son. I knew from the moment that my pregnancy was confirmed that I would share this story. I knew that I wanted to encourage other women who feel isolated while going through this journey. I persevered and I was able to experience the miracle of feeling a life growing inside me. I can watch him grow as a walking and breathing testament to my own strength and endurance. The journey taught me to feel worthy regardless of the outcome and I am looking forward to helping other women feel empowered and strong.
-Kasi
How Endometriosis Affects Fertility: Causes, Symptoms, Diagnosis and Treatment
We spoke with Dr. Laurence Jacobs, a reproductive endocrinologist with over 30 years of experience, to explore how endometriosis impacts fertility and how to recognize the signs of this often misunderstood condition.
How Does Endometriosis Affect Fertility?
Endometriosis can make it much more difficult to get pregnant. In fact, 20-50% of all infertile women have endometriosis, making it a prevalent issue in reproductive health.
One of the main ways endometriosis affects fertility is through scar tissue formation. When endometrial tissue grows outside the uterus, it can create scar tissue, adhesions and inflammation around the ovaries and fallopian tubes. This can often distort the normal anatomy of the pelvis, making it harder for the fallopian tubes to move over to the ovary and pick up the egg during ovulation.
Endometriosis can also interfere with ovulation. Endometriomas, which are cysts formed by endometriosis growing deep within the ovaries, can disrupt ovulation by affecting both the development and/or release of eggs. Additionally, some research suggests endometriosis can negatively affect the egg quality due to the inflammatory environment it creates within the pelvis.
Another concern is embryo implantation. The inflammation caused by the endometriosis can make it more difficult for the embryo to successfully implant within the uterine endometrial lining, leading to infertility or recurrent pregnancy loss.
The severity of endometriosis plays a significant role in its impact on fertility.
- Stages 3 or 4 (more advanced endometriosis) involve severe adhesions and endometriomas, which can have a major impact.
- Stages 1 or 2 (milder cases) may only involve small implants of endometriosis, which can still affect fertility but to a lesser degree.
The stage, severity and location of lesions and implants all play a significant role in how endometriosis affects fertility.
How Can You Tell If You Have Endometriosis?
The most common symptoms of endometriosis include:
- Pelvic pain
- Moderate to severe menstrual cramps
- Pain during sexual intercourse
Although some women with endometriosis have no symptoms at all. A pelvic exam can sometimes reveal signs of endometriosis, such as hard nodules at the bottom of the pelvis.
Ultrasound is another useful tool for identifying endometriosis. Endometriosis growing very deep inside the ovaries, can form a cyst called an endometrioma and these cysts can be seen on ultrasound. However, most smaller implants of endometriosis cannot be seen on ultrasound. Ultrasound can only detect advanced stage 3 or 4 endometriosis, while smaller implants and adhesions seen in Stage 1 or 2 may not be visible.
How Is Endometriosis Diagnosed?
Symptoms and signs of endometriosis and even ultrasounds can make one suspicious of endometriosis, but the only way to definitively diagnose the condition is through laparoscopy. A laparoscopy is a minimally invasive procedure that allows a surgeon to look inside the pelvis using a laparoscope, which is a thin, telescopic rod with a video camera on the end. Not only can laparoscopy surgery confirm endometriosis, but the procedure can treat it as well.
Why does surgical expertise matter?
Because advanced endometriosis (Stage 3 or 4) often involves severe adhesions affecting the ovaries, intestines, bladder and ureter, it is highly recommended that the laparoscopy be performed by a skilled reproductive surgeon rather than a general gynecologist.
- A skilled reproductive surgeon can both diagnose and remove endometriosis in one procedure.
- You don’t want to undergo surgery just for diagnosis, only to need a second procedure for treatment.
- A less experienced surgeon may leave some endometriosis behind or be unable to treat complex adhesions.
New Advances in Endometriosis Testing
In the last seven years, innovative diagnostic measures have been developed to help determine if a woman with no symptoms or ultrasound evidence might have endometriosis. It also helps physicians decide who would be a good candidate to undergo laparoscopy.
Back in the 1980s and 1990s, it was standard procedure that everyone with infertility undergo laparoscopy, but now we try to be much more selective. The ReceptivaDX test, an endometrial biopsy performed in the office, checking or sampling the uterine lining, measures a protein called BCL6, a marker usually associated with endometrial uterine inflammation and potentially silent endometriosis.
An abnormal biopsy result usually means there is endometriosis or inflammation in the pelvis. This biopsy can be very helpful for women who have no symptoms, evidence of endometriosis on ultrasound or unexplained fertility.
