‘But I don’t have high blood pressure,’ I argued.’: Woman’s IVF journey with white coat syndrome to conceive twins

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“My first fertility treatment was in a state park, the day of a popular local women’s triathlon. After crossing the finish line, I kept running–to the car for my first injection. The act felt illicit, wrong somehow, such a departure from my normal activities which included multiple IRONMAN races per year and epic training weekends alongside my athletes and friends.

Woman who struggles with fertility holds bike above her head after completing an Iron Man Race
Courtesy Bethany Rutledge

The lifestyle that accompanied those activities felt ‘normal’ to me, while deciding to undergo IVF after a lifetime of thinking I’d remain child-free felt anything but.

John and I already had our two fur babies, Sadie and Bailey. And although we had been married for over ten years, and he wanted children, he never pressured me. It was the simple way I loved Sadie, unconditionally and whole-heartedly–the way I imagined God loves us–that made me realize I may have it in me. God chose Sadie for me. She needed me. But more than that I needed her.

Husband and wife who struggle to get pregnant stand on shore of water holding onto their two dogs
Courtesy Bethany Rutledge

It wasn’t long before my husband John and I realized keeping things a secret wasn’t going to work. As part owners of Atlanta Tri Club, a large tri club in Atlanta, and Energy Lab a cycling and coaching studio. My day job involves training with fellow athletes, attending races all over the country, and racing myself. Suddenly, I was having trouble with all of that. My tells included skipping Saturday morning bike rides, inability to keep up with my usual training partners, and general vagueness about future-oriented plans.

After talking and praying about it, John and I decided to share our efforts, which I announced in a blog post:

I have a confession to make, I’ve been secretly training for an event. And not just an ordinary event, it’s a really long one. Longer than RAAM (bike ride across America), or ultraman (multiple ironman race), or even the Tour (multi-week stage race).

So here it goes, John and I are embarking on an IVF journey. This has been on our minds for the last several years, but it was only recently that we found out it would be necessary if we wanted to pursue the goal of having biological child(ren). After that though there was always another event or race that pushed things off. ‘Oh, we’ll think about it after xy or z.’ We’re busy, there is this trip or project coming up, etc. There is always a reason not to start. Then before you know it, I am up on another birthday!

The older you get; the faster time seems to go. And while I was never sure I would have children; John and I would both have regrets if we didn’t give it a fair try. And a fair try involves trying everything we’re comfortable with that’s available.

I applied the same energy I’d given to racing and training to approach IVF as efficiently as possible.

The first step was the egg retrieval game—the process of pumping your body up with hormones so it will release and mature multiple eggs. Then they take the eggs out, fertilize them in a lab, and put them back it. It sounds simple. In fact, if you could take out the financial and emotional toll, divorce yourself from the consequences, it was a game. It’s exciting in the beginning, and I was armed and ready to take it all on.

To start the process of IVF, you really have to be up for something— the mental, financial, logistical—all of it. You show up early and smile at the people who don’t seem as upbeat. You print an extra copy and sit at the front of the room. You raise your hand when there’s a call for questions.

During my first retrieval, I set a timer for my injections. I made sure I was at home and iced the spots for at least 5′ beforehand. I saved multiple instances of prescribing information— because pleasure reading.

But then effort didn’t correlate to results—at all. The first round wasn’t just bad it was a DNF. Did Not Finish. I had three viable eggs and none of them ended up mature.

Undeterred, rounds two and three quickly followed. By the third retrieval I uncapped syringes with my teeth while driving down the road and stabbed myself in the gut without looking. I could complete four separate injections in two minutes or less; never used ice; injected in parking decks, national forests, and restaurant bathrooms. My phlebotomist gave me actual track marks.

After that, I wasn’t up for something so much as down for something. It was easier to keep going than to stop. We’d already been lighting piles of money on fire. I already skipped the conference, Thanksgiving with the family, the fall races, and any and all things I used to consider ‘fun.’

