Grrrrrraduation

Please permit me to grouse for a moment.  I don’t get to do it much in real life these days since I haven’t told many people about our miscarriage.

Last weekend was our university’s commencement ceremony.  One of my research students just finished his bachelor’s degree and is staying on in my research group to write a masters thesis next year.  So, he graduated this year, but he’ll also graduate next year (assuming all goes well).  He’s a nice kid, came in as a transfer student from a big state school after his sophomore year, switched majors from English to physics at the same time, and then proceeded to complete the entire physics major in two years!  He’s had some hiccups, and his research skills need work (which is why I’m glad he’s staying for a masters), but it’s extremely impressive that he did what he did.  He’s also just a really nice kid, who works really, really hard, and so despite some of my frustrations with his lack of research progress, I very much enjoy working with him.  I was really looking forward to meeting his family this week and telling them how great it’s been to have him in my research group and how glad I am that he’s staying for another year.

But his dad.  OMG.

To set the scene a little: One of my colleagues (who has three kids) traditionally brings his kids to watch commencement from a beautiful grassy hill overlooking the ceremony, right near our building, which makes a convenient meet-up point for our majors to come visit after the ceremony.  This year I decided to bring my son and join him — it allowed me to participate in commencement and congratulate our students without giving up weekend time with my son, and my son had a blast playing with my colleague’s kids on the hill during the ceremony (or mostly watching them in awe and trying to steal their baseball when they weren’t looking).

So, after the ceremony, my student wanders up with his dad.  I get to congratulate my student, beam, and lay it on thick with his family — I really love getting to talk up my students to their parents, especially students that I genuinely enjoy like this one.  It’s a win-win feel-good situation.  Then his dad stayed to chat while I was supervising my son’s shenanigans with the big kids.  The following conversation ensued:

Him: How old is your son now?

Me: 15 months

Him: So, are you going to have another one?

Me (inwardly rolling my eyes): We’ll see!

Him: No, but really, do you WANT more?  Are you planning on it?

Me (through gritted teeth): We’ll see!

He actually seemed like he was going to push the subject(!) so I excused myself and scooped up my son.

How clueless are people?  And why, WHY would you ever think it was OK to interrogate your kid’s professor about her reproductive plans?!  This one of the few times that I felt that bringing up our losses would have been not only socially awkward but… unprofessional.  I mean, there were times when I had to discuss the loss of our daughter with colleagues, since it affected a lot of my professional life as well as my personal life.  But… a student’s parent?  And a week after a miscarriage?  Seriously?  Argh.

Several people have asked me about my reproductive plans since our miscarriage (which was only TWO WEEKS AGO), but this one has just been gnawing at me.  I’m so angry about it.  Oh, I won’t hold it against the student… if people held my dad against me I’d never have gotten anywhere in life.  But I might just try to avoid one-on-one conversations with his dad next spring.  And I also want to vent on my blog.  Check that one off the list!

Anyway.  Things here have settled down a bit.  I did have one freak-out this week… I had some pelvic pressure, pain, and fever, but I also had a terrible respiratory infection of some sort from my son that might have accounted for the fever, so I didn’t know what exactly was going on but I was so afraid that I was getting another pelvic infection.  The doctor was great, saw me right away, did a repeat ultrasound, redrew my HCGs, and assured me that the fever is probably unrelated.  Turns out I have a medium-size ovarian cyst, which she said can be common during pregnancy or after a miscarriage and is most likely responsible for the pelvic pressure and pain.  I had a cyst during my first pregnancy with my daughter as well, so I think it’s just something my body does in (doomed) pregnancies, maybe?  Anyway, I am mostly reassured and only feeling a little sheepish for having another freak-out around this miserable pregnancy.  I think it’s just that with everything I’ve been through I really don’t trust my body anymore.  With my first pregnancy, I was a pretty laid-back pregnant lady, but look where it got me — not only did my daughter die, which was unavoidable but nevertheless made me question every little risk I took in that pregnancy, but when I didn’t push about getting symptoms addressed after I delivered her, I wound up with retained products, hemorrhaging, and an infection that damaged my fallopian tubes.  I am just so done with the laid-back approach and am glad that they are investigating my worries comprehensively.  Hopefully this is really the end of it now!

