elfrink day 1

LEOPOLD, Mo. -- Kenny Elfrink is a man's man. n He fixes cars for a living. He farms for fun. He pitches in the "Fat Boy League," a three-team, co-ed softball outfit he helped organize. He considers deer season a sacred holiday. He's a perpetual teaser, a good ol' country boy from the friendly, one-street Catholic town of Leopold, Mo.

Had the circumstances been different, Barb Elfrink might have laughed when her burly, whimsical husband walked into the bedroom that fall 2001 morning carrying a pregnancy test in his hand.

"When were you going to tell me?" he asked her.

"Oh, it was negative," she said. "I didn't want to ruin your day."

Kenny and Barb already had a 10-year-old son, Trent, but something seemed missing. At least in Barb's life. Kenny was content with Barb and Trent, but his wife wanted more children. The mother of one felt an emptiness. And with that came guilt. She knew there were many people, millions of them, who weren't able to have any children, and she felt terrible for them. And because of her own failures to have more children, Barb was that much more grateful for Trent.

A finger-walk through the Cape Girardeau phone book finds literally hundreds of Elfrinks, Eftinks, Vandevens and Horrells. The majority don't live in Leopold anymore, but most of them can find their roots or at least their relatives in this small Bollinger County village a short drive from Marble Hill.

At the time, Trent was the lone only child in his class at Leopold.

Leopold is an extended family. It holds one big party every year, the famous Leopold picnic, where everyone brings food, smiles and relatives to the shaded park near the church and school grounds to raise some money for the parish.

Along Route N, where the Elfrinks live, a prayer has been written one phrase at a time on white boards above fence posts. The folks in Leopold are as proud of their Catholic heritage as they are of their families.

With that heritage come values. Perhaps nothing in Leopold is valued more than life itself.

A purple pro-life banner has been attached to the left field fence of the town's Knights of Columbus baseball park. Yellow and black "Vote Pro-Life" signs are numerous during election season.

One of those pro-life signs adorned the Elfrinks' yard, too. Considering their history, perhaps that's no surprise.

By the time Kenny came walking into the bedroom that morning, Barb was emotionally exhausted, tormented about her inability to bear another Elfrink. The couple had been using fertility drugs off and on for more than six years.

Kenny and Barb were fortunate with Trent. He was conceived easily, shortly after the couple married. The pregnancy was fine, but the delivery in 1991 was difficult. After 18 hours of labor, the doctors took him by Caesarean section. He developed an infection after birth, and it scared Barb to the point where she brought in a priest for baptism just in case he didn't make it. Trent ended up being OK after a nine-day hospital stay.

About nine months later, Barb thought she was pregnant again, but it was a false alarm. Her body didn't act quite right at that time, and now she thinks that might have been the beginning of her problems.

Problem begins

Back in 1991, the Elfrinks lived in a trailer on the family farm in Leopold. Kenny was a mechanic, and Barb worked late shifts as a respiratory therapist. They didn't make much money, but they were at peace with their situation and, when Trent turned 3, Barb and Kenny decided they wanted to give him a sibling.

A year passed with no conception. Barb became frustrated and worried. She finally visited her doctor, Scot Pringle, in February 1997.

Barb told Pringle she didn't have normal menstrual cycles. So he ran some tests, including a blood sugar test, and diagnosed her with a condition called polycystic ovary syndrome. The diagnosis wasn't good news, but it wasn't horrible news, either.

PCOS is a non-fatal disease that gets worse over time, Pringle told her. The more advanced the disease, the more the body rejects fertility drugs. But PCOS is common, conservatively estimated to affect 5 percent to 10 percent of women. And it's manageable. The word "polycystic" means many cysts. When the eggs in ovaries do not develop to maturity, many small, fluid-filled sacs develop and can be seen on the ultrasound. Barb had a shot at having more children, but it was a long shot, especially considering how advanced the PCOS was in her body.

Pringle prescribed a popular oral fertility drug called Clomid.

The drug didn't work.

Frustrated, the Elfrinks went off the drug for several months.

Then they tried it again.

Still no luck. The couple grew accustomed to negative results, and Kenny became angry at the drugs and the doctors when they couldn't fix the problem. Kenny is a fixer. If the drugs weren't fixing the problem, there was no use enduring the emotional beatings. The drugs' ineffectiveness grated on him, but he was angry for his wife. More than anything, it hurt him to see Barb hurt, but his wife wanted to keep trying, and Kenny supported her.

