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)
How Uterine Fibroids Can Affect Your Fertility
Did you know that 30% of all women have fibroids by the time they’re 30? While fibroids are incredibly common, for some women, they can be a cause of infertility, especially when their location affects the uterus. We asked Dr. Charles E. Miller to help us better understand how fibroids affect fertility and the recommended treatment options.
Why Fibroid Location Matters
The problem lies in where the fibroids are located. Fibroids in the uterine cavity or near the cavity are particularly concerning when it comes to fertility.
In the past, we always recommended surgery for women with fibroids in the cavity. But over the years, we’ve learned that fibroids near the cavity can be just as problematic.
Back in the 1990s, I conducted a study on women who were either miscarrying or unable to get pregnant and had fibroids within 4mm of the endometrial cavity. After surgery, 70% of them went on to have a successful delivery.
Treatment Options for Fibroids
Surgery remains the primary mode of treatment for fibroids that need to be removed. The approach depends on the size and location of the fibroid:
- If the fibroid is in the cavity or small and close to the cavity, we typically remove it using a procedure called hysteroscopy. This involves placing a small telescope into the uterus and removing the fibroid without any incisions.
- When the fibroid is firmly in the muscle wall or is larger, it needs to be removed laparoscopically. At our practice, we take great pride in performing these procedures minimally invasively.
Unfortunately, at other places, fibroids are sometimes removed via a mini laparotomy, a small but still open incision, similar to a C-section cut. My concern with this method is that it increases the risk of scar tissue, which can further impact fertility.
The Bottom Line
If you’re having trouble achieving a successful pregnancy and you have fibroids, don’t wait. Seek out a specialist with the expertise to evaluate and treat those fibroids properly.
I absolutely recommend a hysteroscopic or laparoscopic approach whenever possible. It’s effective, minimally invasive and gives women the best chance at a healthy pregnancy.
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.
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.
Helping Women Navigate through Infertility and Reproductive Health Challenges
I’m excited to be writing the first post for our new blog! I say this all the time, but back in the day, when Michael Jordan and Oprah were in Chicago, I used to say I had the third best job in the city. With their absence, I guess I have the best! As a successful reproductive endocrinologist and minimally invasive gynecologic surgeon, I am fortunate enough to lecture around the world, conduct research and contribute scholarly articles to scientific journals and textbooks. However, what really motivates me is the opportunity to take care of you and help you achieve your health goals, and for many of you, help grow your family tree. That’s why this blog is for you.
I want this blog to be a resource for those seeking information about infertility treatment or gynecologic care. We will be discussing the latest in women’s health topics and sharing relevant information, research and news stories. I am so intrigued by all the medical and surgical advances we have seen since I was a medical student and look forward to sharing my thoughts as they continue to develop and expand. Not only will you hear insights from me, but also Dr. Cholkeri-Singh, Dr. Sasaki and other staff members.
I also hope to use this blog as a dialogue for my patients and anyone else who is looking for support with infertility or gynecologic care. I will write about topics you will hopefully find inspiring, offering you the strength and courage to continue to face treatments or surgery head on.
One of the best parts of being a physician is getting to know my patients and helping them resolve issues – whether it’s the resolution of pain and bleeding or finding just the right treatment plan to help a couple achieve pregnancy and fulfill their dreams of starting a family.
You’ll also hear from patients who will share their stories and journeys in hopes to show you that you are not alone in your struggle. It is a process – a very personal one, that can be long and with ups and downs -- and we are with you all the way through it.
My incredible staff will be highlighted in this blog. They are truly amazing and the backbone of my practice. Each month a staff member will be featured so you can get to know them better.
Lastly, I want to hear from you. Do you have questions about infertility, uterine fibroid treatment or endometriosis? Do you have a success story you would like to share that might give others hope? Drop us a line in the comments below or contact us through our website and be sure to follow our Facebook page.
To your health,
Dr. Miller