Slow-Motion Miscarriage

I really wanted medical management of my miscarriage, i.e., to take medication to speed it along.  I wound up not having that option, since my indicators last week were not great, but also not totally inconsistent with a healthy pregnancy.  Since my doctors weren’t sure, they didn’t want to intervene with medication or surgery (a decision I certainly understand and agree with), which meant that I wound up undergoing a slow-motion miscarriage as, over the course of the week, I slowly went from spotting to bleeding to passing tissue and knew that it was over.  An ultrasound this morning confirmed that my body passed the tissue on its own (even though I am still bleeding), so I have officially miscarried.  Gravida 3, para 1.

The strange thing about going through a slow-motion miscarriage is that you can’t just curl up at home with a pint of Ben & Jerry’s and wait for it to pass.  I mean, I guess you could (perks of the flexibility of an academic job?), but mine has gone on for at least a week, and that would require more pints of Ben & Jerry’s than I am really comfortable consuming.  So, as a result, I wound up doing a lot of things that I never imagined I might do while having a miscarriage:

  • Having a miscarriage during research meetings with my students and postdoc
  • Having a miscarriage while talking with my department chair
  • Having a miscarriage while writing an invited major review article on recent advances in my field
  • Having a miscarriage while sitting on the grass and listening to a student folk music concert with my toddler
  • Having a miscarriage at my department’s end-of-year party
  • Having a miscarriage while baking cookies and playing board games with my old college roommate, visiting from New York City
  • Having a miscarriage during an ice cream fundraiser for my son’s daycare

I mean, on the one hand, if you have to have a slow-motion miscarriage, many of these things are quite pleasant ways to pass an otherwise depressing time.  On the other hand, I’ve felt weirdly disconnected from my life this week, and it’s bizarre to be engaged in some other activity and then have the intrusive thought “wow, isn’t it weird that I’m doing this while having a miscarriage?”  It also feels strange, and somehow dishonest, to interact with other people when they have no idea that you’re having a miscarriage during the interaction — but not quite enough that I really felt like telling them about it (I did tell the two close friends who happened to call this week, and my visiting college roommate).

It’s also frustrating because my son seems to be old enough now that people feel comfortable asking me if we’re planning to have another baby.  Twice this week alone, I got the question, and not from people that I’m particularly close to.  I wanted to yell at them that I was having a miscarriage, and they really shouldn’t ask questions about people’s reproductive plans (or at least point them to this amusing flow chart).  Instead, I just gave my stock answer of “we’ll see!”

One thing I found both disturbing and reassuring this week was a recent study on 2nd and 3rd trimester loss that was published in 2016.  I wasn’t aware of it until this week, since it wasn’t published yet when I was scouring the literature after we lost our daughter in September 2014.  I thought it was such a great study that I emailed the author to thank her for doing the work, particularly since there seems to be so little research on 2nd trimester loss.  You can read the full article here, but these are the two main takeaways for me:

  • Second and third trimester pregnancy losses are strongly correlated, indicating similar etiologies.  Once you have had a 2nd or 3rd trimester loss (including before 20 weeks), you are about an order of magnitude more likely than a typical woman to have another one.  The overall probability is about 4%, with recurrence more likely if the cause of your first loss was placental or maternal, and less likely if the cause was fetal or unexplained.  (This was the disturbing part — my first loss was placental/maternal, which puts me in the higher risk category of ~8% recurrence.  I sort of knew that already, but this was the first time I’d seen the probabilities broken down in that way.)
  • First trimester miscarriage is not correlated with 2nd or 3rd trimester loss, including recurrent 2nd or 3rd trimester loss.  Roughly a quarter of previous pregnancies ended in first-trimester loss for all the women in the study, regardless of the number of previous 2nd or 3rd trimester losses, which is not significantly higher than the general population.  (This was the reassuring part — it makes it more likely that my current miscarriage was just run-of-the-mill bad luck.)

