[Editor’s note: In 2009, shortly after marrying her (first and only) husband, Paolo, Elizabeth Heath was diagnosed with premature menopause and resulting infertility. Paolo and Liz are now parents to a baby girl, Naomi. In this series, Liz recounts the couple’s struggle with infertility, and how they finally achieved a successful pregnancy and parenthood.]
Our first meeting with the fertility clinic in Chianchiano, Italy went reasonably well. The doctor, a young and very attractive Florentine woman, outlined the in-vitro fertilization (IVF) process for us, and then gave us several pages of tests that had to be run before we could start an IVF cycle. It was now October, 2009, and this battery of tests was going to take a while for us to complete. The soonest we could do an IVF cycle was March of 2010. March. 2010. Nearly six months away. Tick tock indeed.
The doctor was straightforward with us, and didn’t give us false hopes. We had about a 25% chance of getting pregnant with a round of IVF. My age and my abysmal FSH and LH numbers were negative factors, and would likely lower our odds even more.
Getting all the tests run was no easy feat either, in part because it was still a chore for me to speak Italian, particularly when it came to anything just the slightest bit tricky, like trying to schedule blood draws and urine samples and vaginal swabs. Though I am a fan of Italy’s national health care program, when a test or procedure or specialist’s visit is not urgent, there is usually a significant wait time—as in months. Since none of the tests we needed were medically urgent, Paolo and I had to go to private laboratories for many of them. So, tests to see if either of us were cystic fibrosis carriers, and tests for other congenital anomalies cost us in the range of 500 Euros (around $650 USD). Others were between 100 Euros (around $130 USD) and 60 (approximately $75 USD) Euros. It all added up, but none of it seemed excessive if we got a baby out of the deal, right?
The last test I needed was to measure my Inhibin B. As the name suggests, Inhibin B, a protein produced in the ovarian follicles, inhibits the production of FSH. So the more Inhibin B you have, the lower your FSH (a good thing). It’s used to test ovarian reserve, and a high Inhibin B correlates to a good supply of high quality eggs. (Women are born with about 200,000 eggs, and that number diminishes as they age. There is no way to cultivate new eggs.)
Inhibin B is measured with a blood draw on the third day of a woman’s menstrual cycle, when its numbers should be the highest. The Inhibin B score of a fertile woman is normally between 45 and 200 pg/mL (that means picograms per milliliter). Lower than 45 pg/mL in a pre-menopausal woman is considered abnormal, and an indication that both the quantity and quality of her eggs is low.
To find a lab where I could have the Inhibin B test done in a timely manner, we had to drive to Perugia, about 75 minutes away. Paolo went with me for the blood draw, but to pick up the results, I drove by myself. At the time, I didn’t know what a picogram was (not that I really do now), nor did I realize the significance of Inhibin B. So my result, written as 30,0 pg/mL, didn’t mean that much to me.
It wasn’t until I got home and looked for information online that I realized the bad news. Paolo was there with me, and I remember trying to tell him that my Inhibin B was 300, that the lab just threw in that comma by mistake. No, he told me. My Inhibin B was 30 pg/mL, or barely registering on the chart. It was a terrible prognosis for our upcoming IVF cycle.
Before the end of the year, we took all our test results to the clinic in Chianchiano, and presented them to the pretty doctor. (I mean, seriously, she was so striking that we both had a hard time taking our eyes off her.) She scanned the results, lingered on the Inhibin B report, and promptly announced that she was moving us up in the schedule. (Tick tock, tick tock, every passing month felt like three or four to me…) Instead of starting our IVF cycle in March, we’d start in January, right after the holidays. From the point I started taking drugs to the point I’d have one or more embryo implanted, nearly two months would pass.
I got up to use the bathroom and while I was gone, the doctor basically told Paolo that we shouldn’t get our hopes up—that damned Inhibin B result meant our chances of success—already not great at 25%—were no better than 5%. A five percent chance that we’d get pregnant? That was the same as a 95% chance that we wouldn’t.
While we were happy to be getting an earlier start on Project Baby, we couldn’t be happy about the reason—if it weren’t for my lousy test results, the doctor would never have moved up our cycle. Plus, the new schedule meant postponing a trip to the US we’d already planned and paid for. But when you want to have a baby and someone offers you even the thinnest thread of hope, you grab at it. We agreed that the IVF cycle took priority over our trip, so we said yes to a January cycle and dismal odds, and I set about changing flights and cancelling hotel reservations.