30-year-old entrepreneur, writer, and community builder Natalie Franke underwent brain surgery to remove a pituitary tumor at age 27 so she and her husband could start their journey toward pregnancy. By giving up control and redefining the concepts of success and family, Natalie embraced fertility treatments and an unexpected path to parenthood. Now trying to conceive her second child, Natalie’s recent treatment rounds have not yet been successful. Here, she reflects on her first fertility journey.
I’d always envisioned myself starting a family. But when my husband and I got engaged, I realized that I was 22 years old and I’d never had regular cycles. While I had discussed the fact that I only got my period once or twice a year with a doctor in my teens, he told me there was nothing to worry about. I thought to myself: If I barely get periods, will I be able to get pregnant?
I made an appointment to see an OB-GYN because I assumed I’d need some kind of medical help to conceive. The doctor ordered a blood work panel that revealed my estrogen and prolactin levels were “through the roof,” and she suggested the hormonal imbalance was likely related to my ovaries. When a transvaginal ultrasound showed my ovaries were normal, she said there was only one other place to look: my brain. So, on the day I’d originally planned to take my engagement photos, I got a brain MRI instead.
“You have a pituitary tumor”
Once the MRI ended, the radiologist asked me, my mom, and my fiance to join him in another room. “This is a scan of a normal brain,” he said, showing me an image of a brain and pointing to its tiny pituitary gland on the screen. “This is yours,” he said, pointing to my MRI scan and the big white circle where my pituitary gland is located. “You have a pituitary tumor.” I’d later find out that the mass was a benign tumor and a cyst, and both made it so that my hypothalamus and pituitary gland were not communicating — a necessary step for normal hormone production. A reproductive endocrinologist then diagnosed me with hypothalamic amenorrhea (translation: when menstruation is interrupted due to a problem in the hypothalamus). My fears about likely needing some type of fertility treatment to get pregnant were confirmed.
After the appointment, I grieved for what I had long imagined pregnancy would be like. I’d been led to believe from a young age that I was entitled to a pregnancy and family on my own terms. As I prepared for the possibility of brain surgery, medication, and fertility treatments, I tried to redefine my identity as a woman and rethink what family means. My husband and I were high school sweethearts. I asked him, “Do you really want to marry someone who might not be able to give you biological kids?” He was in disbelief that I’d even asked. My fertility struggles didn’t alter my worth in his eyes, but I struggled to truly feel the same way.
My medical team initially recommended I wait and see how my condition changed before pursuing a drastic option like brain surgery. But in 2016, after a few years of being married and unsuccessfully trying to conceive on our own, I learned from my reproductive endocrinologist that I couldn’t safely pursue fertility treatments without first getting the tumor removed. I decided to pursue brain surgery — this was right around the time that Rising Tide Society (the company I co-founded) was acquired, I moved to San Francisco, and joined HoneyBook as their Head of Community.
Getting brain surgery at age 27
After moving to San Francisco, I connected with the UCSF Reproductive Center and UCSF neurosurgery department to get examined by a reproductive endocrinologist, neuroendocrinologist, and neurosurgeon. They said I was an excellent candidate for brain surgery, and three weeks later, at age 27, I had an operation to remove the pituitary tumor.
After surgery, I experienced complications that could have potentially delayed fertility treatment. I’d developed low cortisol levels and diabetes insipidus, which results in an imbalance of fluids. I was told by doctors at the reproductive center that we could begin treatment in six months if my cortisol levels had increased and if I had recovered from diabetes insipidus. Six months and one day after the date of my operation, I returned to UCSF for my follow-up — I wasted no time. A lot of people are afraid or unhappy to start fertility treatment, and it seemed that I was the one person in the world who couldn’t wait for it. When the doctors said I was in the clear, I celebrated being healthy enough to begin medications for ovulation induction.
The frustrations of fertility treatments
I admittedly stopped celebrating when I realized that the success of fertility treatments is something I can’t control. I’m an overachiever in every aspect of my life and career, yet there is nothing I can do to improve how my body responds to fertility medications. When I first took high doses of Clomid to induce ovulation, my estrogen levels didn’t change at all and I didn’t get a single mature follicle. We tried again with higher doses and got the same result — the doctor said it was like my brain wouldn’t even register the medication. I felt like a failure. She suggested injecting the hormones instead of relying on pills. The only goal, she said, was to see if I could produce an egg. Because of my husband’s high sperm count, she was not yet recommending intrauterine insemination (IUI) or in-vitro fertilization (IVF) treatments to help me conceive. All we needed was that egg.
