But there’s another option that can help a woman with an incompetent cervix carry her own children. Two years ago, Brigham and Women’s Hospital opened a Pre-Term Birth Clinic, one of the first of its kind in New England. The clinic refers patients to Dr. Jon Einarsson, director of the hospital’s Division of Minimally Invasive Gynecologic Surgery, who has been working on a procedure that seems to hold promise: laparoscopic abdominal cerclage.
A vaginal form of cerclage, which involves sewing a stitch around the cervix in the early stages of pregnancy to keep the uterus closed, has been around for decades. Doctors have a success rate of 85 percent with it, according to the American Pregnancy Association, but the procedure just isn’t enough for couples like us.
Enter Einarsson, whom Jill and I met with not long ago. His procedure, usually done before conception, involves keeping the uterus closed by stitching higher up on the cervix, where it is stronger. And since it’s done laparoscopically, there’s a faster recovery than with traditional abdominal cerclages, which is comparable to a caesarean section in recovery time. Often women can go back to their daily lives within a week, rather than a month or more. And having the procedure usually means a woman can be spared spending extended periods in bed under observation, the way Jill did. “The goal here is to free women from that confinement,” Einarsson says, “and to free families from the worry that comes from not knowing how their lives will change during pregnancy.”
Einarsson has performed the procedure on more than 50 women in recent years and about half of them delivered healthy children. That’s a far more impressive statistic than it might sound. For one, the surgery only helps pregnant women stay pregnant, and about half the women haven’t been able to conceive yet. “Out of the ones who’ve gotten pregnant, we have over a 90 percent success rate,” he says. And after all, Einarsson sees the toughest of the tough cases — it was not that long ago that many of his patients could not have delivered children at all. The few who could would likely have had to spend months in bed.
After the exam, Einarsson concluded that Jill was a good candidate for the procedure. But as with so much else connected with this issue, the two of us had mixed feelings. The fact remains that even with the most modern procedures and treatments, the kind you get in what is arguably the best medical city in the world, there are no guarantees for couples facing the most difficult fertility challenges.
So we’ve also begun looking into adoption. It’s expensive — $25,000 or more, we’ve been told — but at least Jill’s health wouldn’t be threatened, and we wouldn’t feel responsible for a surrogate’s health. Besides, when we were struggling to keep Max, we made a promise to whomever was listening that at some point we’d try to adopt a child who needed parents.
Whether we go a medical route or the adoption one, it’s comforting to have options. I think I might be able to handle hearing “I want another child” again; I just hope I don’t have to hear it at 3 a.m. too often.