(From left) Tyler (6), Bryan, Griffin (3), Ann Mason (16 months) and Megan Adams; Ezra Gray (10 months), Holly and Rachel Gray Lee; Mark, David (4) and Kathy Crowder.
When a couple decides they’re ready to expand their family, they expect to get pregnant relatively quickly and easily, and they start making plans. They may begin telling friends about their anticipated delivery date, designing a nursery and filling their home with colorful light-up toys and fluffy stuffed animals.
But for one in eight couples, the plan doesn’t work out so smoothly.
Caitlin Kirby, a licensed clinical social worker in Daphne, and her husband were one of those couples.
In 2016, they started trying to get pregnant, but months went by and nothing happened. Caitlin, 30, tracked her ovulation and synched up their intercourse to match, but still, nothing worked. So they went in for fertility tests and hers came back normal, while her husband, 46, showed surprise abnormalities. He underwent surgery, but his urologist said there wasn’t much improvement.
“He basically said, you are never going to get pregnant ever, don’t even try,” Caitlin recalled. “That was the worst experience of our lives.”
Caitlin turned to her gynecologist in 2018, who suggested they meet with the fertility specialists at Mobile’s Center for Reproductive Medicine (CRM). Caitlin was skeptical and considered traveling to a larger city like Birmingham or Atlanta for treatment instead.
“There’s not many options in South Alabama,” she said. “We were at such a devastated point and I just thought somewhere else would be better. But I didn’t know how specialized or how advanced someone in Mobile could be until our first appointment with [CRM].
“They said, ‘We can help you.’ And we didn’t think about anywhere else ever again.”
The Center for Reproductive Medicine, located on the Mobile Infirmary campus, is one of the largest fertility clinics on the Gulf Coast, with secondary locations in Pensacola, Fla., and D’Iberville, Miss. CRM has contributed to the birth of more than 7,000 babies since its founding in 1993, offering fertility and genetic treatments for women and men ranging from basic ovulation induction to invasive In Vitro Fertilization (IVF).
Specialized fertility clinics are rare in this region — only seven medical centers in Alabama offer assisted reproductive technology (ART) — and CRM’s success rate for IVF is even more unheard of: In 2017, the last year final statistics were available, CRM’s success rate for live birth with IVF was 82.6 percent for new patients under 35 and 71.4 for new patients 35-37. According to the Society for Assisted Reproductive Technology (SART), which publishes ART data, the national success rate for live births with IVF in 2017 was 68.5 percent for new patients under 35 and 56.9 percent for new patients 35-37.
“IVF success rates continue to improve as we learn more about culturing and selecting the best embryos to transfer,” CRM’s founder and medical director, Dr. George T. Koulianos, said. “We’re very fortunate to have the best infrastructure in the state. Outstanding outcomes and SART is a reflection of that. Our investment in technology, infrastructure and people allows us to offer patients the best science, medicine and care in our region.”
The Infirmary Foundation helps fund the center, which has allowed CRM to purchase advanced technology and receive training in cutting-edge techniques, which increase the chances of fertilization and survival rates of embryos. Those include time-lapse incubators, “floating” lab tables that are impenetrable to vibrations (like those from hurricane-force winds), and an air sterilization system that filters out COVID-19, which “no one else has” in the state.
And being in the hospital means CRM is protected by the facility’s sturdy infrastructure and backup generators, which, even during disasters, can keep the clinic running smoothly and secure its embryos, some of which have remained in frozen storage there since the 1990s.
“We can do things that other programs can’t do,” Koulianos said. “Like the morning that Hurricane Ivan hit, the morning that Hurricane Katrina hit, the morning that Hurricane Sally hit, we were still doing egg retrievals.”
Dr. K, as he is known at the center, is joined at CRM by physician and partner Dr. George B. Inge, who specializes in LGBTQ patients, reproductive endocrinologist Dr. Adelina Emmi, and a team of healthcare professions and lab technicians, including an onsite lab director. They see a thousand new patients every year.
When the Kirbys started their treatment at CRM, they opted for a round of more affordable intrauterine insemination (IUI), which involves placing sperm inside the uterus to facilitate fertilization. That didn’t work, so Caitlin underwent more tests and discovered she had stage three endometriosis, a painful condition in which the uterus lining grows outward. She had surgery to remove a lot of the endometriosis tissue and they moved forward with IVF in the summer of 2020, a procedure that cost them tens of thousands of dollars out of pocket.
“At that point, we both had such significant underlying medical conditions, and we didn’t want to waste money on any more IUI,” Caitlin said. “We had some long discussions and Dr. Inge had great advice. We just knew that anything less than IVF was not going to get us pregnant.”