We started off with one vial of Menopur injections, but with no signs of ovulation yet again, we quickly approached three vials per day. My doctor was honest and shared that, once you reach three vials, it may be time to start considering IVF. I mentally prepared for my treatment cycle of medications to be canceled at my next appointment, and to be told it was time to start exploring IVF. Instead — seemingly out of nowhere — the nurse practitioner discovered my ovaries had produced three eggs and my estrogen levels had finally increased. That’s how we got pregnant with one healthy baby, our son, who is 20 months old (at time of publication).
The joys (and struggles) of pregnancy
I was at my office when I experienced what I thought could be my first symptom of pregnancy — a heightened sense of smell. During my lunch break, I rushed to a nearby pharmacy to pick up a test a few days before my beta and took it in the bathroom: I was pregnant! I sobbed on the floor, feeling joy like never before and, simultaneously, a deep, unexpected sadness. I was struck by a sudden onset of new anxieties that I’d never even had the “privilege” of worrying about — like fears of miscarriage. In some ways, I’d been naive to complications that can accompany pregnancy because I hadn’t been able to dream beyond the positive pregnancy test. Then I thought of all the people I’d met online who were on their own fertility journeys, still waiting for their positive results. Others may refer to fertility treatment as a club that no one wants to be in, but you couldn’t be in a club with better, more supportive people. I was so excited for the future, but I immediately felt like I was leaving behind the community that had carried me.
As I wrestled with my anxieties in the early stages of pregnancy, my husband helped me move forward despite my fears and doubts. After our son arrived, he would share with me that, during treatment, he’d already accepted that the medications may not work. While I was emotionally drained by every up and down of the fertility process, he was calm — already believing that we’d have our family no matter what, even if the route changed. His presence, as well as the support of colleagues and friends, continued to calm me throughout a difficult pregnancy.
Around my eighth week, I worried that I’d miscarried after experiencing a subchorionic hemorrhage. I recovered, but my complications continued into the third trimester when my blood pressure increased and I developed preeclampsia. While visiting the doctor at 36 weeks pregnant for what was supposed to only be an appointment, I learned my blood pressure had gotten too high — I suddenly found myself in the labor and delivery wing, getting induced a month early.
My birth experience wasn’t what I expected, yet it was the most empowering moment of my life. I’d always believed the narrative that childbirth would be a painful, isolating experience. But the reality is that I was surrounded by family who loved me and a medical team that encouraged me and listened to me. I’ve never felt stronger.
On the moment I became a parent
Looking back, I remember crying to my mom when I hadn’t developed a single follicle after treatment, and she replied something to the effect of, “Welcome to parenthood.” She reminded me that I can’t control anything as a parent, and that I was unfortunately learning that lesson early on. This loss of control — and my resolve to keep trying anyway — felt like my initiation into parenthood. I believe I became a mother the minute I decided I was going to do everything I could to become one. I wish I could tell my past self, “You may not have a baby in your arms yet, but you are part of this club because you have opened your heart to a child.”
My husband and I talk about how we’ll explain my pregnancy to our son. We want him to know how he got here, that there is no one way to have a family. If he wants children one day but needs help bringing them into his life, he will know that’s nothing to be ashamed of. I will teach him that needing help doesn’t make him — or anyone — a failure. When I learned that lesson on my fertility journey, it disrupted my entire sense of self in the best, most transformative way.
On having another kid
This past spring, we restarted fertility treatment using the same Menopur injectable cycle protocols we used two years ago to conceive. Unfortunately, my FSH levels are higher now, so it’s been more difficult this time around.
After three failed injectable rounds (in June, August, and October 2020), my husband and I have made the difficult decision to take a break from fertility treatment for a while. We are hopeful that next year and a potential change in treatment protocols will bring us another miracle.
Fertility could be top of mind or on the back burner for now — but it has the power to impact everything. We’re sharing your stories to both celebrate and create space for the many ways we navigate our careers, relationships, and finances in relation to our reproductive health. If you have a story to share, get in touch.