Seeking Expert Care
If you think you might have endometriosis, it is imperative to seek out an experienced reproductive surgeon specialized in treating advanced endometriosis. In my opinion, Dr. Charles Miller, Dr. Kirsten Sasaki, and Dr. Molly McKenna are among the best reproductive surgeons for endometriosis treatment in the Midwest. Their expertise ensures that patients receive the highest level of care for both diagnosis and treatment, improving their chances of achieving a successful pregnancy.
Request a consultation or call 630-428-2229 to schedule.
Understanding Endometriosis: What Patients Need to Know
In honor of Endometriosis Awareness Week, we asked Dr. Kirsten Sasaki what she thought patients need to know about this disease that affects 1 out of 10 women.
What to Expect During Your Endometriosis Appointment
If you think you may have endometriosis, being prepared for your medical appointment can help you get the most out of your visit. Here’s what you can expect:
- Thorough medical history including any surgeries and menstruation history
- Physical exam including pelvic exam and pelvic ultrasound
- Depending on findings, your doctor could recommend further lab work and/or an MRI
How to Advocate for Yourself During Your Appointment
Advocating for your health is important, especially with a condition like endometriosis that is often misdiagnosed or overlooked. Here’s how you can make the most of your appointment:
- Tell the physician about any pain, discomfort, bloating or abnormal bleeding you are experiencing
- Don’t wait for your physician to bring up these questions. Write them down before the appointment. Writing down your questions and symptoms ensures you don’t forget to mention any concerns.
- Be direct with your physician. Ask if any of these symptoms might be occurring because of endometriosis.
Key Endometriosis Symptoms to Track
Tracking your symptoms can help with diagnosis and treatment. Pay attention to:
- Pain both on and off your period
- Pain during intercourse
- Painful bowel movements
- Changes in bowel habits during and around your period
- Heavy or prolonged bleeding (periods lasting more than seven days or needing to change protection every 1–2 hours)
- Frequency of NSAID use for pain relief
- Missed work or social activities due to pain
Common Misconceptions About Endometriosis
One of the biggest myths about endometriosis is that if your imaging (such as an ultrasound) is normal, you don’t have the disease. In reality, many patients have normal imaging results yet still experience all the symptoms of endometriosis. A laparoscopy can definitively diagnose the condition by allowing the doctor to confirm the presence of endometriosis and remove the diseased tissue via excision.
Finding Relief from Endometriosis Symptoms
Various treatments can help manage endometriosis symptoms and improve quality of life. Patients may find relief through:
- Pelvic physical therapy can help reduce pain and improve mobility.
- Acupuncture may help alleviate symptoms by promoting circulation and reducing inflammation.
- Exercise and regular movement can help reduce pain and improve overall well-being.
- Eating a healthy diet rich in vegetables while limiting processed foods and red meat may help manage inflammation and symptoms.
Endometriosis is often underdiagnosed and misdiagnosed leaving many patients to endure years of pain and countless doctors appointments before receiving a diagnosis. No one should have to leave their pain untreated.
Our dedicated team is here for you, request a consultation.
May 10 is Dr. Miller Day!
Did you know May 10th is Dr. Miller Day? Neither did we, until our patient, Jamie, shared that she created this special day to remember her fertility journey, the support she received from her “village” and of course the doctor who helped her become a mom!
Jamie writes:
Our fertility journey started as most do, with a lot of hope and a lot of disappointing negative pregnancy tests. During my initial testing, I found out I had 2 fibroids and one was very large. Although I kept asking about the large one, I was told by 3 different doctors that they weren’t an issue and was encouraged to start IUI or IVF.
Although reluctant, we started planning on how and when to move forward. Through that process, we started applying for grants. While looking at the grant application, I started reading into how it would be scored. In the fine print, I noticed certain types of fibroids would disqualify us from the grant, and that is because they can make IVF less successful. This made me, once again, question my fibroid. I told my husband that I wanted to find an expert opinion to rule out the fibroid causing my fertility issues before beginning any treatment. I started to research fibroid experts, and one name kept coming up again and again in my search, Dr. Charles Miller.
In April 2022, during my consultation with Dr. Miller, I expected to hear, once again, that the fibroid was “fine.” Dr. Miller recommended surgery, and on May 10th, 2022 he successfully removed both fibroids. We spent the next few months healing, trying to enjoy life, appreciating what we have, and planning our next steps to bring home a baby of our own.
In August 2022, I returned to Dr. Miller’s office, and he told me that things healed well and we could start trying again. During that same month, I was on pins and needles hoping to hear that we got the IVF cycle grant. However, less than three weeks after my follow-up visit with Dr. Miller, our jaws dropped when we got our positive pregnancy test! It was clear that the fibroid was what had been causing my infertility, and if we hadn’t done our research and sought out Dr. Miller’s expertise, we would have spent thousands on IVF without any success.
