Just a quick note to say that things were measuring right on track (in fact a day ahead) at our ultrasound this morning — and crucially, they were all in my uterus where they belonged. 🙂
We saw a gestational sac, yolk sac, and a fetal pole at 5w4d. No heartbeat yet, but the doctor told us before she even started the ultrasound that we shouldn’t expect to see one this early. We’re going back in a week and hoping to see one then.
So we’re breathing a big sigh of relief today — not ectopic! Yay!
She also checked out the “partial hydrosalpinx” that had been seen on the HSG, and it was very clearly visible on the transvaginal ultrasound. I asked her if it would raise our probability of miscarriage, and she said there are no data on the effect of hydrosalpinx in spontaneous pregnancy. I wasn’t exactly reassured by that, as I know the data from IVF pregnancies show that ultrasound-visible hydrosalpinx reduces pregnancy rates by almost 50% and increases the miscarriage rate in that context, but I’m going to choose to be optimistic and keep sight of the fact that my betas were great and things look exactly as expected at this early stage.
I did also ask the doctor a question that’s been weighing on my mind during this whirlwind: whatever the outcome of this pregnancy, we will probably want to get pregnant again. What should we do at that point? She gave a fairly vague “it depends” answer — she said that if I wind up delivering by C-section, we’d want to plan ahead so that whoever does the C-section can visualize and possibly remove/seal my damaged left fallopian tube while they’ve got my abdomen sliced open anyway (fun!). She also said that after this pregnancy contraception will be very important because any attempt at pregnancy should be carefully monitored because the risk of an ectopic pregnancy will still be quite high (which is actually not such a simple thing, since I’ve been banned from all hormonal contraception thanks to Factor V Leiden, but I didn’t want to go down that rabbit hole today). She also said I might need a third HSG whenever we do decide to try to get pregnant again, because things might well change between now and then (for the worse, presumably). But she also pointed out that this is good evidence that even with the scarring my right fallopian tube is still at least somewhat functional, so it wouldn’t be crazy to try without IVF for a while. So that seems like good news!
I also want to give a shout-out to the flexibility of an academic schedule in all this. I was able to skip several hours of my conference last week, another couple of hours of work today, and next week I’ll be at a conference in Western Massachusetts but can still take off an afternoon to drive the ~2 hours each way to this ultrasound appointment. Then I’m in town for the next month, and able to schedule doctors appointments pretty much anytime — even if it happens to be during a weekly appointment with my students, I can easily shuffle things around. Once the semester starts things get a little more constrained, but other than my actual lecture times, just about anything else is movable. I realize this is a big privilege! And I don’t even have to clear my time off with anyone else and make up awkward excuses for why I’m not in my office! The main difficulty with an academic schedule is all the travel it requires — when we told my in-laws that I was pregnant this week, one of my mother-in-law’s first comments was “Well, I think you should not travel for the rest of the pregnancy.” That’s a bit drastic, and I’m still planning to give my two invited talks at a conference in Hawaii in August, but travel is the one major tension that I’ve felt with the academic calendar throughout this entire process. More on that later, I’m sure.
For now, we’re optimistic and happy about the firmly in-the-uterus pregnancy. Now on to the next milestone: heartbeat next week, I hope I hope I hope!