No More Miracles as D-H Ends Infertility Program

  • While dinner is cooking Kya, left, and Trisha White relax on the couch at their home in Ascutney on May 11, 2017. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Aiden Bushway-White plays Skipbow with his parents Kya, center, and Trisha White at their home in Ascutney, Vt., on May 11, 2017. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Trisha and Kya White walk to their car after picking up their son Aiden Bushway-White from his afterschool program at Weathersfield School in Ascutney, Vt., on May 11, 2017. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Kya White plays basketball with her son Aiden Bushway-White at their home in Ascutney, Vt., on May 11, 2017. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Wearing Easter Bunny ears, Saoirse, 3, is buckled up by her mother Stacy Dion, of Tunbridge, Vt., after being picked up from daycare in White River Junction, Vt., on May 12, 2017. Dion was a patient at Dartmouth-Hitchcock’s Reproductive Endocrinology and Infertility program. “Without Dartmouth, I would not have had her,” Dion said of her daughter. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Stacy Dion, of Tunbridge, Vt., picks up her daughter Saoirse, 3, from daycare in White River Junction, Vt., on May 12, 2017. Dion was a patient at Dartmouth-Hitchcock’s Reproductive Endocrinology and Infertility program, which is scheduled to close on May 31. “This is tragic," she said. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Saturday, May 13, 2017

Lebanon — Like many parents in the Upper Valley, Stacy Dion and her husband celebrated the birth of a child at Dartmouth-Hitchcock Medical Center.

But their daughter Saoirse’s arrival in 2013 was particularly welcome because of the difficulty her parents had had in conceiving her.

“It took me a long time to get pregnant,” Dion, a Tunbridge resident, said in a telephone interview last week.

Dion, an Army veteran who works at the White River Junction VA Medical Center, and her husband, a Marine veteran, first began trying to get pregnant when Dion was 32. She was 37 by the time Saoirse, now 3, was born.

Though it was a long road, Dion credits their success to the care and support they received through Dartmouth-Hitchcock’s Reproductive Endocrinology and Infertility program.

“Without Dartmouth, I would not have had her,” Dion said of her daughter.

That sentiment was echoed last week by several mothers who had children — or are now trying to do so — through the infertility program and are hoping to persuade D-H to keep it open, to the point that they were willing to talk publicly about what many regard as a very private matter.

Earlier this month, D-H began informing patients of the plan to close its infertility program on May 31. The news saddened many across the Upper Valley. Some families, like Dion’s, credit D-H with helping them to grow their families, sometimes after many years of struggling to get pregnant and to carry a child to term.

The four physicians, including one per diem, currently employed to provide this care by D-H will no longer be employed by the hospital system after this month, and there are no plans to restart the program after it closes, D-H spokesman Rick Adams said in an email last week.

But, in a telephone interview on Thursday, D-H’s chief clinical officer, Dr. Edward J. Merrens, said reopening the clinic in the future isn’t completely off the table.

“We always have to kind of figure out what we can and can’t do,” he said.

Merrens drew a parallel between this decision and a previous choice not to offer liver transplants because D-H officials determined they did not have sufficient resources to do so. D-H providers do perform kidney transplants, he said.

“These are issues that we face at DHMC all the time,” Merrens said.

Merrens said D-H struggled to find the right “mixture” of staff to cover the infertility clinic seven days a week. That included nurses and coordinators for the program. It wasn’t just a matter of recruitment, he said.

D-H simply “didn’t have the team” necessary to continue the program, he said.

Despite the closure, Merrens said, D-H’s gynecologists will still provide some services for women struggling with reproductive endocrinology issues such as polycystic ovary syndrome, a condition that can affect hormone levels, periods and ovulation. It is infertility treatments such as in vitro fertilization — a procedure in which an egg that has been fertilized in a test tube is inserted into a woman’s body — that will no longer be available, he said.

The D-H program closure is systemwide and affects D-H’s Lebanon location, as well as New Hampshire locations in Bedford, Concord and Nashua and another in Brattleboro, Vt.

D-H’s laboratory, where patient samples — embryos and semen — are stored, will remain open. D-H officials realize patients are counting on these samples and may need them if they find another program, Merrens said. D-H staff, he said, are working to refer infertility patients to other providers.