So, anyway, here I am, just waiting again.  Waiting for the bleeding to taper off, waiting for my cycles to reestablish themselves, waiting to see if we can get pregnant on our own again.  The OBGYN had me make a follow-up appointment for August, mostly as a chance to check in and come up with a plan if necessary.  She half-suggested that I could go for an infertility evaluation at the local big state hospital system if I wanted, but since I’m already being followed by an RE at the other major hospital system in the state I figured it wasn’t necessary, at least not yet.  As I discussed with her, while it’s great that we spontaneously conceived (and so quickly!), it does make it hard to know how long to wait before going back to the RE again.  I did put in a note through the electronic messaging system to my RE to update her about this pregnancy and ask if she had any suggestions moving forward, and her one suggestion was: stop breastfeeding.  I’m not quite ready to do that yet, and it seems pointless to go back to her before I am.  So I guess the plan is to wait a few months, see what my cycles are up to, and then reevaluate.  I think I’m OK with that plan for now.

Because Nothing is Ever Simple

So, apparently my HCG levels are still rising.  They went from 1600-something on Monday to 2300-something on Wednesday.  Much lower than they should be at this stage, and not doubling particularly quickly, but still within the “normal” range for the 4w3d ultrasound measurement from Monday.  Argh.  So now they want me to go back for another ultrasound on Monday, just to make absolutely sure there’s nothing in there before giving me the misoprostol to end the pregnancy.

Oh, and to add insult to injury, when I got my blood drawn for the 2nd HCG test yesterday, by the time I got to my office (a 5-minute drive from the hospital lab) my arm had swelled up to the size of a tangerine at the site of the needle stick.  I freaked out and called my doctor’s office, and they said to come in, all so that the doctor could hand me an ice pack and tell me that it happens sometimes (supposedly when they drive the needle out the back of your vein so that it bleeds into the surrounding tissue).  As a bonus, I do have a large and colorful bruise on my arm today!

The doctor called last night with the HCG results, and was awkwardly trying to be reassuring while not giving me false hope — she is a really funny and weird old lady with whom I’ve had awkward conversations before (like the random 3rd-trimester checkup during my pregnancy with S where she said to me, “So, just to make sure, you NEVER, EVER use your cell phone, right?”  My husband and I were looking at each other confusedly, so she repeated herself… and I said, “Um, yes, I do, is that a problem?” and she said, “Oh, I mean, while driving!”)  So on the phone yesterday she kept saying, “Now, I don’t want you to feel like I’m being too optimistic.  But I don’t want you to feel like I’m being too pessimistic either.  I mean, we’ve seen it all.  But that doesn’t mean it’s going to work out this time.  But it might.”  And she kept going until I was like, “It’s fine, I’m glad you’re being thorough so that you can be completely sure before taking any action,” and she seemed content with that.  I like her because she always says exactly what’s on her mind and is very decisive and action-oriented — she’s like a little tornado of doctor every time she comes into a room, even if her verbal communication skills could use some work.  After the bad ultrasound on Monday she walked into the room and two minutes later whipped out a phlebotomy kit and drew my blood then and there for the HCG test — I’ve never seen a doctor do that before!  So I’m actually kind of glad she’s been the one managing this (likely) miscarriage even though I usually prefer the younger, kinder doctor (married to one of the other faculty members at my university) who made me feel so reassured after our daughter died.  I actually just want frank talk and decisive action rather than reassurance right now.

So now I’m just waiting… again.  I’ve been spotting for the past few days and even had some bright red blood this morning, so maybe this will all just end on its own soon.  But otherwise I’m in limbo until Monday.

Too Good to be True

We went for an early ultrasound today, when I should have been 6w1d or 6w2d according to my ovulation date (or 7w based on the date of my last period).  The only thing there was an empty gestational sac measuring 4w3d.

The ultrasound tech and doctor were bending over backwards trying to reassure me that it’s very common to get dates wrong in early pregnancy, but I’m quite certain of the dates (I mean, I had a positive home pregnancy test two weeks ago — it’s basically impossible that I’m only 4w now!).  There’s just no way this pregnancy is viable.  I also had an inkling, since yesterday (Mother’s Day in the US, no less) I had just a bit of mucus tinged with dark brown flecks that looked ominous.  That quick conception was just too good to be true.