IVF, which Caitlin described as “overwhelming,” involved nearly daily trips to CRM, doing blood work and receiving injections before she could have her egg retrieval. The procedure resulted in nine eggs, which were then fertilized in the lab to create embryos. Two embryos survived and were frozen for storage.
Caitlin continued hormone treatments and monitoring and six weeks later, one of their embryos from the lab was transferred into her uterus. Then she had to wait to see if it successfully implanted itself in her uterus. While waiting, she tested positive for COVID-19, so she couldn’t return to the clinic for her scheduled blood work. She took some pregnancy tests at home and the result — which was later confirmed in the lab — was a big, fat positive.
“I was in disbelief,” Caitlin said. “My husband became incredibly emotional, and we were just thrilled. This embryo has been through a heck of a lot with IVF and COVID — I knew it was sticking around.”
After further hormone treatments, monitoring and ultrasounds, CRM was able to pass her back to her gynecologist. Caitlin is now seven months pregnant with a boy and, inspired by her own experience, has become an infertility support coach to support others going through the same thing.
“This infertility journey is so draining and difficult, physically, emotionally; it really tests everything about you,” she said. “When you get that negative pregnancy test over and over again, you start wondering, what’s wrong with me? For men, it’s a blow to the ego. There’s so much shame associated with it. It’s not something you thought would ever happen to you.
“Your grief starts the moment you realize this is going to be difficult, that you’re not going to be able to have the family you want and the timeline you want it on. Then you’re having to make financial decisions and go through hormone treatments, which can make you even more emotional. The anxiety, stress, fear of the unknown just skyrocket,” she said.
Perhaps even more frustrating, while 40 percent of infertility cases can be attributed to the man, 40 percent to the woman and 10 percent to a combination of the two, 10 percent of infertility cases are never solved. A cause is never found. As much as doctors can accomplish in the lab, there’s still much about fertility that remains a complete mystery.
Dr. K is a man of faith. His office is filled with Christian symbols and texts: crosses, prayers, angels. He can talk just as much about religious iconography as he can about embryo cryopreservation. In fact, his Greek Orthodox faith was one of the reasons he originally came to Mobile.
After graduating from the University of Texas Medical School at Houston, the Houston native did his residency in obstetrics and gynecology at Texas Tech Regional Academic Center in Amarillo. Then he took a fellowship in reproductive endocrinology and infertility at Tulane Medical School. It was a brand-new field at the time; the first IVF baby was born in 1977.
While at Tulane, his division chief asked Dr. K to follow him to the University of South Alabama (USA).
“I had independent funding, so I could have gone elsewhere,” Dr. K said. “But my boss wanted me to come and my godparents told me how lovely the Greek community was in Mobile. So I figured, OK, I’m going to check it out.”
He moved in 1990 and while he had visions of moving back to Houston to be near his family, Mobile grew on him. In 1993 he completed his fellowship and left USA for Mobile Infirmary, where he launched his own program.
“It started from scratch, and I made it what I wanted it to be,” he said. “We’ve been very fortunate. We have a hospital that supports reproductive medicine. They recognized the value. If I went somewhere else, I couldn’t control my quality. And that’s what matters to me more than anything.”
For example, if a patient at the Infirmary is diagnosed with cancer and is facing chemotherapy treatment that could make her infertile, the foundation will subsidize her egg banking. That drastically reduces the cost of the procedure from roughly $10,000 to $2,500, making the life-preserving operation much more affordable.
“We are here to serve our community,” Dr. K said one morning after a marathon session of six surgeries. “That’s really the bottom line. The community trusts us to put their interests before our own and that’s what we try to do.
“Whoever we’re competing against, we’re going to out nice them, we’re going to outwork them, we’re going to out science them. Because it’s not about how much money you make. When you go to sleep at night, you want to be able to look at yourself in the mirror and say, did I give the person who trusts me my absolute best?”
Megan Adams, who turned to CRM in 2014 after two years of struggling to get pregnant, remembers Dr. K praying with her before an IUI procedure.
“It was so comforting to not just be another patient to him,” she said. “It was almost like he wanted it just as much as you did.”
The gesture was especially touching to Megan, who was in her mid-20s at the time and had faced criticism from people in her life for seeking treatment. “If it’s in God’s plan for you to have children, then he wouldn’t have placed infertility in your life,” she recalled some people saying. It weighed on her, but after four rounds of IUI, she and her husband, Bryan, became pregnant with a girl who they named Tyler.
