Patient Testimonials - Amaras Story :
By Amara Graps
The storks were preparing for their babies during the Spring, when I was travelling through the countryside to the clinic. In the clinic, I had my embryo transfer. Then I became pregnant. Then I gave birth to a beautiful little girl with a birthmark on her right eye, called: "Stork bite". :-)]
My pregnancy...
You can see from my photos that my pregnancy was a fantastically
wonderful experience for me.
Before giving birth, the uncomfortable side effects had been
relatively minimal. I had no back pain before her birth, no round
ligament joint pain, and the middle trimester gave me a tremendous
burst of energy. Until the big snowfall in Boulder arrived in late
November, I was riding my bicycle around town every day, and I'm
sure that the baby girl was loving the rocking motion. I talked to
her, played music for her, and pushed on her little (big!) feet, and
she responded in turn, giving me a good sense of her personality.
My birthing...
I believed that the baby tried her best to be a team with me for her birthing; she dropped into the most optimal anterior position, but something happened at the end to make it a back labor, possibly that my uterus is tilted. I think that she was so low that she 'rode' my tailbone. Despite my back labor pain, my birthing environment was beautiful, women helping and supporting me for 15 hours, singing, massaging my back, lighting my (electric) candles, encouraging me. My photos of the person most supportive of my path of motherhood, my cousin Gaida Mägi, who died October 2008 of breast cancer, was prominently displayed. I'm glad that I fought so hard (as hard as for my IVF) to set up my natural birthing environment, so that the little baby was born into a room of warmth and love. And oh my god, when they cleaned her, there is an amazing baby. Clear, beautiful skin, plump and vibrant, those big feet, ready to take the world. I'm 47. I prepared emotionally, physically, for any outcome. I know that one can find many other over-40 women can handle natural birth (no medical intervention) too, so I encourage over-40 women in Estonia to find a way to have a natural labor birth for their babies.
My Estonian connection ...
On October 4, 2008, I lost Gaida Mägi, my (only) cousin and closest relative while I was living in Europe during the 10 years 1998-2007. The success of her largest support and influence in my life, the baby girl I birthed on January 2, 2009, was sadly the reason that I couldn't be with Gaida during her last weeks in October. We all knew there was not much time left, but I had a false hope that she could stay with us in this life a few more months until I could make the long travel to Tallinn with my newborn. Gaida supported my decision to be a (single) mother, from the beginning, and it was she who found the Elite Klinic in Tartu for me, when she and I were discussing my prospects in Spring 2006. Gaida's battle with breast cancer spanned many years with seven years in remission, when we, her family felt sure that it was a problem of the past. But in Spring 2004, her only sibling, Gunnar Graps died suddenly of a heart attack, and that shock seemed to have triggered her cancer to emerge out of remission. From Fall 2004 to her death in Fall 2008, she bravely fought cancer again, while it metastized, and weakened her, and during the last two years left her in a great deal of pain. I'm glad that she is no longer in pain, still nothing prepares you for your dear one's death when it happens. One moment they are alive, and the next moment they exist in only memories in your heart. Gaida is with me in my newborn, and I will make sure that my baby, Vija Alexandrea Graps, knows who is Gaida Mägi, and her brother Gunnar Graps.
Technology- When it works (8 June 2008).
I think that Sunday, June 8 was destined to be an extra good day because when I woke up, there was an email in my inbox from a 72 year old woman in Latvia who told me that my smile in my pictures at my web site looked just like my grandmother's smile. Since my grandmother died before I met her, this woman was drawing on memories 60 years ago, when she had met my grandmother, grandfather, and father in a Displaced Persons (DP) camp in Esslingen, Germany, immediately after WWII; her mother and my grandmother sang Latvian folk songs in the DP camp together. Would such a contact have been possible before the Internet? Not easily. Today, humans have the fragments of a network of a global consciousness, and when it works, it works in surprisingly rich ways to enhance human lives. When it works. You see for the technology to function as advertised requires a godly amount of effort.
