When Hala Sabry-Elnaggar's period didn't come, she and her husband, Mohamed, thought they were pregnant. Though married and of child-bearing age, they weren't thinking about kids just yet.
Hala, who was 29 at the time, recently graduated from New York College of Osteopathic Medicine. She'd just moved across the country to start a residency at the county hospital in San Bernardino, California.
She doubted a pregnancy announcement would be met with a warm welcome. The tide was changing, but there is still sexism in medicine, she said.
So when the pregnancy test came back negative, she and her husband were surprised at how devastated they were.
The thought of having children excited them.
It was time to try to have kids
The disappointment prompted a new thought: Maybe their unexpected heartbreak meant they were ready to be parents.
It wasn't the most ideal timing in the world, but at least they'd have nine months to get things figured out, Hala thought.
She and her husband started trying for a child. But not a mere "if it happens, it happens" sort of attempt. She and Mohamed were on a mission.
"I got ovulation kits, and I read up on different factors to improve fertility," Hala said. "We were a really educated, trying couple."
Despite regular periods and on-time ovulation, she still wasn't pregnant after six months.
Hala had done everything right, she thought. She went to medical school, got married and had a promising career. And her mom never had fertility issues. There was no explanation.
Why was this happening?
Inconclusive tests results didn't leave her with many options
At the recommendation of a friend, Hala and Mohamed visited a clinic in southern California in 2008.
Tests came back inconclusive — medical speak for "we don't really know why."
One of her hormone levels was slightly elevated. Mohamed's sperm count appeared low at first, but follow-ups rejected that. On paper, they should have no problems getting pregnant.
The clinic suggested In Vitro Fertilization, the process by which mature eggs are retrieved from a woman's body and fertilized in a lab with a man's sperm, forming an embryo. That embryo is then implanted back into the woman's body to carry out the pregnancy.
It's a groundbreaking reproductive technology that's led to the birth of more than 8 million babies, according to a recent study. The first baby to be born from IVF, Louise Brown, turned 40 on July 25, 2018.
The start of her IVF journey
Hala didn't hesitate.
"I never saw IVF as a negative procedure or a negative process. I was actually really welcoming it and excited about it. ... I remember thinking, 'This is going to be amazing! I'm going to have twins and I'm going to be done!' "
But it didn't happen like that.
Hala didn't get pregnant after the first round of IVF. Nor the second. Nor the third or the fourth.
Each time, the doctors tweaked something. And each time, Hala and Mohamed got their hopes up, only to be met with grief.
"It was really hard," Hala said. "I went through a lot of depression."
Every time she logged on to social media, she saw friends who married at the same time she had sharing pregnancy announcements and baby photos.
At times, the burden of wanting a baby but not being able to have one became too much to bear. It forced her to temporarily put some friendships on hold. She made new friends through IVF support groups online.
"The highs in IVF are so high and the lows in IVF are so low that only someone else that's going through it or has gone through it can understand you," Hala said. "And that's just how I survived."
A brief moment of happiness
On the fifth IVF cycle, Hala and Mohamed finally got the news they'd been dreaming of: They were pregnant.
But five weeks and three days later, devastation hit again. Hala miscarried. Her hCG levels, a pregnancy hormone standing for human chorionic gonadotropin, were too low.
"At that point, we thought, ‘Maybe we need to change clinics. I know this clinic worked for my friend, but maybe there’s some kind of variable that hasn’t been found or my body doesn’t vibe with the clinic,’" Hala said.
So, they switched doctors. That wasn't easy, either.
"Some of my regrets with the first clinic were hope and loyalty," Hala said. "You have doctors that you become very attached to, and it's very hard to break that attachment. This person's been part of making your family."
Taking a new path on the IVF road
To avoid getting too close to the physicians at the second clinic, Hala and Mohamed decided they'd only complete two IVF cycles there and hope for the best.
Two cycles would allow for one attempt and then one more to make any necessary tweaks.
The first cycle passed without success. On the second cycle, Hala became pregnant but again miscarried at five weeks three days, the same as before.
It was time to move on, as she and her husband had planned. And her doctor understood.
"He was very supportive. He said, 'You know, this is not about me having my family of my dreams; this is about you having the family of your dreams,'" Hala recalled.
Then, she found where she was supposed to be
After two clinics, seven IVF cycles and two miscarriages, Hala and Mohamed decided it was time to change tactics.
Hala, began researching IVF conferences, scanning online forums and scouring IVF success groups. She kept seeing one acronym: CCRM, Colorado Center for Reproductive Medicine.