I’ve got a lot of mixed feelings swirling around in my head right now.  I’m sad, obviously.  This was a much-wanted pregnancy.  It was a little quicker than we were expecting, but we were delighted that we were able to conceive so easily and looking forward to the prospect of a little sibling for S.  Honestly, I also felt like I might have dodged a bullet — if everything had gone smoothly, it might well have been the end of my reproductive phase of life, which it now looks like is going to drag on even longer with a bit more heartbreak.  I am so done with this phase of life… except that I’m not, because we really want another baby.

On the other hand, there are some silver linings.  The timing of this pregnancy was messing with my tenure clock, and now the odds are that I’ll be able to stick to my original clock, which would be nice.  Also, two under two was a little bit daunting, and now we’ll have a little more time to enjoy our amazing little guy on his own, and he’ll be a little bit bigger and more independent before (hopefully) a future sibling disrupts his universe.  I know these things.  They are not really all that comforting, though. I wanted that baby.  A lot.

The big question now is, what next?  Given how undeveloped the pregnancy is, why is my body still holding onto it?  The doctor drew some blood to check my HCG levels and told me to come back in a week, so there are no immediate plans to intervene (although she did say she’d call later today to discuss the outcome of the blood test).  I hate the waiting game more than anything.  I think that if nothing happens in the next week, I’ll start to ask for medical management with misoprostol.  I just don’t want this to drag on forever — I want it to be over with so that we can move on with our lives, and hopefully with another healthy pregnancy.

In a way, I’m also kind of uneasy about what it means that we conceived so quickly.  Does it mean that the RE won’t want to move forward with the plan we developed before I got pregnant this time?  Possibly not, since I’ve still been having irregular periods since my son was born, and I still have the abnormal HSG — those two things have not changed, although at least now we do have the good indication that my right fallopian tube is still functional after the birth of my son.  I can’t help but be certain that the quick conception was a fluke, and that we’re in for a long haul with conceiving another viable pregnancy.

I guess the other silver lining is that I’m handling this a whole heck of a lot better (at least so far, about three hours after getting the news) than I handled the news of our daughter’s loss at 18 weeks.  For one thing, it’s a lot less unexpected — having no heartbeat on an otherwise totally uneventful pregnancy at 18 weeks was like getting hit by a truck.  At least this time around we knew the probability of bad news was significant.  With early miscarriage rates around 20%, and this being my third pregnancy… well, it was not exactly an improbable outcome.

For another thing… we’ve been in worse places before.  Once you’ve handled second trimester loss, first trimester loss seems somehow more bearable.  That’s not to say that first trimester loss isn’t devastating for many families — of course, it is.  My heart breaks for the stories I read here about first trimester loss — multiple losses, no living children… it’s devastating.  You can’t measure or weigh grief.  Our grief this time is just a little more muted, by two things: the loss of our out daughter “broke us in,” in a way — I just don’t expect good news when I’m pregnant anymore, so this bad news was a little easier to take because of our experience with bad news in the past.  And, the other half of the muted grief is that we have a beautiful, wonderful, amazing little boy at home who means the world to me and whose snuggles take the edge off of the loss of his nebulous, but no less longed-for, sibling.  Plus, he gives me hope that I might someday be able to carry another pregnancy to term.  This time, the statistics make sense.  If we have another early loss in the future, I actually suspect it’ll be a whole lot harder to handle.  Right now we’re at one full-term baby for three pregnancies.  If it becomes one full-term baby for four pregnancies, I’ll start to wonder again what more might be wrong with me that makes my uterus a place where babies go to die.  I also hope we’re not playing “collect them all” with pregnancy outcomes — so far, we’ve had one first trimester loss (still in progress), one second trimester loss, and one full-term healthy baby.  The other outcomes don’t look particularly appealing, so I hope we’ll be able to take a pass on those!

Well, anyway, wish me luck that this doesn’t drag out too long and that we’re able to move on and conceive again soon.

My Blog Title is Apt Again

Well, whaddya know.  I’m pregnant.

It has never taken us less than 8 months to conceive before.  This time, first try.  We are thrilled and a little stunned.  I’ve always been a little skeptical of the stories you read of how people who have experienced infertility/loss often get pregnant quickly after a full-term, healthy pregnancy — I mean, maybe it happens to some people, but I was sure it wouldn’t happen to me.  Well, here I am!

