Like most mothers, Lacey Berning has a pregnancy story filled with happiness, transformation and new life. But Lacey's journey to having her baby also involved loss, sickness and lots of needles.
For Lacey and her husband, Seth, however, the waiting, worry and needlesticks — a necessary component of the in vitro fertilization (IVF) process they went through to become pregnant — along with the extreme nausea and vomiting Lacey experienced while pregnant, fade away when they look at their daughter, Brielle.
"My pregnancy was awful. I was really sick," Lacey says. "I was going in for fluids every three days at the hospital, and I lost 15 pounds before the third trimester. But it's one of those things where I just kept thinking how lucky I was and just couldn't complain about being sick because it was a miracle I was pregnant."
The odds of Lacey and Seth conceiving naturally were minute because both of them had fertility issues. Even using IVF, the couple had less than a 50-50 chance of achieving a live birth. But Lacey, who always dreamed of having a daughter, had to give it a shot. "I knew I could never live with myself if we didn't try," she says.
She and Seth are forever glad that they did. With the support of a Mayo Clinic team from the Division of Reproductive Endocrinology and Infertility that included Zaraq Khan, M.B.B.S, and Elizabeth Stewart, M.D., the couple achieved pregnancy following one cycle of egg stimulation, retrieval and embryo transfer. On July 5, 2018, Brielle was born.
Now Lacey is happy to share her family's story with others. "You always hear about the bad stories where patients leave unsatisfied," she says. "I thought if I could give some positivity, even if I change one person's mind, and they get the miracle of having kids, then it's totally worth it."
When they decided they wanted to have a baby, Lacey and Seth, who live in Eyota, Minnesota, had no idea that they might face infertility. But after a year of trying to conceive, Lacey, who was 28 at the time, grew concerned that something was wrong. She took those concerns to her Mayo Clinic primary care physician.
Lacey's doctor ordered a hormone test to measure her ovarian reserve. That test came back below normal. Lacey was directed to track her menstrual cycle to hone in on her most fertile time. For about a year, Lacey recorded her cycles while she and Seth kept trying. When that didn't work, Lacey made an appointment in Mayo Clinic's Division of Reproductive Endocrinology and Infertility. At the visit, Lacey was prescribed clomiphene — a medication that causes ovulation.
"The first month, nothing happened. The second month is when we got pregnant for the first time," Lacey says. "We did an ultrasound early, and at six weeks, everything was good. We had another ultrasound at eight weeks, and they told us that once there is a heartbeat, the odds of losing a baby are a lot less, so we told our parents."
An ultrasound at 10 weeks came back normal, as did one a week later. However, a day after that appointment, Lacey had a miscarriage at home. When they went to the hospital, Lacey and Seth were met by Cassandra Liss, a certified nurse-midwife in Mayo Clinic's Department of Obstetrics and Gynecology.
"When Cassie came in into the room, she looked at me," Lacey says. "I will never forget seeing her. With tears in her eyes, she said: 'I know we will see you again, and I know you will have a positive outcome. You just have to hang in there.' Those words are burned into my mind."
Genetic testing revealed the fetus carried a chromosomal defect that would have resulted in an abbreviated life expectancy had the child survived pregnancy. In addition, test results showed it had been a partial molar pregnancy. That meant that Lacey's placental tissue formed abnormally and couldn't support the developing fetus.
"For young patients like Lacey, molar pregnancy is a difficult diagnosis because it jeopardizes a lot of timelines for getting pregnant."Zaraq Khan, M.B.B.S.
Women who have molar or partial molar pregnancies require extremely close monitoring and follow-up care because the condition can lead to a serious disorder known as gestational trophoblastic disease in which abnormal placental cells in the uterus develop into fast-growing tumors akin to cancer.
"For young patients like Lacey, molar pregnancy is a difficult diagnosis because it jeopardizes a lot of timelines for getting pregnant," Dr. Khan says. "We have to be more hands-on with monitoring to make sure their pregnancy hormone levels come back to normal for a certain time period before we can start talking about them trying again. For fertility patients, time is of the essence. Telling them they have to wait for six months to a year can be devastating."
Following the miscarriage, Lacey went on birth control to prevent another pregnancy because becoming pregnant at that point would cause abnormal placental tissue to quickly multiply. Her pregnancy hormone levels initially were checked every two weeks and then every month to monitor her levels.
"All fertility care is very high-anxiety provoking," Dr. Khan says. "But for her, it was even more because she was just waiting out a condition where we wanted to make sure she was healthy first before we could start talking about pregnancy planning."
In November 2017, after eight months of monitoring, Lacey's pregnancy hormone levels were normal, and she was cleared to begin fertility treatment again. For the couple, resuming their efforts to conceive meant a new round of testing — this time for Seth. His tests reveal a below-normal sperm count. That result coupled with Lacey's low ovarian reserve led the couple's medical team to suggest IVF.
"They were in a unique situation where there was room for improvement on both sides," Dr. Khan says. "I talked to them about the best way of approaching this appropriately and aggressively with IVF."
The couple waited to begin the process until the following September. On their wedding anniversary, Lacey gave herself the first injection to begin stimulating her ovaries. The daily injections continued for 10 days. Then the day before her egg retrieval, Seth gave Lacey an intramuscular shot that prompted her ovaries to release the mature eggs.
Lacey's care team retrieved 13 eggs. Four of them survived fertilization and grew into embryos. Her team monitored the embryos' growth, and five days after retrieval, one embryo was transferred into Lacey. "I remember Zaraq saying, 'This is the one that is going to be your baby," Lacey says. "He was always super optimistic. Both he and Dr. Stewart were really good to work with. "
Fourteen days after the embryo transfer, Lacey took a home pregnancy test. "My husband and I couldn't decide who got to look at the pregnancy test first, so I peed on two sticks and gave him one to look at. We counted down and looked at the same time. They both said pregnant."
At Lacey's first ultrasound a month later, the baby's heartbeat was strong and easy to find. "They told us we were due on the Fourth of July," she says. "Obviously, we were just stoked."
Lacey held on tight to that emotion through her pregnancy, the first two-thirds of which required IV infusion therapy to manage relentless nausea, daily vomiting and extreme dehydration. "Christmas morning, I was in getting fluids. New Year's morning, I was in getting fluids. It was rough, but (the infusions) were a game-changer," Lacey says.
"People tell you what a miracle having a kid is, and it's just amazing how your heart triples in size the day they're born."Lacey Berning
Lacey's extreme nausea subsided in her third trimester, and she gained back seven pounds. In the days leading up to July 4, Lacey felt great. "The third of July, I felt so good. I was like, 'There is no way this baby is coming tomorrow."
At 5 a.m. the next day, Lacey woke up having contractions. Throughout the day, she kept herself busy while the contractions went from seven minutes apart to two, which is the point at which she was directed to go Mayo Clinic Hospital — Rochester, Methodist Campus. Lacey's labor slowly progressed until early the morning of July 5, when she was finally ready to begin pushing. After just 15 minutes of hard labor, Brielle entered the world.
"People tell you what a miracle having a kid is, and it's just amazing how your heart triples in size the day they're born," Lacey says. "I knew I would love my kid, but you don't realize how much."
Their child, Lacey says, is the light of her family's life. "She is this little girl who is so spoiled and loved. There's just something special about having a little girl. All her little boy cousins think she's just the bees' knees."
Although the couple has two more embryos frozen and will consider trying for a second child in the future, simply having their daughter is a gift. "In a perfect world, we would love to have one more," Lacey says. "But I know that if it doesn't work out, I'm totally satisfied with our little miracle. I feel lucky to have Brielle."