Today I gave myself my 88th and last hormone injection to support the ten week old fetus growing inside of me. For this injection, I didn't need any more the bulls-eye circles that I had drawn on my rear-end starting in April, because my bruises were guideposts enough to know where to poke the long needle to inject the progesterone. But after today, my base level hormones are enough for the fetus to continue growing its placenta to protect and nourish it for the rest of my pregnancy. So far, we succeeded, my extraterrestrial and I. Without the extra medication, it is sure from the early IVF efforts that the fetus would not have survived, and I would have miscarried, so I am grateful that today's technology gave me this opportunity to start my family. Twenty years ago I would have been imprisoned by my chronological age, forever remembering my terminated teenage pregnancies, and the choices I made in the following years to educate myself, get experience, build myself in all of the ways that I wanted to be, in order to support well a family.
Women have a bit of a conundrum, in this respect. All of their eggs are formed before birth and their most fertile years are when they first enter puberty while the age and number of their eggs are already on a decline. Since thirteen year olds rarely have advanced their education and experience to a PhD level, they lack the life skills to support well (for the next 20 years) a family. So those women that want a family do their best, making tradeoffs for how much time to spend on their careers and how much time to spend on their personal lives, hoping that there will be a convergence of education, experience, and partnership before her time to reproduce is finished. By age 35, her probability to become pregnant starts to steeply decline, so if she is not established well in her career, her family choices steeply decline, as well.
I had thought I made all of the right decisions. I stopped my marriage at age 36 because my spouse didn't ever want a family, I learned from my work-related repetitive strain injury a few years before, that I need more control over my work environment, and I knew that I could much better support a family and have a longer career future if I took my education to the next PhD level. So after reducing some of my crippling debt, off to Germany I went, following the best advisor I could have found and given a free education by the German government. Three years later at age 40, I had a PhD and a clear financial story and I could put the attention I needed to start a family. There was a convergence too, because I had found a partner, only it was a minor inconvenience that he was located in Italy, but I could get a job there too, right? Right, but one unable to support me. However, my partner who told me not to worry about that because he would help me, moved me to his country, put a deposit on the flat that we would share and I arrived with high hopes for my newly enriched personal life and long scientific research life, expecting that I would not need to make another international move.
The universe thought that I needed to learn more lessons however. Because when I arrived for my new life in my new country, my partner had 'no time to see me', and with no visa and no job for anywhere else, in a profession that was not supported by the country to which I had moved, I was in a bit of a sticky situation. I tried to make the situation function by working nights and weekends at other jobs, while watching my bank savings lessen month by month. I became extremely resourceful too, doing alot, on a little, and managing to not lose too much of my career. But this left no time for my personal life and when my savings ran dry, my desperation went into overdrive. After two years of concerted job search, refining better each time what was the most appropriate job and place for me after that experience, I'm in a recovery phase, in a country to which I didn't want to move, but one that _does_ provide everything that I need to jumpstart myself to the next level, both scientifically and personally.
"When life gives you lemons, make limoncello."
What I lost forever in my previous life was my last chance to reproduce, but technology did offer a possible solution, if I was willing to put in a godly effort, which I was. Since there was a 1% chance of pregnancy success using my own eggs due to my age, I decided the next best thing I could do is pay homage to my ethnic roots with a Baltic baby. Today I am essentially a womb-without-a view to an extraterrestrial (a little joke after my Estonian doctor kept referring to the embryo transfer as "ET"), whom I'm calling Myrtle, for now. That Myrtle exists seems like a miracle to me. What does not seem like a miracle, however, was the discovery that women using in-vitro fertilization women must go through very long, physically demanding experience to modify their basic reproductive functions.
If a woman today wishes to have IVF, she must carefully guide and prepare herself at each stage of her monthly cycle with hormones, first to suppress the follicles and egg production, then to stimulate them (if she is using her own) for surgical extraction, then to bleed off the uterus lining and build it back up for maximum thickness to be ready for embryo implantation. Which, today, after all of her previous efforts, has only a 10-20% chance of success. Hormone preparation requires daily injections (because the hormones don't stay in the body more than 24 hours), either into the fat tissue (first phases) or injections into the muscle tissue (second phases), and it's unavoidable to exit those phases without bruises. If one doesn't care for the injections, one can try suppositories, which usually leave rashes and sometimes, infections, so the alternative is not comfortable either. Most women, who go through IVF, are unsuccessful at pregnancy the first time.
If implantation is successful, then the woman might rejoice that her daily bruising injections can stop, but she would be wrong. Because she skipped a step in her normal reproductive cycle of the egg dropping into the uterus and shedding material that releases progesterone and other nutrients that the fetus needs for its placenta, the woman must supply it externally. So more injections (or suppositories) for another two months. Is she willing to do that? Of course she is, because it is for the baby to survive. But would any woman follow this path if they knew? That is less clear.