For now, of course.  I know as well as anyone that first trimester miscarriage is a distinct possibility, as are losses at later stages of pregnancy, as are all manner of other health problems (I’m still at elevated risk for ectopic pregnancy and placental abruption, for example).  But for now I’m pregnant, and that’s a very, very good thing.

We’re a little shocked at the timing — I mean, we were trying to get pregnant, obviously, but we just didn’t expect it to happen this quickly.  Of course our minds started jumping to the possible reality of having a new baby join our family in January.  Two under two — yikes!  It would also throw a monkey wrench into my tenure plans (I’d been on track to submit my materials a year and a half from now), but… we’ll deal with that.  Our family is more important than my tenure case, and if I wind up using both my clock extensions and spending nine years on the tenure clock, so be it.

I was also just starting to cut back on pumping at work this week, but for the moment I’m still breastfeeding/pumping four times a day, which is going to start feeling like a lot as I get more pregnant.  But… what if I wean, and then miscarry?  I’ll be mourning the loss of a baby simultaneously to mourning the loss of a wonderful breastfeeding relationship.  I suppose I’ll just keep doing what I’m doing (i.e., weaning from the pump during the day, since I would never mourn the loss of a relationship with my pump!) and see how things go over the next few weeks.  I’ve got a viability scan scheduled for a week from Monday, after which we’ll know a little more (and, if all goes well, I’ll start back on Lovenox).

What a weird and wonderful week it’s been.  Pregnant again.  Holy cow.  Here’s hoping this little bean sticks around!

A Plan

Yesterday I visited my reproductive endocrinologist (RE) for the first time in almost two years(!), and now we officially have A Plan.

I’d originally intended to wait a little longer, but last week I had my annual OBGYN appointment, and of course the fact that we were already trying to conceive came up during my visit.  I mentioned that it was hard to know how long to try on our own before going back to the RE, especially since we don’t know whether things are the same or worse than they were at my abnormal HSG right before we conceived our son two years ago.  I also mentioned that the HSG seems to be helpful, or at least lucky, for us since both times I’ve gotten pregnant before it’s been the cycle after an HSG.  She encouraged me to go back to the RE and talk to her about getting another HSG sooner rather than later — as she said, it won’t hurt (too much), it will give us more information, and it might help!

So after that appointment I called the RE’s office, and they had a cancellation this week so they were able to get me in right away.  Yesterday I made the trek back down (it’s about a half-hour drive — in the smallish college town where I live there are no REs so we have to go to one of the large state hospital systems).  It felt so odd walking into that building again, realizing that I hadn’t been there for two years!  And since it’s National Infertility Awareness Week, they had cupcakes in the waiting room — hey, sucks to be infertile, but here, have a cupcake!  Actually, I thought it was very sweet — they were clearly homemade, and I wondered who among the office staff took the time to bake cupcakes for all their patients.

The RE was very sweet, and excited for us, and positive about our chances of conceiving again.  As expected, she gave me a talk about cutting back on breastfeeding before we start getting serious about intervention.  But she didn’t take as hard a line as I was expecting — she said that once a day was probably OK.  She would have been happy to put in the order for the HSG right away, but she pointed out that to maximize the fertility benefit it might make sense to wait until I’ve cut back on breastfeeding.  I was cool with waiting a few months — as I’ve mentioned, we’re really not desperate to get pregnant immediately.  I’ve been thinking a lot lately about trying to at least wean off of daytime pumping, since I dislike it so much and I’m not convinced that at this age there’s really any benefit to breastfeeding four times a day as opposed to two.

So, here’s the plan: I’ll slowly (super-slowly, since I’m so prone to clogged ducts!) wean off of pumping during the day over the next ~month, but continue to nurse morning and evening, plus maybe a little extra on weekends or sick days if S asks for it.  I have the order for the HSG whenever I’m ready, which I’m thinking will be around July or so — if he’s still nursing then, I’ll see how I feel about cutting back to one session (probably bedtime, since he’s often impatient with the morning session anyway — too excited to start his day!).

So that means that we’ll keep trying on our own for a few months, then probably do the HSG and my bloodwork mid-summer, then try on our own for a few more months while my husband gets his testing re-done, and then if nothing has happened by mid to late fall, we’ll be ready to escalate.  The timeline I discussed with the RE is that we’d like to be pregnant within about a year, but it’s OK if it’s not immediate, so we’re content to try this for a while.  She’s optimistic about our chances for a spontaneous conception.  I’m happy with the plan, my husband is happy with the plan, and it just feels good to HAVE a plan and know what to expect.

