As a little girl growing up, riding horses and playing outdoors, Danielle Cavender Hicks was told she'd never be able to be a mom. That's because at just six weeks of age, doctors removed a tumor from her tiny body - and with it, both of her fallopian tubes and one ovary.
"You have to have tubes to deliver an egg in order for it to be fertilized," she said simply.
At the time, treatment options were all but unheard of. Danielle did a lot of babysitting, and worked at a daycare center. And yet, becoming a mom to a child of her own was something she never quite gave up on.
"All my aunts and uncles, they have three and four kids apiece, so kids were always a major thing for me," she said.
When she started dating Ricky Hicks, the man she would eventually marry, she knew kids were important to him, too. So she was very direct.
"I told him, 'I don't know if you're going to want to stay with me, because I can't have children.' And he said, 'I love you for who you are, not what you can do.' I thought that was so sweet."
"I was in love with her, so I was going to be with her regardless, and I knew we were going to make it work," said Ricky.
His mission became one of keeping their spirits up.
"She would get down on it. And we knew there were other options out there to make it happen but I had faith and I just felt like this was going to work out."
The field of fertility treatment grew rapidly from its infancy in the 1950s and 60s to include invitro fertilization, which successfully produced a healthy baby for the first time in 1978, just a few years before Danielle was born.
As Danielle grew up, there were other significant advances in the fertility world, including a treatment protocol known as intracytoplasmic sperm injection, or ICSI, which produced its first child in Singapore in 1992.
Still, by the time Danielle and Ricky were married in 2009 and ready to start a family, it appeared she had no viable options. It wasn't that doctors offered little hope - they offered no hope.
"I went to multiple gynecologists trying to see if there was anything I could do, and they all said the same thing, that I would never have a baby."
One doctor referred her to Dr. Pickens Gantt, a reproductive endocrinologist at Charleston Area Medical Center.
Her chances of becoming a mother were miniscule, Gantt said.
"Danielle's case was more challenging because of the removal of her ovary, because that makes a difference in the number of eggs" her body is able to produce, he said.
Of course, a woman only needs one egg to conceive a baby, but it has to be the right egg, one that's healthy, that can survive and ultimately thrive as it is fertilized, becomes an embryo and grows from there. Danielle would need expensive medications to stimulate the production of a greater number of eggs, but she still had only a slim margin of success.
"I would have given her maybe a 25, 30 percent chance - maybe," he said.
And her physical condition wasn't the only barrier to motherhood. Danielle and Ricky were young, and hadn't established the good credit they needed to afford the costly, uncertain treatment.
"My insurance plan didn't cover it. It's an $8,000 procedure, plus the medications, and we didn't have that just lying around, so we worked to get our credit scores high enough so we could get a loan," she said.
The process took two years but finally they were approved for a loan that would take more than five years to pay off. It would give them one shot at having a child.
"Dr. Gantt wasn't sure I was the best candidate and he was kind of discouraging us, and we were like, 'We've come this far.'"
"That motherly instinct is extreme. It drives us all for procreation," Gantt said. But he wanted to be forthcoming with the Hicks: roughly half of their money would be returned if the treatment didn't produce a baby, but after a time consuming, emotional, sometimes painful journey, no one in their situation really wants the money back. And in Danielle's case, there was a significant chance that even the best treatment available would fail.
"A lot of programs won't accept someone who's a poor candidate because it skews their numbers and statistics, which are reported," said Gantt. "We share all of the different criteria we look at with the patient, but it's not our job to make the decision on whether they can give it a shot. It's our job to let them know what their chances are."
Danielle and Ricky decided to go for it. And early on, the signs were positive.
For one thing, her body, with its single ovary, produced 11 eggs, more than anyone expected. They were taken, or harvested, and then injected, one by one, with Ricky's sperm. Then there was a tension-filled time of waiting and hoping the embryos would grow. Seven of them did. The two strongest, healthiest of the bunch were implanted into Danielle, effectively replicating the process of conception.
Then it was a waiting game. Danielle wouldn't medically be considered pregnant for about two weeks, and only then if her hormone levels indicated that at least one of the embryos had implanted itself into the walls of her uterus. Roughly one-third to one-half do not, and are then dissolved and flushed from the body.
"I started bleeding a week later so immediately I thought, 'Well these doctors were right,'" she said.
"I was devastated. It was awful. We were getting ready to go out to dinner and I was numb... Dr. Gantt said it was normal, but still, you have all this riding on it."
There was nothing to do but wait. Finally, after a lifetime of hoping, and years of trying, a simple blood test came back positive.
"We were ecstatic. We cried - it was insane. We couldn't believe it. We were in shock. It really got real six weeks later when you got to hear the heartbeat."
The next seven months were a roller coaster of emotional extremes, with unexplained bleeding, symptoms of a miscarriage, late term complications.
Richard Lee Hicks III, or Ricky Junior - R.J for short - was born four weeks early, three minutes before Christmas, on December 24, 2015 at 11:57 p.m., weighing in at 4 pounds, 6 ounces, and nothing short of amazing.
"The NICU (neonatal intensive care unit) was waiting on him but he never went to the NICU. He is now a whopping 12 pounds at 4 months old. He's done great," Danielle said
"It's been a long road to get him but it was well worth it," Ricky said.
Infertility treatment has improved significantly in recent years, Gantt said. So much so that five short years ago, Danielle would almost certainly have faced a different outcome.
"It turns out she was able to get pregnant on the first round," he added. "I'd have to say it's a miracle."
An estimated 6 percent of American women between 15 and 44 are considered infertile, and an estimated 7.4 million women in this country have sought fertility treatment in an effort to have a child, according to the Centers for Disease Control. Depending on the patient's age, anywhere from 6 to 57 percent of them will be successful on the first try.
"I can't believe I'm a mom. I can't believe there's a holiday out there for me," Danielle said. "It's an amazing feeling that I'm somebody's mother."
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