Plot Twist!

Warning: pregnancy discussed.

This morning I woke up early and took my temperature.  I double-checked the thermometer, then stumbled into the bathroom.  A few minutes later I came back out, stood by our bed, and said to my husband,

“Hey, [husband], want to hear something crazy?”

Him: “Sure”

Me: “I’m pregnant.”

Him: “Hunh.  Hope it’s OK.”

Me: “Me too.  I hope it’s not ectopic.”

Him: “Yeah.”

Then we went back to bed.  (I didn’t sleep, of course.)

There’s no doubt that I’m pregnant.  I had one old First Response test in the medicine cabinet, and after I dipped it, it only took a few seconds for both lines to appear.  The test line appeared immediately, at the same time as the control line, and wound up being about twice as dark.  No squinting or worries about evaporation lines for me today.  It’s as though the First Response test was saying, “Please, this is child’s play — give me a challenge next time!”

Immediately my mind was off and running in circles about the implications of this plot twist.

First: the danger of ectopic pregnancy.  After my recent abnormal HSG, we were gearing up to start IVF.  During the HSG, when I asked if I’d be able to get pregnant with scarred tubes, both the radiologist and the fellow told me that it was possible, but that I’d be at high risk of an ectopic pregnancy and that I should discuss it with my doctor.  Since I knew I’d ovulate before I saw her next, I sent her a message through the practice’s electronic messaging system, asking if we should hold off on trying because of the danger of ectopic pregnancy.  Here is her verbatim response:

I have reviewed your report as well as images of HSG- yes there is concern about the status of your tubes – while both tubes did spill the dye, there is concern about how freely open the tubes are. Your risk for an ectopic pregnancy Is higher based on this appearance but it is not 100% by any means!

You can try to attempt timed intercourse but recommend close monitoring with serial bloodwork in the event that your period gets delayed, as if it is an ectopic pregnancy, we want to diagnose it in its earliest stage. I believe you are scheduled for follow up with me next month – it is however OK to avoid pregnancy until the office visit, so we can discuss options/strategies.

That sounded pretty good, so we went for it.  When we saw her a couple weeks later, she told us that our chances of getting pregnant on our own were very low and presented our options, including surgery to try to repair the tubes or moving straight to IVF.  She recommended the latter.  We agreed, and have been going full steam ahead on starting IVF as soon as possible.  Then this happened.

I guess “not 100% by any means!” is encouraging.  I’ve looked up some information, and while of course there’s nothing out there about my specific case, it sounds like a ballpark probability for ectopic pregnancy in the case of known tubal disease (or previous ectopic pregnancy) is about 20%.

While walking the dog this morning, I did some math.  If we assume a normal first trimester miscarriage probability of about 20%, and a risk of ectopic pregnancy of about 20%, then this pregnancy has approximately a 64% chance of making it through the first trimester.  I’ll take it, I guess!

So, I suppose I’ll be getting a lot of bloodwork this week.  It’ll be a bit tricky since I’m scheduled to fly to Tennessee for a conference on Tuesday, but hopefully I can find a lab that can do the test there and fax the results back to my doctor?  Not sure exactly how that’s going to work.

I have other worries as well, but mostly they’re just the sort of worries that involve rearranging your conception of the future around new information.  Bizarrely, the part of me that believes there’s no way this pregnancy will survive is frustrated at the delay in starting IVF.  Assuming that this embryo dies, either through miscarriage or ectopic pregnancy, it means a whole ‘nother round of heartbreak and waiting to start the more safe and effective route of IVF.  I realize that I’m borrowing trouble here, but I’ve hit the crappy end of the probabilities in so many different ways now that I just assume that I’ll hit them again this time, and I certainly don’t relish the prospect of going through either an ectopic pregnancy or a first trimester miscarriage.  I was so optimistic about the probability of a healthy pregnancy with IVF, and the possibility of saving extra frozen 32-year-old embryos, which would be like gold if we ever got to the point of being able to think about a second baby.

Anyway, I can read this and logically know how absurd it all sounds.  I’m pregnant!  I’ve been working so hard towards this goal for so long, and I’m extremely fortunate that I don’t have to go through IVF after all!  (At least not yet.)  I should be over the moon!  I should be jumping up and down!  And my husband and I are all “meh” instead — what is wrong with us?!  I think it’s mostly that I can’t possibly believe at this stage that this pregnancy has any chance of working out, and I’m emotionally insulating myself against the (high, at this point) likelihood of another loss.  I’m also thinking about the long path in front of us if things go well: blood tests and ultrasounds for the next two weeks to make sure it’s not ectopic.  Starting Lovenox injections to mitigate the threat of clotting.  Repeat ultrasounds to make sure the pregnancy is viable and growing on schedule.  Getting through the screenings for chromosomal abnormalities and making it to the end of the first trimester.  A normal 18-week anatomy scan (this is huge for us since we found out that our first daughter had died at our 18-week prenatal visit).  Telling people we’re pregnant again.  And then the second half of pregnancy, which I’ve never experienced before, but which for me carries a 30% risk of placenta-related complications.  And then labor and delivery, which I’m completely freaked out about since my only experience with it is delivering a dead baby and I’m irrationally convinced that if we ever make it to full term something terrible is going to happen during delivery and the baby and/or I will die.