Particularly noteworthy to her were the success stories from women who had been patients. According to the Centers for Disease Control and Prevention, the chance of getting pregnant per embryo transfer for women under 35 at CCRM was 72.5 percent.
But she and Mohamed were still anxious. If they went to a third clinic and failed, they might never have biological kids. Their pregnancy attempts could come to an end.
She decided to set up a consultation, despite living out of state in California. If they were going to invest in this place, they needed to know everything.
After visiting, she knew there was something different about this place.
"I remember working out that morning and running on the treadmill and (feeling) super pumped," Hala said. "I just felt like we were at the mecca of infertility."
It felt an honor to even be given an appointment, she said. These people were the experts. She was sure of it.
After tests, she got news she'd heard so many times before: There wasn't a clear medical reason that she couldn't get pregnant. Dr. William Schoolcraft, the center's founder and medical director, didn't know what the problem was.
Hala was wrecked.
"To be sitting with the most expert person in the field and for him to be dumbfounded by your case that should be quote on quote 'easy,' it was scary. It was really scary."
She decided to try one more time
Schoolcraft said he would go through with one cycle only because he didn't want to repeat unsuccessful methods, Hala remembers. He reminded her of the other options to becoming a parent.
Hala's fertility dreams were crashing down. She called her mom, crying that she may never get pregnant.
"I was just hoping to walk in there and they're going to be like, 'Yep, this is what you have to do and you're definitely going to get pregnant,'" she said. But that didn't happen.
Leading up to the appointment, Hala said she felt immense pressure. Her embryos looked great, her doctor encouraged.
Then, the results: Hala had six genetically sound embryos. More than she'd ever had during an IVF cycle.
They implanted two.
October 19, 2012: About four years into IVF cycles
Hala broke into hysterics. She called Mohamed but couldn't get words out through the tears. He asked if she were bleeding or hurt.
She hung up and sent him a photo: A positive pregnancy test.
"That was a special day for us... We were so broken and we knew that there was a chance of miscarriage," Hala said. "But we had hope and confidence that we had made the right move going to CCRM."
At eight weeks, Hala miscarried one of the embryos. She still had one.
On June 27, 2013, she gave birth to a healthy baby girl named Syriana.
Almost immediately after, Hala felt the urge to get pregnant again. She wanted to give Syriana siblings.
CCRM transferred two more embryos. This round was a resounding success.
Evangeline was born December 4, 2014. One minute later, her twin brother, Ramzey, came into the world.
After years of heartache and disappointment, Hala and Mohamed were parents to three healthy babies.
It was everything they'd dreamed of.
What should she do with the last two embryos?
Hala and Mohamed had two embryos left. What should they do with them, they wondered?
Their hands were full with three young children.
There wasn't a lot of guidance or advice available to them. When your struggle is infertility, no one preps you on what to do once you actually have kids, Hala said.
"If these two embryos can be donated to science and help another couple, that would be great," Hala remembers thinking. "But every time I looked at my embryo picture, I imagined my children," she said.
They took some time and adjusted to their new life as parents before revisiting the topic.
"Everybody that's in the situation, I think they will make the right choice for them. I'm glad there are choices that women can make, whether they donate them, discard them or transfer them," she added.
She and Mohamed felt they had to give the last two embryos a shot.
"I remember that girl that struggled during those seven cycles. I never want to lose touch with her," Hala said. "I want to remember where I came from in this journey."
Schoolcraft warned the likelihood of twins a second time was low.
But on June 28, 2018, one day after their first daughter turned 5, Hala and Mohamed welcomed their second set of twins. First came Farrah and then Athena.
After everything, she regrets nothing
Hala's IVF journey was nothing like she expected, but she regrets nothing, she said.
Each of her doctors played an integral role in the formation of her family, and for that, she is forever grateful.
She is glad to have five beautiful, healthy children. And her priority now is to help other women who share similar experiences and struggles.
Whenever Hala posts a picture of her kids, she mentions something about her IVF journey. She doesn't want others to feel alone, as she often did.
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She remembers the hurtful comments that well-meaning but ignorant people said. Things like, "Just stop trying so hard!," or "Go on a vacation!," or, "When it happens, it happens."
Hala, who is now an emergency-room physician, set up a large Facebook group for mothers in medicine, where they discuss topics such as sexism in the industry, parenting and infertility.
To women struggling with fertility issues, Hala wants to say:
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