“Bravelle + 2 = 5”
The Deluca family and their little miracles, Molly and Jamie; Cape Coral, FL

Attempting to conceive is a numbers game. You count the number of days in your cycle until you are ovulating, the number of days until you can take a pregnancy test, the number of frustrating months until you visit a specialist, the number of procedures you need to determine the problem, the number of methods you can try to improve you chances, the number of other happy pregnant women you see in the streets while you remain desperate, the number of assisted attempts you can bear, and the number of disappointments you can weather.

My husband and I entered the game in our late twenties, after establishing ourselves in our careers. I am a teacher and he is a journalist and as “the big three-oh” loomed ahead of us we were ready to start a family. Despite the fact that I wasn’t have regular periods, we managed to conceive naturally in just a few months. After a positive pregnancy test, we went out to dinner and did what most couples do: started talking about baby names and our future family. We had no trouble getting pregnant, so it never occurred to us that we had a “problem.” Unfortunately, during our first ultrasound around 12 weeks the OBGYN looked at an empty gestational sac on the screen and uttered the dreaded words, “I don’t see a heartbeat.” We were unprepared for such an outcome and completely distraught, but the doctor assured us that having one miscarriage was not uncommon, and that we just needed to try again. After the D&C, he suggested I begin working with a fertility specialist to facilitate the process, because of my age and my irregular menstrual cycle.

After meeting with a noted specialist, Dr. Craig Sweet, and running tests, it was discovered that I had polycystic ovarian syndrome (PCOS), which indicated a hormone imbalance and explained the amenorrhea. He recommended a number of options, but we decided to start with an oral ovulation stimulant, Clomid. This drug was ineffective for me, and the many months I spent on it felt like a waste of time. I was growing older and more anxious. We decided to try a more aggressive form of treatment: superovulation plus insemination, which to our delight worked on the second cycle. Unfortunately, on our twelve week visit to the OBGYN, we discovered that the fetal heart had stopped beating. This was a devastating blow. It was even more difficult when a few months later we did superovulation, got pregnant, and again miscarried around twelve weeks. Something was definitely wrong. We feared we would never have a child of our own.

After this third miscarriage, Dr. Sweet suspected there was a genetic issue causing the losses. He offered several options, including a relatively new procedure involving in vitro fertilization coupled with pre-genetic diagnosis (PGD). PGD is a procedure in which the embryos undergo genetic testing before implantation. Only embryos deemed genetically normal would be implanted. We opted for this procedure and once again went through the process of superovulation using a new set of stimulation medications: BRAVELLE and REPRONEX.

We were back in the numbers game, this time counting the number of cc’s of BRAVELLE and REPRONEX my husband would inject into my lower back each evening, monitoring the number and growth of follicles by ultrasound, and suffering through numerous blood draws to monitor my hormone levels. The medications stimulated my ovaries very well and on the scheduled day, Dr. Sweet was able to extract twenty-seven oocytes (potential eggs for fertilization)! Nineteen of the oocytes were mature enough to attempt insemination and sixteen were successfully inseminated producing sixteen embryos for genetic testing.

The information we received from the testing was invaluable. Nine of the sixteen embryos were determined abnormal. This was an unusually high ratio of abnormal to normal for someone my age at the time (32). This provided strong evidence that had I continued to try on my own, I would have continued to be devastated by miscarriages due to genetic abnormalities. The good news was that since BRAVELLE and REPRONEX helped me produce so many follicles, there were a fair number that were genetically normal: four female, and one male embryo. Having had gone through so many miscarriages, we were able to convince Dr. Sweet to let us implant three (two female, one male) and cryo-preserve the other two. We waited patiently for nine days after the embryo transfer and then it was time to have my blood drawn for the HCG levels. We were thrilled when the nurses called to say that I was pregnant, and that the high HCG levels suggested there was more than one! Three weeks later we were able to confirm through ultrasound that I was pregnant with twins. Ten weeks later we learned that we would be blessed with two girls.

Molly and Jamie were born in October, 2005.

When the twins were 7 months old, I began thinking about trying again. We willingly got back in the numbers game: scheduling procedures to check the condition of my uterus, scheduling a surgery to clean out scarring left from my c-section, and patiently waiting for two menstrual periods to pass so that I would be in prime condition to conceive. Soon after celebrating the first birthday of the twins, in November of 2006, we thawed out two remaining embryos. Though both survived the thawing process, only one continued to grow properly. We transferred this one and were delighted nine days later to learn that I was pregnant again. I will deliver a baby girl in August of 2007.

These days the numbers I count are fingers and toes, days until the next check-up, the number of teeth that have come in, birthdays…and of course all my blessings. I am thankful for the hard work of Dr. Craig Sweet and his staff, and thankful for the technology that brought us BRAVELLE and REPRONEX, which allowed us to give birth to our own children on our own terms.