In 2000, Pringle added a drug called Metformin to the mix. Metformin, typically used as a diabetic drug and a fairly new weapon against infertility, had been found to increase metabolism among women with PCOS.

The Metformin didn't help either. Still no regular cycles. Still no little Kennys on the way.

Barb didn't fully trust the PCOS diagnosis. She figured there was nothing wrong with her since she had given birth before. She turned her head away from the clear PCOS symptoms and blamed her problems on stress.

Two job lifestyle

Her two respiratory jobs -- one at a local hospital and the other as a traveling therapist -- were inhibiting her family life. She had to work evenings, weekends and holidays, which meant she missed quality time with her son and husband.

At the age of 25, she decided to go to college and fulfill a childhood dream of becoming a teacher.

Once she started going back to school, the family moved to Cape Girardeau to eliminate Barb's 40-minute commute from Leopold.

For the next five years, summer semesters included, Barb filled roles as respiratory therapist, mother, wife and student. Because of her crazy hours and enormous load, she and Kenny decided to go off the fertility drugs indefinitely. She stopped going to the doctor. They told themselves they weren't trying to have children, but Barb was playing mind games with herself. She was always told that pregnancies among infertile couples often happened when they least expected.

If she didn't expect it, a baby would come.

As busy as she was, she was never too busy to forget the incomplete feeling, the voice in the back of her mind.

Every year at family Christmas get-togethers or social activities, new babies appeared like Christmas trees. Every house seemed to have one, what with cute stockings, twinkling eyes all aglow. Good tidings of great joy could be found in baby cribs everywhere. Barb had plenty of babies to buy gifts for. But none of them was her own.

"When are you going to have another child?" one aunt would always ask.

"Well, I've already got two kids," Barb said, referring to Trent and her husband.

The next year, the same aunt asked the same question.

"Well, we'll see," Barb said.

Then the next year.

"Well, we're trying," she said.

At the age of 30, Barb graduated from college after the fall semester. The family moved back to Leopold so Trent could go to school at a smaller, rural school district.

Barb was immediately hired to teach fourth grade at Meadow Heights Elementary School in Patton, Mo., beginning after the Christmas break.

She finished the school year and, with her job secure, she could now rid her mind of much of the stress in her life. It was a good time to have a baby.

She went to Pringle again, and once more he put her on Clomid -- this time the maximum dose at $70 per month -- and Metformin. Pringle, like many times before, urged her to see a St. Louis specialist.

This time she agreed.

Experimental drug

As she was leaving the doctor's office that spring day in 2001, the receptionist called and made an appointment at a fertility clinic in St. Louis. Barb agreed to a time and day a couple of months later, then headed out the door.

By the time she reached her van, the incomplete voice that whispered inside her mind, the voice of denial that assured her that nothing was wrong and the voice of doubt that echoed for years that she might never have more children, became an overwhelming roar.

There in the Doctors' Park parking lot, she melted.

I'm broken, she thought.

Years worth of pent-up tears dropped from Barb's eyes in the parking lot at 15 Doctors' Park. She didn't know if she could have another baby. And she didn't know if she could even afford to find out.

In that sense, Dr. Valerie Ratts was the Elfrinks' miracle doctor.

In the late 1990s, fertility theorists only speculated on the effectiveness of Metformin for fertility purposes for women with PCOS.

It was known that PCOS victims suffered from an insulin regulatory problem, much the same as diabetics. Ratts, who specializes in reproductive endocrinology at Washington University, helped write contributing research on the theory.

Then she became one of the first doctors to test the theory of Metformin combined with a specific and expensive fertility shot. The shot of gonadotropin called "gonal F," when injected, is supposed to help women grow eggs.

Ratts spent a year working behind the scenes. She got permission from Washington University's human studies committee to do the analysis, and she convinced the pharmaceutical companies to donate the necessary drugs so the patients wouldn't have to pay for them.

Ratts visited with Barb for the first time in June 2001. She looked over the charts and found that Barb had a history of PCOS. She knew Clomid didn't work. And Dr. Ratts found that Barb was otherwise healthy. She'd be a perfect candidate for the study.

The study boiled down to this: All 12 subjects were to take the fertility shot twice a day. Half of them, including Barb, were to also take Metformin.

Ratts explained several options to Barb and then outlined the study and the medications. Barb was to start the fertility shots in September.

