For one couple, the IVF journey to becoming parents made them realize how lucky they were
Jenna Loo is the proud mom of 4-month-old baby Hannah. “We lucked out and got a really easy baby—she only cries if she wants something, and she’s already sleeping through the night,” says Jenna. Despite the hardships around being able to conceive, Jenna counts herself and her husband as extraordinarily lucky that their multiyear pregnancy journey turned out as it did.
Beginning with a win
Jenna came to Stanford Medicine Children’s Health Fertility and Reproductive Health Services, a specialty service provided by the Johnson Center for Pregnancy and Newborn Services at Lucile Packard Children’s Hospital Stanford, when she was 30 years old, after trying to get pregnant with her husband, Joseph, for a year. “It was very stressful to have to take ovulation and pregnancy tests every month, so we decided to see a specialist,” she says. Their first stroke of luck, according to Jenna, was becoming the patient of Steven Nakajima, MD, fertility specialist at Stanford Medicine Children’s Health Fertility and Reproductive Health Services and clinical professor in the Division of Reproductive Endocrinology and Infertility at the Stanford School of Medicine. “We were very lucky to be under his care,” she says. “He is actively involved in research, so I felt like we were the beneficiary of the latest methods.”
The Fertility and Reproductive Health Services team offers many services and treatments for women dealing with a loss of fertility, like Jenna, and they are proud to treat women whose chances of conceiving are very low due to genetic predispositions, advanced maternal age, previous surgeries, or unique health conditions. Dr. Nakajima has helped many perimenopausal and menopausal women in the 45–55 age range, for example, to conceive and deliver healthy babies through in vitro fertilization (IVF) and egg donation. He and his other attending colleagues also work closely with maternal-fetal medicine specialists at Stanford Medicine Children’s Health to help complex patients, such as cancer survivors, conceive and then manage high-risk pregnancies.
Some daunting statistics
After talking with Jenna and Joseph about their medical histories, Dr. Nakajima recommended that they have genetic testing—a service that the Stanford Children’s team offers to couples. This turned out to be the couple’s second stroke of luck, says Jenna. “We discovered that Joseph’s genetic condition, autosomal dominant polycystic kidney disease, was more aggressive than we thought, since it was asymptomatic,” she says. They also hadn’t known that his disease had a 50% chance of being passed on to their child. Genetic testing revealed that Jenna had a condition that predisposed her to cancer, Lynch syndrome that has a 50% chance of getting passed along to her baby. “So, it was really a blessing that we went to a specialist, or we wouldn’t have known,” she says. Fortunately, as part of the team’s IVF process, they were able to identify embryos that were healthy enough to develop without these conditions.
In talking with the couple, Dr. Nakajima learned that they wanted to have three children. He knew that this would be a challenge: first, because Jenna was already in her 30s; fertility drops at age 35. Second was the number of eggs they’d need in order to produce an embryo that didn’t have either Jenna’s or Joseph’s genetic mutations. Dr. Nakajima advised that they retrieve enough eggs to have an opportunity to transfer an unaffected embryo into Jenna’s uterus at a future time. The first egg retrieval cycle was hard on Jenna. “At first, it was disappointing because only one embryo developed properly, and it turned out to have both of our genetic diseases, so we couldn’t use it,” she says. “We had done a month of medications and many ultrasounds and didn’t get a healthy embryo.”
One embryo at a time
Jenna was undeterred despite the slow progress and did seven retrievals back-to-back. Each entailed four weeks of medication and ultrasounds, then two weeks of recovery. “It felt like a marathon,” she says. “Dr. Nakajima helped a lot. He was practical about setting goals, so there were no real surprises. We’d try not to look too far ahead, and I could see that we were making progress—one embryo at a time.”
Dr. Nakajima was impressed by the couple’s determination. “They knew what they were up against and showed incredible resiliency,” he says. “A lot of couples wouldn’t have done it because it’s emotionally too difficult.” That’s why some patients rely on Johnson Center mental health services while building their families. The Fertility and Reproductive Health team in particular assesses each patient’s mental health when they first come in and then offers mental health support based on their needs, such as individual therapy sessions around trying to conceive, a support group around conceiving, and mental health care around recurrent pregnancy loss.
Lucky breaks
Jenna’s second egg retrieval cycle produced one unaffected embryo. With additional egg retrievals, they were able to bank 10 healthy embryos in total over the course of the multiple egg retrievals. When it came time to transfer the embryo into Jenna, she had a 50% chance of a live birth. Luckily, her first transfer resulted in a healthy pregnancy – and, nearly nine months later, Hannah.
According to Dr. Nakajima, a major contributing factor to this outcome was the skilled Stanford Children’s IVF Lab staff’s ability to develop high-quality embryos, biopsy them in order to screen for the two specific genetic mutations, and have them properly frozen and thawed—all of which, he says, is an art as much as a science. In the lab, highly skilled embryologists monitor embryos’ development for up to seven days to identify those that are more likely to result in healthy pregnancies after the transfer. Despite their best efforts, though, there need to be two or three chromosomally normal embryos in order to have a reasonable chance to have one child. Dr. Nakajima also credits the multidisciplinary team’s strong focus on research, which brings the latest advances into the practice.
Dr. Nakajima acknowledges the role that luck played, since both Jenna and Joseph had challenging medical conditions beyond infertility that made it unlikely that they’d have a healthy baby—or, hopefully, several babies. “Usually, a couple with just one genetic condition is challenging,” he says. “But because each of them had one—and they wanted more than one child—it required an inordinate number of embryos,” he says. “The fact that we were able to bank 10 unaffected embryos with their conditions is just incredible. They really beat the odds.”
As part of his holistic care plan, Dr. Nakajima referred Jenna to see maternal-fetal medicine specialist Deirdre Lyell, MD, to oversee her pregnancy, since Jenna had a history of heart palpitations. “Dr. Lyell was great because she didn’t overwhelm us with information, so it wasn’t stressful,” says Jenna. Then, toward the end of Jenna’s pregnancy, she recalls, “it was really lucky that I was seeing her because I had preeclampsia. My blood pressure got really high, and she caught it and had me induced at 37 weeks.”
Jenna and Joseph are still undeterred on their path to creating the family they’ve dreamed of. And they have luck on their side. With the long months of egg retrievals behind them and a good number of healthy, unaffected embryos cryopreserved, they have every reason to believe that their familial dreams can come true. “Their story is definitely one of the most heartwarming things that have happened to me in the past 10 years at Stanford,” says Dr. Nakajima. “Their persistence and unwavering determination speak volumes about this couple.”
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