It’s a lot.  Even if we’re fortunate enough to have everything go textbook normally from here on out (which is unlikely), it’s not going to be easy.

But, one step at a time.  Today I am pregnant, and that is a very, very good thing.  I need to keep that in perspective.  Seeing those two pink lines this morning was very different than the first time we saw them, and this is going to be a very different pregnancy than the first no matter how it turns out.  But for now I have hope, and that’s a really good feeling.  I’d say at the moment I’m feeling anxious but cautiously optimistic.  There are much worse places to be (and I’ve been in a lot of them).  Wish us luck — we’ll need a lot of it.

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11 thoughts on “Plot Twist!

  1. My Perfect Breakdown

    First, congratulations! Today you are pregnant with reason to hope. I know you have countless reasons to be afraid, and countless reasons to be concerned. So I hope you can hold onto moments of hope and get through all the waiting and worrying that will undoubtedly occur throughout this pregnancy. Sending you love and hoping you get to have a drama free full term pregnancy that results in your living, happy, and adorable little baby!

    Reply
    1. lyra211 Post author

      Thank you for your kind words, as always. I appreciate the congratulations. I would *love* a drama-free full-term pregnancy. The odds of that are low (I got a little carried away with my statistics answer to theskyandback, below…), but that is certainly the outcome I am hoping for!

      Reply
  2. theskyandback

    Congrats! Woo! Like you said, today you are pregnant, and that is awesome. Secondly, this is not a scientific guarantee or anything, but the fact that your second line was so dark and immediate is a good sign. Friends I’ve known with ectopics have had squinters, and one didn’t even get a positive test until two weeks after her missed period. And with my blighted ovum, the test was also super light. So while not a sure bet, a dark test is very good. And second, being a physicist, I’m sure your grasp of stats is much better than mine, but: a 20% chance of ectopic and a 20% chance of miscarriage does not mean a 40% chance of the pregnancy not working out, right? Like don’t those two stats exist independently of one another vs. adding them together? And even if I’m wrong about that, a 60% chance is still on the right side of the odds! This ish is freaking scary, so I am with you there. But I definitely think there is so, so, soooo much hope! I believe!

    Reply
    1. lyra211 Post author

      Thank you — that is so very reassuring to hear that you’ve had friends with ectopics who got squinters, and that other pregnancies that haven’t worked out have also been light. I know I can’t count on it, but it’s helpful to be able to interpret that dark line as a good sign.

      Ooooh, a chance to talk about statistics! My pleasure! Here’s the math:

      We want to know the probability of having the baby survive the first trimester. There are two independent ways that the pregnancy might end poorly before that point: (1) an ectopic pregnancy, and (2) a first-trimester miscarriage. Each of those has a 20% chance of occurring. So the chance of *neither* one occurring is (the chance that I don’t have a miscarriage)x(the chance that I don’t have an ectopic pregnancy), or 0.8×0.8 = 0.64

      When probabilities are independent (my risk of having a miscarriage is mostly independent of my risk of having an ectopic pregnancy), you multiply them together. You certainly could go the other way, and it would work out like this: my pregnancy might end badly if (1) I have an ectopic pregnancy but not a miscarriage, (2) I have a miscarriage but not an ectopic pregnancy, or (3) I have both an ectopic pregnancy and a chromosomal abnormality leading to miscarriage (no idea what this latter case would be like, and I don’t want to find out!). The chance of (1) happening is (the chance of having an ectopic pregnancy)*(the chance of not having a miscarriage) = 0.8×0.2 = 16%. The chance of (2) happening is the same but with the probabilities reversed (16%). And the chance of (3) happening is 20% of 20%, or 4%. Let’s make sure these all add to one…

      All possible outcomes:
      (1) ectopic pregnancy but not miscarriage (16%)
      (2) miscarriage but not ectopic (16%)
      (3) both ectopic and miscarriage (4%)
      (4) neither ectopic nor miscarriage (64%) <– preferred outcome!
      16 + 16 + 4 + 64 = 100%! That's good, because there had better be a 100% chance that *something* happens.

      Yay, statistics works! That was probably more of an answer than you were looking for… 🙂

      Reply
  3. Sondra

    Congrats friend! I couldn’t agree more with MPB. Today you are pregnant. I always love the quote, “New sperm, new egg, new pregnancy.” Our history often scares us because we are so afraid of it repeating. I know you’re worried, but I so hope this new pregnancy is different. Sending love and support your way. I’ll be thinking of you.

    Reply
    1. lyra211 Post author

      Thank you so much for your love and support. I haven’t heard the “New sperm, new egg, new pregnancy” saying before, but I like it. 🙂 Today I am pregnant, and that’s a very good thing.

      Reply
  4. Wifey

    I know it’s impossible not to think about the past and worry about the future, so I won’t tell you not to. But, try to also embrace the present and enjoy the moment. I will continue to be hopeful for you. Congratulations!!

    Reply
    1. lyra211 Post author

      Thank you so much! I’m trying really hard not to assume that every little twinge I feel is an ectopic pregnancy — after a couple of blood tests that should be easier. 🙂 But you’re right — I need to try to focus on the future, and hope that things turn out better this time. Thanks for your support!

      Reply
    1. lyra211 Post author

      One hurdle at a time, indeed. 🙂 Looking forward to how things turn out for both of us over the next couple of weeks! Thanks for the congratulations!

      Reply

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