But there would be some risks involved. Women who take the fertility injection had a 25 percent to 30 percent chance of having multiples. There would be an increased risk of overstimulation of the ovaries, which can result in fluid abnormalities, kidney failure, blood clot problems, need for hospitalization and theoretically even death.

Ratts also explained that other than the initial consultation, Barb wouldn't have to pay for any of her services or any of the drugs.

Barb weighed the pros and cons.

"Let's go for it," she said.

Barb was one of 12 people in a first-of-its-kind study. Her visit to Dr. Ratts fell in a six-month window of opportunity. The circumstances were perfect.

The Metformin pill was easy to swallow.

But the fertility shot -- usually costing $2,500 for a 45-day supply -- well that was a pain in the abdomen.

As a respiratory therapist, Barb had 10 years of experience drawing blood from other people. Poking herself wasn't as easy.

She overcame her body's natural instinct not to hurt itself and soon got used to the daily routine.

Along with the shots came frequent trips to St. Louis, as many as three times per week.

On weekdays, Barb would leave at 4:30 a.m. The sun would begin peeking up from the horizon at about the time she reached Arnold. Technicians drew blood and took ultrasounds to determine whether the drugs were working. Barb missed several hours of work per week, but Meadow Heights' school officials were amiable. She would leave St. Louis and be back in her classroom by around 11.

Early results showed nothing.

Ratts increased the dosage.

Nothing.

At least 15 trips to St. Louis. At least 15 negatives.

There was only one time Barb thought about giving up. The day was Sept. 11, 2001. When the jets crashed into the twin towers in New York, Barb thought about war, perhaps nuclear war. She asked herself whether she wanted to bring life into this world. Friends and family encouraged her to keep trying, and Barb continued injecting her abdomen twice a day.

On the 45th and final day of her fertility shot, Barb had a scheduled appointment.

She had no reason to expect anything but bad news. She had figured if the drugs were going to work, they probably would have worked by now, and her instincts were right. Ratts knew that women typically take to the drug between days 10 and 25, but she didn't tell Barb that.

Barb made the mundane drive through the sunrise to the fertility clinic braced for the worst. She went through the motions of checking in, waiting and going to the room.

Later, nurse Kathy Dodds came into Barb's room with ultrasound results in her hand.

"Congratulations, Barb," she said. "You're ovulating."

A rush of joy swelled through Barb. She couldn't believe it. She could think of nothing else but jumping off the examination table and calling her husband.

The nurse further explained that she wasn't just ovulating. She was really ovulating.

There were four eggs on the ultrasound and a cluster of other undeveloped follicles that stood no chance at fertilization.

Family project

On the 45th and final day, the drugs had worked. But she wasn't pregnant yet.

She knew her body was working properly, it was just a matter of execution. Trying conventional fertilization, she would have to wait another two weeks to find out if the eggs were fertilized.

Barb's crusade to become a mother again became somewhat of a family project. She told details about herself that many relatives would perhaps rather not know, but friends and relatives rooted for her anyway.

Barb kept the interested parties updated, and the suspense reached a boiling point when Barb drove to St. Louis for the all-important test on a Saturday in November.

She wouldn't get the results until Monday, but she just had to know if she were pregnant. She went out and bought a pregnancy test.

Early Monday morning, around 5:30 a.m., about half an hour before her husband would get up, Barb couldn't go back to sleep. She went to the bathroom, opened the pregnancy test and read the directions. One line meant negative. Two lines positive.

She followed the directions and waited the required three minutes. Her heart pounded. She didn't want to look.

One line.

Negative.

Barb's heart sank. She deflated and tossed the test into the garbage. She went back to bed depressed, the voice of doubt in the back of her mind roaring again.

She lay in bed for 30 minutes, knowing she would hear the official word from the St. Louis technicians later that day. She dreaded the phone call and crawled back into bed.

Barb's line of thought was soon interrupted by Kenny stirring.

Kenny rolled out of bed, stretched and made his routine trip to the bathroom. He discovered a pregnancy test box that had been tossed in the garbage. He pulled it out and read the package.

One line meant negative. Two lines meant positive.

He looked at the results and quickly walked out of the bathroom, back into the bedroom, still wearing his pajamas.

"When were you going to tell me?" he asked.

"Oh, it was negative," she said. "I didn't want to ruin your day."

Kenny, a puzzled expression on his face, looked down at the pregnancy test in his hand, then back up at his wife.

Then he asked, "Don't two lines mean positive?"

bmiller@semissourian.com

243-6635