On April 17, 2023 our miracle baby girl, Fontana, was delivered via c-section. We cannot thank Dr. Miller enough for taking his time to listen to our concerns, truly evaluating the fibroid and its impact, and for his flawless surgery. Without Dr. Miller, we wouldn’t have had a first birthday to celebrate last month.
This Friday we will celebrate our second Dr. Miller Day. This year we took the time to reflect and appreciate those who were a part of our village by writing cards to family, friends, and those strangers who supported us during our darkest days of infertility. Each person is represented by a house, and when we put them all together, it was empowering to see just how many people helped us along the way. No two infertility journeys are the same, but for those still in the trenches, trust your gut and advocate for yourself.
Ovarian Pexy- A Simple Procedure to Help Improve Egg Retrieval Outcomes
We posted a video of Dr. Miller discussing a recent surgical procedure he performed called an Ovarian Pexy that helps improve egg retrieval outcomes. We figured this was a procedure many were unfamiliar with, so we asked Dr. Miller for more information. Get ready to understand how this simple procedure can make a big difference on your road to becoming a parent.
Q: What is an Ovarian Pexy?
Dr. Miller: A laparoscopic procedure to move the ovaries closer into the pelvis so that the follicles can be more easily identifiable.
Q: How do you know if you are a good candidate for Ovarian Pexy?
Dr. Miller: The procedure would be performed on someone whose ovaries are out of position. A woman can be born with her ovaries misplaced, making IVF difficult. Additionally, another potential cause is adhesive disease – whether from infection, endometriosis or prior surgery, the ovaries are simply pulled away from the pelvis.
However, keep in mind that you don’t know whether or not there is room for improvement until you look at the anatomy. If I cannot see the ovary, I will not take the patient to stimulation. Generally, we have indications that the ovary is not in the right place and see this while the patient is undergoing transvaginal ultrasound or when I perform a saline infused sonogram. At that point, I recommend surgery. Pexy of the ovaries is ultimately a game time decision at the time of surgery, when the anatomy can be seen.
Q: Why does this procedure improve your chances for a more successful egg retrieval?
Dr. Miller: It gets the ovaries to a place where they can be easily visualized via ultrasound and thus, makes egg retrieval easier.
Q: What is the recovery time and how soon can you do an egg retrieval after the procedure?
Dr. Miller: The recovery time is 5-7 days at home and the patient can start preparing for an egg retrieval with her next cycle.
Q: How common is an Ovarian Pexy?
Dr. Miller: Since most reproductive endocrinologists do not perform surgery, this procedure is not routinely performed. Instead, patients settle for a lesser amount of eggs. Oftentimes, Dr. Miller sees patients who have gone through cycles with other physicians and have not had eggs retrieved on one side because of the ovary position. After the ovarian pexy procedure, patients can go from not being able to retrieve eggs to having a comparable number of eggs retrieved from either ovary.
Interested in scheduling a consultation with Dr. Miller? Call 630-428-2229 to set up an appointment or request a consultation online.
Patient Story- Breda
“Not everyone will understand IVF or be able to relate, so it’s important to surround yourself with support. More people than you realize struggle with infertility.”
Today’s patient story is from Breda. After not finding success or feeling comfortable at another fertility clinic, Breda came to us. We are all glad she did! Dr. Miller was able to diagnose her with endometriosis and after surgery and IVF, she was able to get pregnant. Breda is due in January!
Breda writes:
I met my husband later in life and we got married when I was 38. I was and still am wary of the stigma of older mothers, even though being older is accepted. I’ve always wanted a family and we started trying right away, but I had three miscarriages in a year and a half. I was at a different fertility clinic for a year, but didn’t feel comfortable there. My husband’s colleague recommended we see Dr. Miller and what a difference!
We first met online during COVID and Dr. Miller told us, “You’ll be a mother, kiddo.” He was so kind, didn’t rush us, and he explained everything. He learned I was an English teacher and told me a story that put me at ease. He never stopped his storytelling, and I welcomed his personable demeanor after some bad experiences at the previous clinic. Dr. Miller found issues that the previous doctor did not, including endometriosis.
After a biopsy, Dr. Miller found abnormalities in my uterus and I was diagnosed with Level 1 endometriosis. During surgery, he removed five spots on my uterus. I also had the Endometrial Receptivity Assay biopsy to determine the receptivity of the uterus to implantation. Soon after, we had an egg retrieval and two transfers.
