A PERFECT PLACE
By Christine Tumpson
“We’re in a perfect place for this to be happening at this point at our lives. It hasn’t set in yet, but it will tomorrow!” Emily Walz grins, looks at her husband, Ryan, sitting next to her in the obstetrics office at West Penn Hospital, and breaks into laughter. Her melodious peals are contagious, enveloping everyone in the room in the joy of the moment. Today is Emily’s official due date to deliver the couple’s first baby.
That happiness from being in the right place at the right time is one for the Walzes to relish with their team of physicians at Allegheny Health Network’s Jones Institute for Reproductive Medicine, a center specializing in assisting families with fertility issues, and Seasons OBGYN, one of the area’s leading general obstetrics and gynecology practices. “I heard really good things about the Jones Institute, and the labor and delivery here,” says Emily. “I knew I had asymptomatic endometriosis, so I thought I might have problems getting pregnant. I really liked AHN’s approach of trying naturally, staying fit, eating healthy, and getting regular follow-ups.”
After a year of focusing on pregnancy, and not conceiving, Emily and the medical team reviewed her options, deciding to continue on the path of natural fertilization but with medical intervention to remove the growths blocking the fallopian tubes leading to the uterus. Emily illuminates the importance of communication with the team of physicians. “It seemed like the best option was surgery to clear up space in the tubes, but they told us they would have to remove them if they were too damaged. They said there might be a way to maybe keep one of them intact. I said please keep it, as long as it’s open even a tiny bit. That’s all I needed, just that little bit of hope.”
Dr. Emily Lebovitz of Seasons found that little bit of hope as she performed Emily’s surgery. “Going into the procedure, we knew we were likely to have problems. We took out the left fallopian tube because it was completely blocked. The right fallopian tube was significantly dilated from the endometriosis. But I remembered what they had told me,” she now recalls, looking at the couple. “And I wanted to give it one more try. So when we saw it wasn’t completely blocked, we decided to keep it intact.”
“We knew IVF (in vitro fertilization) was not for us,” Emily says, “so this surgery was our one shot. And we were completely OK with it not working.” Ryan winks at her, and together the couple describes a beautiful life. She as a social worker, he as a Pittsburgh City firefighter with an impressive lineage, as both parents are former Pittsburgh City firefighter chiefs. They share a 200-year-old country house set on four acres in the middle of the city; three dogs — a silver Labrador Retriever named Luke, a chocolate Lab named Remy, and a Newfoundland named Theo; and a great network of family and friends.
Turns out, while they were building that perfect nest, Mother Nature was planning for that perfect moment. Three months after the surgery, Emily conceived naturally, just as she had wanted. “We rely on one another in this office to be involved with all aspects of a patient’s needs, and we respect one another,” explains team member Dr. Ganya Alvarado-Reagans. “We know what we are doing is helping families, and there are many options to consider. With everyone working together, we are able to have a successful outcome.” Dr. Lebovitz agrees, “Emily’s scenario is not an uncommon one. Together, we have to make decisions to best
meet people’s goals.”
After ensuring that the pregnancy was not an ectopic one, a natural complication with a blocked fallopian tube, Emily’s pregnancy was celebrated by her team. Says Lebovitz, “I feel like we were lucky. For most couples, they can see a fertility specialist and they can be doing IVF, but in this particular case, we were in the middle.” Those are the situations where the teamwork shines, says Dr. Alvarado-Reagans. “When a couple is faced with these challenges, many people think in vitro infertility treatments are the only option, which can be a high-priced ticket. That shies some people away from seeking treatment. But the sources of infertility are varied and the treatments are tailored to the individual. That includes their financial resources and their family goals.”
For the Walzes, those goals are being accomplished in ways they could never have foreseen, as the baby’s due date is also the couple’s anniversary. The perfect moment, or as Emily beams, “just as it was meant to be.”
+ Pictured above: Emily Lebovitz, M.D., left, and Ganya Alvarado-Reagans, M.D., right, of Allegheny Health Network’s Seasons OBGYN worked as a team to help Emily Walz, center, conceive naturally despite her blocked fallopian tubes.
FINDING A WAY
By Abby Dudley
Daljinder Kaur, an Indian woman in her 70s, became a first-time mother this year when she gave birth to a baby boy who, by all accounts, is healthy. Closer to home, Janet Jackson made recent headlines for postponing her world tour after becoming pregnant just two weeks shy of her 50th birthday. She’ll join a long list of Hollywood’s elite who welcome babies into their lives well after the typical age of doing so. If these newsworthy women are indicative of anything, it’s an ever-growing frontier for reproductive health innovation.
Stories like these can give the erroneous impression that pregnancy at an advanced age is easily accomplished, says Lori Homa, M.D., Allegheny Health Network reproductive endocrinologist and infertility specialist. Often, advanced infertility treatments are behind such “miracle pregnancies.”
“Women who are either in Hollywood or are getting in the press for these sorts of things are likely using donor eggs,” says Homa. “They’re not likely to be using their own eggs.” Homa, board certified in obstetrics and gynecology, sees firsthand the unrealistic expectations that the media so often creates surrounding eligible pregnancy age. “I have a lot of people come in who didn’t realize that fertility rates decrease exponentially when you reach your 40s. So we see women at age 44 or 45 who are expecting that everything is still fine, and they’re thinking for the first time, ‘I should see someone at this point.’ But, really, they should have thought about seeing someone earlier, maybe by their late 30s, or even at 40.”
Dr. Homa says women and couples hoping for parenthood should seek advice and treatment sooner rather than later. Later-age pregnancies that make headlines in the media are pushing back the age many women start seeking medical counseling, with unrealistic expectations they can still become pregnant with their own DNA. But women are born with a certain amount of eggs. “They’re actually highest around 20 weeks of gestation, so you have your highest number of eggs before you’re even born!” Dr. Homa says. “And the number only continues to decrease as women age. We can never make more.”