I filled three personal sharps containers to the brim, made the switch to keto, screwed up my hair with DHEA, experienced a hundred invasive ultrasounds. I lost touch with a dozen friends and ten-x number of acquaintances who I realized I only saw while riding bikes. My car automatically set my commute to the reproductive endocrinologist’s office.

Finally, after six months and four egg retrievals—consulting with everyone, reading everything, and trying something different each cycle, we had exactly two usable embryos, one of which was controversial to transfer—a mosaic.

A mosaic embryo is one that has a mix of normal and abnormal cells genetically. The science of genetic testing is changing so fast. Just a few years ago, mosaic embryos were automatically treated as abnormal and mostly discarded. Now, it’s been shown that in many cases these embryos can self-correct, but there is also a higher chance of miscarriage, and a potentially higher risk of birth defects

Neither John nor I could imagine not giving this embryo a fair shake, a chance at life. The rest would be in God’s hands. To maximize chances at pregnancy I opted to transfer both embryos at the same time. After all the drama of the egg game, the actual implantation procedure is surprisingly low-key and anticlimactic. Then you wait ten days, during which time period you’re not supposed to take a pregnancy test and come back for the results.

With so many bumps along the way what were the chances the first transfer would work? My expectations were low. March 1st, ten days later, was a bittersweet day. It was the day we found out our transfer worked, and the day that Sadie, my original baby girl, went to heaven.

Woman who was pregnant via IVF stands next to husband as they hold dog near body of water
Courtesy Bethany Rutledge

My biggest children related wish was that Sadie would live to be a part of things. Anytime I ever thought about pregnancy or babies, Sadie was front and center in my daydream. She was so gentle and tender with children and I imagined her thinking of a tiny human as ‘her’ baby. Anytime I thought of a pregnancy announcement, it involved Sadie.

Sadie had undergone major surgery a few weeks earlier, but she was as energetic as a puppy.

That afternoon we waited for two calls—from the Reproductive Endocrinologist’s office, and the other from vet mid-surgery to let us know whether anything could be done for our girl. At one- thirty. we found out our transfer had worked. Fifteen minutes later, we had to let Sadie go.

Sadie did live to be a part of things, but not in the way I’d hoped.

For several weeks, I couldn’t bring myself to say the word ‘pregnant.’ How could I expect things to work when life seemed so fragile? And how could I react the way I ‘should’ when the news was so closely tied in with my grief? After, everything I imagined with the pregnancy had a big Sadie-shaped hole in it.

One afternoon, I crashed after a busy day. I had a dream about Sadie and woke up sad with a sense of dread. Then I realized I was bleeding, a lot, and ended up in the ER.

I was so sure we had lost everything—my girl and now the embryos, too. That night in the ER was our first ultrasound, and John and I saw two tiny sacs but only one heartbeat. The ER physician thought one wasn’t viable. But the next day there were two heartbeats. What were the chances that both of them would stick? We were thankful but also cautious. Our eyes were open to exactly how many things could go wrong at any given time.

I think we were all surprised when both continued to grow. Two little boys. Over the next several weeks I started to look pregnant. By eight weeks I was in maternity clothes and there were two strong heartbeats, and two babies growing. One was small for gestational age, but we were optimistic. Things went smoothly for the next several weeks, then a few more bumps in the road.

In July after visiting an urgent care for a respiratory infection, the physician on call immediately sent me straight to Labor and Delivery–where I was admitted for high blood pressure.

‘But I don’t have high blood pressure,’ I argued.

Yes, it measures high when I’m in the doctor’s office, but it’s white coat syndrome.

Sure, it was high when I was undergoing IVF, but the situation was stressful.

And, yeah, it was high during the first trimester, but it’s because of a medication I was on, since discontinued.