So, we’ll see what happens.  I’m feeling more positive these days about trying again.  And little S is a huge light in my life, making me appreciate so concretely every day how fortunate we are to have him, even as we look towards a hopeful future of perhaps, someday, a family of four here on Earth.

Dragging My Feet on Trying Again

I’m curious whether any of you have ever felt this way.  Before we were pregnant with our daughter, and then again after her death, I was laser-focused on getting pregnant as quickly as possible.  I was temping, I was charting, I was using OPKs, I was doing everything I could to time things properly and maximize chances of conception.  This time around feels… different.

I want another living baby, very much.  Therefore, I want to be pregnant again.  And rationally, I realize it makes sense to start trying now.  It has never been easy for us to get pregnant, and it probably won’t be this time either.  I’m 34, so Advanced Maternal Age is staring me in the face.  If we want another kid, there’s no time like the present, clearly.

But… our son is still so little.  Our breastfeeding relationship is still going strong.  He’s only just started reliably sleeping through the night.  I’m enjoying the mommy-daddy-baby triad and am not eager to upset it with another little one, even though it’s absolutely what we want for all three of us in the longer run.  Starting over with a newborn sounds exhausting.  Being pregnant again sounds exhausting.  Heck, even getting pregnant again sounds exhausting — getting pregnant with my son was an exhausting and heartbreaking almost-2-year-long haul, counting everything we went through with my daughter.   That’s part of what makes me eager to get started sooner rather than later, but it’s also a big part of what’s making me reluctant.  I just can’t imagine going through it all again.

So, I’ve been dragging my feet a bit.  Just last night my husband asked… isn’t this the week?  And I was surprised to realize that it was, and I just hadn’t really been on top of keeping track.  But he’s keeping track, apparently!

Are we really ready to get back on this roller coaster?  I know that another living baby in our family will be more than worth it in the long run.  But it’s been a LONG run to get to where we are now with our son, and it’s daunting to think about going through it all again.  There’s also my tenure clock lurking in the back of my mind.  If all goes as planned, I’ll submit my materials about a year and a half from now.  Another baby between now and then would practically require me to push back that clock.  But since it’s probably going to take us a while, it still makes sense to start now so that ideally our pregnancy will be timed (ha!) so that my due date would be shortly after I submit my materials.  So there’s the gamble about trying to time it so that it’s soon… but not too soon.  But I also fully subscribe to the mantra that there is no good time for a baby, and that the potential pitfalls of waiting too long are far more dire than the pitfalls of moving back my tenure clock a bit… or even than not getting tenure at all.

Maybe it’ll be easier this time.  Maybe we’ll surprise ourselves and get pregnant quickly without intervention (unlikely, but possible).  Maybe I won’t lose another pregnancy.  Maybe the Lovenox will just inject itself every day.  Maybe we’ll get a magical easy newborn (ha).  Right now, it just looks like a lot to handle, and I’m tired (but not newborn tired, thankfully!), and I want to enjoy my son, whom I love to the very depths of my soul and with whom I never feel like I get to spend enough time.  I’m sure this ambivalence is normal.  But I’d love to hear any thoughts about how to get past it.

In other news, S continues to delight.  He’s walking and climbing all over the place these days, and starting to communicate.  No clear words yet, but definitely several expressive gestures that he uses in different contexts (I won’t call them “signs” because they’re not the official ones that I’ve been using with him, but he has clearly developed his own signs — instead of “all done,” for example, he’ll grab the front of his high chair tray with two hands, and just this morning he also did it when he wanted to get out of his jumparoo.  It was very clearly the same communicative gesture in a different context, and it was so cool to see that he is actually putting together the pieces for communicating with other humans!).  He’s big into blocks and wheels and gets delighted whenever he manages to balance a thing on top of another thing.  He’s very snuggly and pretty social and loves to hang out with our friends and family members, or walk outside and just look at the world and touch the bushes and trees.  I simply can’t get enough of him these days!  Having another little one to watch grow up has to be just as great… right?