Luckily, amazing innovations in reproductive health are ensuring that there are many ways to start a family. Donor eggs implanted through in vitro fertilization (IVF), for example, are a major advancement in reproductive medicine for many couples hoping to conceive. “Donor eggs are a wonderful thing,” explains Homa. In fact, they are just one of the many options that she employs to help treat infertility. Homa and AHN customize a wide range of medical approaches for a wide range of people seeking to start families.
“A patient’s treatment plan can range from oral ovulation induction medications to IVF. And there are many different types of patients who seek our services,” Homa explains. “We might have a single female looking to preserve her fertility for the future, or become pregnant now, or we might have a male-female couple who’s been trying for years and hasn’t been able to conceive. Or, we might have a same-sex couple that comes in and is desiring to conceive through either donor insemination or, if it’s a male-male couple, then they might want to use a gestational carrier for their embryo and a donor egg, so that gets even more complicated,” she continues. “But there are a lot of different scenarios that people come in with, and we’re able to help people no matter what their story is.”
Two specific groups of people are helped by egg freezing technology, which has made some of the biggest strides in the field in recent years. Cancer patients and women who want to extend their fertility are benefiting from the new science that is making the process more successful than ever. Embryo freezing — freezing an already fertilized egg — has been more popular in years past because it is far easier to freeze and thaw a larger mass of cells. An egg, basically one giant cell full of fluid, presents more complications and risk of crystallization. “Egg freezing is a new technology. It has only been approved for general use for a few years,” says Homa. “As the process gets refined, I think the results will continue to improve.” For cancer patients and women hoping to preserve their chance for children, it’s extremely exciting progress.
Whereas Homa recommends that the latter type of woman undergo the operation by age 38, which statistically shows the best results, the former are helped by freezing their eggs before starting cancer treatment. “We have a lot of women who have breast cancer who do it before they undergo chemotherapy. But there are also women with other cancers, too, that decide to go through with freezing their eggs before they move into a chemotherapy regimen that could decrease their fertility afterwards…[Chemotherapy] can affect how your ovaries function and your ability to conceive in the future.”
In addition to fertility treatments of all kinds, Homa performs a lot of reproductive surgeries, as well. These include anything from fixing congenital anomalies — repairing a septum in the uterus or even creating a vagina — to treating diseases like polycystic ovary syndrome, which often starts in the teen years. “It’s a lot of different things — a spectrum of people who want to become pregnant, mostly, but also people who are experiencing other complicated reproductive issues.”
No matter the issue Homa is presented with, she tackles it with success. “Our program is really expanding, and our pregnancy rates with IVF are now well above the national average, so we’re very successful,” says Homa. “Our program has helped many women and couples conceive using a variety of different methods, whether it be ovulation induction, insemination, or IVF. It’s really wonderful to see our patients have successful outcomes,” Homa continues. “It’s a privilege to have such a positive, meaningful impact on their lives.”
FOLLOW THE ADVICE
By Christine Tumpson
Allegheny Health Network obstetrician Dr. Christine Gallis relates first-hand to her patients’ infertility issues. “My husband and I took five years to get pregnant, and I ended up having IVF (in vitro fertilization) because of endometriosis. It worked really well on the first try.” She adds, “So well, in fact, we now have 18-year-old triplets ready to go off to college!”
So when patients eager to become parents look to her for advice, she can step into their shoes, understanding the medical and emotional issues as well. “I tell them, ‘We’re going to keep working on it until we find something that works.’ I tell them that God has a different plan for everybody.” But she tempers her optimism with compassion. “I know what it feels like to think that everybody is getting pregnant except you.”
Samantha Dengler and her Pittsburgh City firefighter husband, Eric, were already raising her sister’s two young children after her sister passed unexpectedly. But they wanted to experience parenthood naturally as well. As a patient of Dr. Gallis at West Penn OBGYN Associates, Samantha was aware that she had fibroid tumors, but had no idea of the severity of disease. “We only saw eight fibroids on the ultrasound.” Samantha says. “But during surgery, they found seven more, 15 in all. It was devastating. What should have been a two-hour procedure turned into four.”
The discovery concerned Dr. Gallis as well. “She had a big problem. She had many, many fibroids, some blocking the lining in her uterus. She had so many, I wasn’t sure that it would end up OK.”
After the operation, Dr. Gallis advised that a lifestyle change would be beneficial. The Denglers listened to every word. “I was 65 pounds heavier,” says Samantha. “I said to my husband, ‘I’m going to get in shape and lose weight. There are no excuses.’ He had bought me an elliptical trainer that was collecting dust. I got myself on a program. My husband got me on CrossFit. We changed the way we ate and cut out fast food. And Eric helped me every step of the way.”
While the Denglers still weren’t getting pregnant naturally, they were undeterred in their new healthy lifestyle. “What I love is that Dr. Gallis told us that the surgery might not work. But I trusted her, so we just kept going.” When the Denglers went in for Samantha’s annual check-up after the surgery, she was five pounds away from her goal of a 70-pound drop. But her plans for a victory celebration went completely out the window when, after devouring a veggie burger at lunch, she took a pregnancy test.
Today, Samantha and Eric laugh at the memory as they bounce their beautiful baby girl, Riley, between them. “Sure enough, I was pregnant.”
For Dr. Gallis, it is a storybook ending, complete with the healthy lifestyle transformation and newest family member for the Denglers. “It’s funny,” she says, “because you have those conversations every day with patients. It’s nice when you have those outcomes. Patients need to follow their doctors’ advice.”
Allegheny Health Network, ahn.org.