After a few days in the hospital, labs and 24-hour urine showed nothing much amiss. Baby Boy B was growing slowly, but blood flow to the cord was good. So, I went home. Everything was fine, and we continued with normal life. I planned events around the release of my upcoming book, Courage to Tri, a part how-to, part encouragement for women seeking their first finish lines. I bought a blood pressure cuff but didn’t use it.

A letter from our insurance company deemed my admission ‘medically unnecessary,’ and they refused to pay for thousands in room and board expenses. It was frustrating, but I secretly wondered if they were right.

A month later at my scan, we were about to leave when my maternal fetal medicine specialist–who I’d come to think of as overly strict–placed her hand on my arm.

‘I can’t let you leave with that blood pressure reading.’

Her statement was so unexpected, I couldn’t muster a good argument. Again, I felt fine. The babies were getting great blood flow via the ultrasound. It was too early. I had too much to do before the boys were born. At least during the last admission I’d felt horrible, which helped me mentally justify time in the hospital. Now, the last thing I wanted was to rack up thousands more in expenses, all for something that just was.

My blood pressure has never hurt anything whether it’s high or not. Why should this time be different?

I just hiked the mountain with Bailey last week!

The boys are active and kicking!

We checked into L and D again, and again the tests showed nothing amiss. I was sent home, this time on blood pressure medication and modified bedrest. Another infuriating ‘medically unnecessary’ letter came, causing me to wonder how anyone besides the Kardashians can afford a baby.

Woman pregnant via IVF smiles in hospital bed beside husband in selfie
Courtesy Bethany Rutledge

This time I checked my blood pressure at home and it was good. Mostly. I mean, if I lay on my side, had no caffeine, was completely silent for ten minutes, and made sure no one spoke to me; if my arm was straight and elevated, and I thought about warm beaches and cuddling with Bailey; I could manage to produce a reading in the borderline range. Mostly.

One week later, the news was worse. Our Baby Boy B had fallen off the growth curve, and I’d be staying in the hospital until delivery. This time I was accepting. My own health issues weren’t enough to get my attention, but I knew in my heart that I belonged in the hospital. Still, I was only at 28 weeks, and my goal was to make it to 31 or 32 for their health.

But only one week later, things escalated. There was debate over whether I should be delivered. John and I voted to wait. Besides the horrible headache from IV blood pressure meds, I felt fine and believed that the boys would be better off cooking longer.

Several hours later, the situation hadn’t improved, and my MFM broke the news. ‘We’re going to deliver you today,’ she said.

I had a mandatory C-section at 2:30 PM. Ethan Avery Rutledge, Baby Boy A, was delivered first at 2 lbs. 14 oz. The five minutes it took for Alexander Battle, my tiny Baby Boy B at less than two lbs., to follow suit, seemed an eternity. They held him up and I saw him for one brief second, he squawked, then was whisked away.

Woman who became pregnant through IVF holds newborn to her bare chest after giving birth
Courtesy Bethany Rutledge

Alex’s placenta was not healthy. It came out in pieces. My body’s super high blood pressure was a warning sign. Although I deemed everything that came before ‘medically unnecessary,’ I’m so thankful that my layperson’s opinion was overruled. And I’m thankful for my ‘overly strict’ doctor’s mandate to deliver.

Three weeks later, Ethan—our Baby Boy A who hogged all the groceries—is thriving in the NICU. Alexander has had a rockier start. Though we undoubtedly have many challenges ahead, we’re all here and alive today. Beyond that, what more can you really ask for?

We’re so appreciative of all the support from friends and family. And I thank God for the expert opinions that overruled mine, that we were in the right place at the right time, that we weren’t far away when things got dire, and that Alex was able to survive the rigors of delivery and is now under the expert care of the NICU physicians and nurses.”

Woman who just gave birth holds newborn conceived through IVF to her chest beside husband
Courtesy Bethany Rutledge

This story was submitted to Love What Matters by Bethany Rutledge.  Follow her on Instagram hereSubmit your own story here, and subscribe to our best stories in our free newsletter here.

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