“They [the staff] do not make you feel like any obstacle is too much for them to handle,” she said. “They honestly became family. I’m super thankful for them.”
Four years later, the couple returned to CRM and conceived a boy, Griffin. A few months after he was born, as if by miracle, Megan said, she became pregnant for the third time on her own, without treatments. They named the baby Ann Mason.
A similar phenomenon happened to Kara Dearman, a Washington County math teacher who got pregnant in October 2019 thanks to an ovulation induction procedure at CRM. Kara had struggled with PCOS, or the hormone condition polycystic ovary syndrome, since she was in the eighth grade, so medical intervention was the only way she and her husband could conceive — or so she thought.
After her son was born, her gynecologist asked if she wanted to be on birth control. She scoffed at the idea; she had only had two natural menstrual cycles her entire life. A few weeks later though, somehow, she was pregnant again.
“I’m 24. I’m about to have two babies under the age of two. I’m done for now,” she said, laughing.
For others, the process can seem less fantastical.
Kathy Crowder, who commuted from Dothan for treatments when she was in her early 30s, went through four rounds of IUI. From start to finish, the process took five years.
“We didn’t have endless funds,” she said. Each round of IUI, which is not covered by insurance, costs hundreds of dollars, plus nearly a thousand dollars for the medication. And due to the time-sensitive nature of the procedure, the funds can often be needed at the spur of the moment.
“[We hadn’t saved for it] because we didn’t even realize [infertility] would be an issue. The tricky thing was, they’d call us up and say, you need this much medication and you need it by tomorrow. So, to be honest with you, there’d be times I’d have to put in on my credit card to be able to afford to do it.
“I remember praying so hard before that last week, like God, please let this work, because if it doesn’t, I don’t know what we’re going to do.”
Her prayers worked; the fourth round of IUI stuck. Her husband, Mark, joked that he wouldn’t believe she was actually pregnant until the baby came out.
“I had the most ideal pregnancy and childbirth,” she said. “God gave me those five years of struggle and then He cut me a break. He gives you what he knows you need.”
The couple now has a healthy 4-year-old, David, who Kathy said is so full of personality, “you can tell he knows he was wanted. He’s our miracle baby.”
In 2017, 1.7 percent of all infants born in the U.S., around 78,000, were conceived using APT, according to the Centers for Disease Control and Prevention. In Northern Europe, that number is 3.6 percent. While IVF still has its critics — such as the Catholic church — its acceptance is increasing as the procedure gets more successful and the need for IVF expands as couples delay childbirth until later in life.
“People are realizing that it’s not some evil demon,” Dr. K said. “There’s like 8 million babies born worldwide from IVF. It’s not an experiment anymore at all.”
For Holly Gray Lee and her wife, Rachel, however, fertility was always going to be a bit of an experiment.
“We’re a lesbian couple, so obviously, getting pregnant was not something that I was going to be able to do at home,” Holly said.
The 31-year-old started with CRM in May 2019 at the recommendation of her gynecologist. The couple did a lot of research online and consulted with other women in fertility Facebook groups before selecting sperm from a cryobank, having it shipped to CRM and going through the necessary hormone treatments and monitoring to prepare Holly for IUI.
“I loved everything about our journey,” she said. “Everybody [in the office] was rooting for us.”
Holly got pregnant after her first round of treatment, which shocked the couple. They now have a 10-month-old baby girl named Ezra Gray and plan on using CRM and the same sperm donor to conceive another child, Ezra Gray’s full biological sibling, in the future.
“I don’t know what I ever did before her,” Holly said. “I feel like I was always meant to be a mother. I was just waiting for my baby.”
Having children, Dr. K said, gives life meaning. He recommends having as many kids as you can afford. He and his wife have one biological son and one daughter, who they adopted from Russia after facing fertility issues of their own.
“Life is short and although it’s a lot of work and they’re not cheap, as you get older, you realize just what great joy parenthood is,” he said. He receives hundreds of Christmas photos and high school and college graduation announcements a year from the boys and girls he calls “my babies.” He even works with a woman who he first met as an embryo.
Caitlin Kirby, whose second embryo is currently frozen in liquid nitrogen at CRM, is going to wait until after her baby is born to decide what to do with their final embryo then. While she hopes to implant it in the future, her endometriosis is expected to return and she may need a hysterectomy by the time she’s 40.
“You know, you start your life thinking, I want two, I want one, I want three kids. I don’t get to make that decision anymore,” she said. “I’m incredibly lucky that IVF worked. We’re excited to have one more [chance], because some people don’t even get one.”
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