Throughout this process, Dr. Miller and his staff explained everything so thoroughly and never seemed irritated or disinterested when I had questions. I also got to know Dr. Miller and the nurses because they talked to me during appointments. I always felt people cared and were invested in our success. I felt so secure going into our procedures and never felt anxiety or stress visiting the office.
Even though our first transfer failed, a second embryo implanted and I will never forget that experience. Dr. Miller, Courtney, and Melody were present for the transfer, and made me feel so comfortable. Dr. Miller even told us a funny story about meeting an actor from Will & Grace. While we waited after the transfer, my husband and I held hands and prayed, and we also talked about how wonderful it would be if it worked. Many times, we dreamed of finishing our nursery and being able to move forward with our plan. The transfer worked, and our baby is due January 8, 3.5 years after we began IVF and what seems like a million doctor appointments.
I was very nervous the first 12 weeks of my pregnancy and braced myself for bad news, but at every ultrasound Courtney reassured me with her positivity. We are so grateful for everyone at the Naperville office.
It took until I was about 20 weeks pregnant for me to relax and realize we’re finally going to be parents! I’ve cried many happy tears for a change! Not everyone will understand IVF or be able to relate, so it’s important to surround yourself with support. More people than you realize struggle with infertility. Meditation and journaling are helpful (as well as long walks with our dog, my first baby). Finally, never stop hoping and praying, even if you’re an older mother!
Patient Story- Courtney
“Keep going even when it feels like you can’t… The little victories will give you strength.”
Today’s patient story is from Courtney. Courtney discovered she had endometriosis when she and her husband were not able to conceive naturally after several months of trying. After undergoing surgery with Dr. Miller, she was able to get pregnant via IVF and just welcomed a baby boy only three weeks ago! Congratulations Courtney!
Courtney writes:
My husband and I began trying to conceive in late 2017. While at my yearly gyno appointment in May 2018, I mentioned we were trying to conceive. I was told to track ovulation with an app and/or pee sticks and go from there. My period had always been like clockwork and I learned that my ovulation was too. I maybe had heavier/more painful periods but nothing that ibuprofen and a heating pad couldn’t fix. My gynecologist did an internal ultrasound and noticed that one ovary was dense, leading her to believe that I might not ovulate on that side, however my pee sticks indicated that I did.
We ended up getting pregnant on our own in the summer of 2019, but that ended in a miscarriage (D&C) as there was nothing in the sac. I then had the dye test to see if my tubes were blocked and they were not. I also did 3 rounds of clomid with no pregnancy. This was the end of the road with my regular gynecologist as she couldn’t help me any further.
I then went to another gynecologist in my hometown to move onto IUIs. He did a natural IUI with no luck. Then we tried a medicated (clomid) IUI with no luck either. During this process, he did an internal ultrasound and that’s when I first learned I possibly had endometriosis. He referred me to Dr Miller.
I had laparoscopic surgery with Dr. Miller in Feb 2021 for endometriosis. We decided to try surgery before an egg retrieval, because Dr. Miller thought he could clean me out and then we could try to conceive naturally or with clomid as he didn’t think the endometriosis was as bad as it turned out to be. However, during surgery he found stage 4 endometriosis on my ovaries and appendix. He removed my appendix and did what he could on my ovaries in order to preserve them for IVF.
After my surgery, Dr Miller said that the endometriosis had been there for quite awhile because the cysts were so fixed to my ovaries. He said he did what he could to minimize the cysts but he couldn’t get rid of them fully because that would ruin good ovarian tissue for IVF. After I’m done having kids, I can have another surgery to fully clean me out.
It was invaluable to have Dr. Miller as my surgeon and fertility specialist. The entire time he was focused on the goal at hand- to have kids. I felt comfortable during the process that he knew what to do during surgery to make it possible for me to have kids.
After surgery, we started preparing for IVF and I had my egg retrieval in July 2021. We ended up with 4 well graded, untested embryos after retrieval. My first FET (frozen embryo transfer) was in September 2021 and unfortunately ended in a chemical pregnancy. Shortly thereafter, we did another transfer and I gave birth to my son, Leo, on August 11.
Going through infertility takes a toll on you emotionally and physically. Here are a few pieces of advice I would give to other women dealing with infertility.
- Keep going even when it feels like you can’t do/go anymore. The little victories will give you strength. For example, the recovery from retrieval was brutal for me, but when we found out we got 4 embryos, I felt like I could do it all over again.
- Ask for help and allow help from others. I am the most organized person out there but I had to have my husband take the reins on the meds because it was all too much for me. I never prepared, mixed, set up, or gave myself one shot!