“We’ve tried to reach out and make those connections for people,” he said.

Though patient samples are safe, Dion said she worries that others struggling with fertility issues will not have access to the care they need.

“It almost brings me to tears that someone else is going to be denied the happiness that I’ve gotten,” Dion said.

Left at a ‘Standstill’

Among the 124 patients scrambling to find care are Trisha and Kya White.

The Ascutney couple have an 8-year-old son, Aiden Bushway-White, but this would be the first child born since the two women got together. They began dating two years ago and were married at their home in January.

As they were exploring ways of growing their family, they considered adoption or foster care, but instead decided to move ahead with in vitro fertilization.

“We want to go through the process of pregnancy together and experience every part of it as a married couple together,” Kya White, 23, said in an email last week. “I want to watch my wife grow our child, and she wants to do the same.”

Their efforts to have children together led them to Dartmouth-Hitchcock about a year ago. They purchased semen two months ago and had an appointment in Lebanon last week. They had hoped that appointment would include in vitro fertilization for Trisha, who is 28, but it was delayed.

The following day, the Whites got a call informing them that D-H would be closing its Reproductive Endocrinology and Infertility program, and they would need to seek care elsewhere.

“It’s very, very upsetting for us just starting our journey,” Kya White said in a telephone interview on Wednesday. The situation “leaves us at a standstill of what should we do? Where else can we go?”

Infertility programs that offer the same range of services are in places such as Burlington and Colchester, Vt.; Exeter, N.H., and Boston and Springfield, Mass. — all at least a 90-minute drive from Lebanon.

In addition to in vitro fertilization, other services provided at D-H’s infertility clinic include reproductive surgeries to correct abnormalities; donor eggs; embryo freezing and frozen egg transfer; and intrauterine insemination, the placement of sperm inside the uterus.

Brattleboro Memorial Hospital, which was collaborating with D-H to provide infertility services, has one physician, Dr. Judith McBean, who provides some infertility treatments, including intrauterine insemination; minimally invasive surgery; evaluation and treatment of polycystic ovaries and abnormal bleeding; and menopause care, said Gina Pattison, the hospital’s director of development and marketing.

The Brattleboro hospital is seeking alternative ways to provide other treatments, such as in vitro fertilization, said Pattison.

In the wake of D-H’s announcement, the Brattleboro hospital is “receiving an increase in calls from upset and disappointed patients,” said Pattison.

Time, Money and Other Challenges

Having to travel farther for infertility care may deter women from having children, Dion said. Some weeks, Dion said, she needed to go to three appointments for two hours each. Adding a drive of an hour and a half each way would quickly exhaust the sick leave she used to attend her appointments, she said. That extra time might discourage her from growing her family in the future.

“I would not be able to successfully do it because of time,” she said.

The time spent away from work to go to appointments is just one of the challenges women face when going through infertility treatments.

Cost is also an issue. Dion, whose fertility was affected by an injury during her time serving in the military police, said her insurance covered most of her fertility treatments.

But, she said, “I’m lucky.”

She’s aware that other families are scraping money together to pay for treatments. The Whites, for example, are paying out of pocket.

Some insurers cover the treatments, but others do not. Infertility treatments are not among the essential health benefits insurance companies are required to cover under the Affordable Care Act.

A round of IVF costs about $8,000, including ultrasounds and labs, egg harvest and fertilization, and embryo placement, according to a 2010 estimate on D-H’s website.

Dion drew a connection between D-H’s closure of the infertility clinic and national discussions to limit insurance coverage of pre-existing conditions such as pregnancy.

“I’m concerned that women’s health care is kind of on the chopping block,” she said. “Women should not have to drive an hour and half each direction for health care. … If Dartmouth is going to hold itself up to being a world-class hospital, it has to continue to offer these services.”

‘You Will Have a Baby’

The type of Infertility care offered at Dartmouth-Hitchcock drew at least one couple from overseas. Susan Uthmann and her husband, Mike, moved from Susan’s native Scotland to Mike’s native U.S., at least in part to have easier access to drugs used to treat polycystic ovary syndrome, Susan said in a telephone interview last week. She also has arthritis, which affected her fertility, she said.