Certainly for me, I didn't think twice. IVF technology offered a solution, and so far, my godly effort paid off. I found my good Estonian fertility clinic during a visit to my relatives while I was still living in Italy and facing draconian Italian laws that forbade me Italian assisted reproductive technology. I thought the clinic was superb and perfect for my plans for motherhood, wherever I lived after Italy, but I admit that an 8 hour time difference away was challenging. But the pieces started falling into place when I arrived in Boulder, Colorado, USA to start my new job. I found a fertility clinic near my town that could support the efforts of the Estonian doctor, to write me the necessary prescriptions (which more-or-less followed the local clinic's own protocols). Setting up the communication between the two clinics required finding the local key support staff and patience through the bounced messages. I taught myself how to give myself my daily injections using You Tube videos and asking many questions to both fertility clinics' nurses. I followed both clinics' instructions precisely. But even precise instruction-following can have some blips.
About the time of my 47th birthday, ten days before I was scheduled to fly to Riga / Tallinn and then to the Tartu, Estonia clinic for the embryo(s) transfer, I was riding my bicycle on the sidewalks like a teenager and misjudged the distance down the curb to the parking lot pavement and the front wheel abruptly made the transition. So abruptly, and since momentum _is_ conserved, that the back wheel made a glorious arc over the front wheel, and I flew in a similar trajectory over the handlebars. And landed on my head/helmet. The helmet was the smart part (I _always_ wear one when I ride), otherwise I wouldn't be writing this story now. No broken bones, no backbone out of alignment, amazingly. But I gained a cervical strain that needed a couple of months to heal completely and made it difficult to turn my neck in order to give myself my hormone injections. But it certainly had an inoculating effect on me, e.g. on how I must be careful, and it happened _before_ I became pregnant, which wasn't the situation for the stupidity gene that was expressed by my first egg donor.
At about the same time, my donor was no longer available, but the clinic gave me a miraculous solution of another donor, which offered precise timing, since I was hormone-ly 'prepared' for the embryo transfer and the new donor was hormone-ly prepared at the same time to donate, all still giving me a 50% probability of pregnancy success.
The rest of the plan proceeded on schedule. I flew from Denver to Riga and then to Tallinn, passing through four countries' airport securities with just one carry-on bag that included 13 syringes (2 inch long needles) and several vials of hormones, giving myself my injections in hotel rooms and disposing the needles into my substitute for a medical disposal container, which was a honey jar. My 24 hour travel was the route Denver - Toronto - Frankfurt - Riga - Tallinn, then a 2 hour bus from Tallinn to the Tartu fertility clinic, where I stayed for two days and had the embryo transfer procedure. The ET itself was a simple outpatient procedure, but I stayed for longer in the clinic because I needed a quiet, restful place to sleep. Then a visit to my relatives in Tallinn, and back to Denver via a similar route and to wait. Did implantation occur? Two embryos were transferred, so, if yes, how many had implanted?
I passed through each step, slowly, anxiously, trying to distract myself with the American Astronomical Society's Dynamical Astronomy Division meeting, which my institute, SwRI was hosting, and answered reviews on a paper that I had submitted with tons of errors, and wrote and submitted another NASA grant proposal along with my normal New Horizons work. After almost two weeks from embryo transfer, the first pregnancy test revealed that I was pregnant. Since my Estonian doctor had completed his role with the ET, the primary care role shifted to my Colorado fertility clinic, where they picked up the responsibility for my full care. Three weeks after the positive pregnancy test, the Colorado clinic performed the first postET ultrasound, where I learned that I was carrying one, not two, with a strong heartbeat and they considered my pregnancy to be strong and viable. Then they handed my full care to a normal ob/gyn, where I experienced more exams and I'm on my path to motherhood. What remains are two prenatal tests to learn if the fetus has any defects. If yes, then I will terminate the pregnancy, probably while crying my eyes out, and start my godly effort all over again. If no defects, which I don't expect, because my donors are young and healthy and I'm older and very healthy, my pregnancy will proceed to around New Year's. At which time, I will have the life in my hands that I created through a fair amount of my and other people's godly efforts with technology that does exist, today.