- Don’t change your lifestyle. Dr Miller never once told me what to eat, drink, do, or not do. Working out was limited with retrieval and FET, but that was the extent of it.
- Take the month off and go on vacation. Dr Miller wrote in my message on the portal that this was a must! You have to continue to live your life as best as possible!
IVF Frequently Asked Questions
What is IVF? It stands for In Vitro Fertilization, but it means a whole lot more for many women and their partners who are going through it.
Scientifically, IVF is an assisted reproductive technology in which eggs are extracted and manually fertilized with sperm in a laboratory setting. The resulting embryo is then transferred to the uterus.
IVF has created millions of successful births to couples who opted to use the technology to become pregnant. It is an option for women and men who have had trouble conceiving naturally, including older women who statistically have a more difficult time becoming pregnant. It is also a viable option for single women who are interested in becoming pregnant as well.
How does IVF work?
In most cases, women are first given fertility drugs to help stimulate egg production so that several eggs can be extracted at once to boost the chance of success. During this time, your fertility specialist will take blood samples to test hormone levels and examine your ovaries as well.
Once the eggs are ready for retrieval, the woman undergoes minor surgery to have them removed. The procedure involves the use of a needle in the pelvic cavity to remove the eggs. After retrieval, the eggs are placed in a laboratory dish along with semen from a partner or donor. In some cases, particularly in situations where fertilization chances are lower, a sperm is directly injected into an egg to encourage fertilization. Once the eggs are successfully fertilized and monitored for cell division, they are then transferred into the woman’s uterus using a catheter. This usually takes place between three to five days after fertilization.
Are there risks with IVF?
IVF has its risks the same as any other medical procedures. Some include nausea and vomiting, shortness of breath, severe stomach pain, infection to the bladder and bowel, and risk of carrying multiple pregnancies, which has its own risks.
People who choose to go through IVF should consider counseling with an IVF specialist first to decide whether it’s the right path for you. While IVF often comes with a rewarding end – a successful pregnancy – it can also have many emotional and physical, not to mention financial tolls.
How do I find an IVF clinic?
There are many doctors who specialize in infertility and IVF. Talk with your gynecologist about doctors they are familiar with and whose reputations are highly rated. Meet with a few specialists to see what their approach is and whether they seem like a good fit. While it’s tempting to go with a place that’s known to be friendly with good bedside manners, which are important, sometimes it’s best to choose a place with a high success rate because, in the end, that’s what you’re aiming for. Most importantly, when going through IVF, it’s important to have a strong support system in place. Involve your partner and your family through the process, and seek out friends or a group who understand what’s happening as well.
Choosing The Right Gynecologic Institute for You
There are many gynecologic institutes in Chicago that focus on women’s health, ranging from fertility to oncology. But because women’s health is so specific and wide-ranging, each one tends to focus on a specific issue or area. Some gynecologic institutes focus on surgery, whereas others may just be general practice. Most, however, are specialists rather than general ob/gyns. Most exist to correct an existing issue that a woman is undergoing. How do you know what to look for?
In many cases, your doctor may refer you to a gynecologic institute in Chicago, which is where you might begin your journey. If your situation is infertility, a gynecologic institute will examine and test what’s causing your problem, and you may undergo surgery to correct it. In other cases, a cyst or abnormal growth may also be removed and examined, and further treatment prescribed. Or, your situation may be preventative, in which you might undergo a hysterectomy or other removal.
While your doctor may refer you to a gynecologic institute, you should also check out others based on referrals from peers or other physicians. The good news is there are plenty of options in Chicago, the more difficult one is how to go about making the choice. Find out what their specialty is and how many procedures they do successfully each year. Learn what hospital they are affiliated with. Talk to previous patients about their experience and whether they had success with that particular gynecologic institute. At the very least, it is always a good idea to have a second opinion as well on your situation.
If the situation is fertility and surgery is required, it may be for assisted reproductive technology, infertility treatment, or some kind of minimally invasive gynecologic surgery. It may stem from cases of endometriosis or scar tissue left behind as a result of endometriosis treatment. In other cases, it may be related to uterine fibroids, uterine prolapse, excessive bleeding, menorrhagia, cervical and uterine cancer.
Gynecologic surgery is extremely high-tech and intended to be minimally invasive. It’s a good idea to ask what kind of technology the surgeon at the referred gynecologic institute uses to perform the procedure. Smaller incisions help minimize post-surgery issues and recovery, and procedures may be even more precise. You can ask a few physicians at different gynecologic institutes around Chicago for their opinion about different types of surgical procedures and which they would suggest.
In addition, if you’re still of child-bearing age and wish to consider fertility preservation, talk to your doctor about options and when a good time to undergo that before your surgery.