They landed in the central Vermont community of Websterville after a job search. Both worked in child care for a time and now Mike works for the nonprofit Washington County Mental Health Services.

The couple gathered information about both fostering and adoption, something Susan said she was interested in before they had trouble conceiving. But they were deterred by the cost of adoption, which at the time was in the tens of thousands of dollars, she said.

“When we investigated it we realized just how expensive it was, and we did not have anywhere close to the financial means to adopt,” she said. The Uthmanns decided not to become foster parents because the main goal is reunification of foster children with their birth families, Uthmann said.

“I knew that I would be devastated when the child I loved may go back into a situation that wouldn’t be healthy,” she said.

Initially, the couple was able to conceive a baby on their own without treatment, but that pregnancy ended in a miscarriage, followed by two more.

The Uthmanns learned of their third loss during an ultrasound at DHMC. They didn’t see any movement on the screen. The technician confirmed their fears; she didn’t see a heartbeat.

In a moment of her “rawest, deepest despair,” Susan Uthmann said she was ready to give up trying to have a child.

She asked Dr. Paul D. Manganiello, a long-time D-H physician who retired five years ago, “How many people, honestly, after having three miscarriages, go on to have a healthy pregnancy?”

“He looked at us both and said, ‘You will have a baby,’ ” Uthmann recalled.

He was right. After finding the right combination of drugs, which helped to regulate her menstrual cycle and helped her to ovulate, Uthmann gave birth to her first daughter, Thia, in October 2009, less than two weeks after the couple celebrated their 10th wedding anniversary.

“I just couldn’t speak more highly of the nurses and the doctors and everybody at Dartmouth,” said Uthmann, who subsequently has had two more daughters without any drug treatment. “It’s such a difficult thing to go through. (It’s) so wonderful to have such a great place to walk that path.”

Mourning the Closing

While the University of Vermont Medical Center in Burlington, which also offers infertility care, is about 15 minutes closer than DHMC to the Uthmanns’ home in a village of Barre, Vt., Uthmann has told other women experiencing fertility issues that it’s worth the drive.

“It’s so sad to me that that’s going to be gone,” she said.

The quality of the care at DHMC was also worth the drive for Kim Ashley, who drove an hour and a half to receive treatment in Lebanon more than two decades ago.

“If you have a real problem, that’s where you want to go,” said Ashley, who lived in southern New Hampshire at the time and now lives in East Charleston in Vermont’s Northeast Kingdom.

She and her husband, Steven Thomas Westgate, who has since died of lung cancer, were married for six years before they visited D-H’s infertility clinic. Westgate had two children from a previous relationship who lived with them, but the couple wanted a child of their own.

“I provided all their care and loved them deeply but you can’t imagine how hurtful it was to see how excited they got when they heard from their mother,” said Ashley in an email. “She would go years without contacting them but they still loved her. I wanted a child to love me like that.”

Ashley suffered a tubal pregnancy before she became pregnant with her son, Steven Thomas Westgate Jr., who is now 25. Though doctors were able to repair the tube, the loss “knocked me back,” she said.

She was encouraged by the D-H staff, one of whom told her, “We see a lot of miracles here,” she said.

Her second pregnancy resulted in her son. Westgate is now 6-foot-3, and a psychology major at Johnson State College in Vermont. He snowboards and enjoys playing football and soccer.

“I can’t imagine my life without him,” said Ashley. “My heart goes out to the women who aren’t successful.”

Sunapee resident Jessica Snider also said the staff at D-H’s fertility center were supportive during the three years it took her to become pregnant with her daughter, Elizabeth.

“They made us feel like every question was important to them,” she said.

The infertility treatments and Snider’s high-risk pregnancy, achieved when she was 37, were both emotionally and physically draining, she said. D-H staff laughed and cried with Snider and her husband, she said.

“They rejoiced with us when we got pregnant,” she said.

Snider said the quality care continued throughout her pregnancy and Elizabeth’s birth. Snider developed pre-eclampsia, a potentially dangerous complication characterized by high blood pressure, and Elizabeth was born on Christmas Eve, about a month ahead of schedule.

“She was the best Christmas present ever,” Snider said.

Like the other women who benefited from D-H’s infertility center over the years, Snider said she mourns its closing.

“I feel badly for the patients who are going through this process right now,” she said.

Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.