Still Looking Good

Since my last post, I’ve had two ultrasounds: my last with the RE, and my first as a new OB patient with the local OB.  Everything is still looking good — growing right on track, nice strong heartbeat, and I even got to see those first little twitchy movements on the ultrasound today.  My official due date is Nov 7, though I’m currently measuring two days ahead, which puts me somewhere around 9w right now (I was measuring 9w0d today, though according to LMP/EDD I’m 8w5d).

The weird thing is, I felt totally calm until after the ultrasound today, and then I got all shaky and weepy and was barely able to hold back tears while I was talking with the new midwife in the practice during my appointment.  She must think I’m nuts — everything looks perfect, and I was an emotional wreck anyway.  I should have been thrilled.  I’m honestly not sure I can explain why I was so weepy today.  Yeah, yeah, pregnancy hormones and all that… but I think it’s also just because with everything I’ve been through, pregnancy is so darn stressful, even when things look good.  In fact, especially when things look good, because I’m an expert at handling losses at this point, but I also know that the later I go, the harder it will be if this pregnancy ends.  There’s the fear of getting attached, the fear of getting hurt as much as I was hurt when my daughter died.  And, let me tell you, when that little nubbin was kicking its little arm and leg stumps on the ultrasound this afternoon, I was amazed and a little in love in spite of myself.  Just dreaming that this might work and we might get to add another baby to our family… it’s so big, and so incredible, and I’m just afraid to even start to believe that it might happen.  Hence the tears and shakiness.  This is wonderful, guys, but it’s also really intense.

I mean, the plus side of almost losing it in front of the midwife is that when I asked if I could come back in two weeks instead of five for a heartbeat check, she didn’t even hesitate — and she also offered to let me come back as often as I need to for reassurance.  I really don’t think I would have been able to stay sane waiting 5 weeks to know that everything was OK.  They might consider me a normal (if geriatric) OB patient, but I am pretty far from emotionally normal, clearly.

She did try to reassure me with the old line about how “a normal heartbeat at this gestational age means that you have a less than 5% chance of miscarriage,” but I put the kibosh on that.  I told her (gently, I think) that those numbers don’t really mean anything to me since losing a pregnancy at 18 weeks (and I didn’t even add that they almost certainly don’t apply to me, since 2nd and 3rd trimester losses are highly correlated and MFM told me I have a significant risk of placental issues in all my pregnancies).  I have long since stopped expecting doctors to have any idea about what it is like to lose pregnancy after pregnancy in the first and second trimesters.  I do appreciate it when they try, but I sort of feel like whenever I’m feeling up to it, it’s a service to the others who will come after me if I try to give them some insight into what it feels like and what is and is not reassuring, so I’m glad I spoke up a bit today.

Anyway, next week is my intake appointment with MFM, along with the bloodwork for NIPT and the other standard first-trimester testing, and then the following week I go back for a quick check-in with my OB, and then it’ll be time for the 12w ultrasound.  So, at least I have weekly opportunities for reassurance over the next few weeks to help me stay sane.

If I am lucky enough to make it through the first trimester, I have to start worrying about the fact that my pregnancy is pretty much at the worst possible timing for an academic, but that’s a subject for another post.  There’s nothing I can do about it now, other than trying (and failing) not to think about it, because it would really make me feel a lot better to have a plan but I can’t make one until I’m ready to tell my department chair that I’m pregnant.  I mean, after four perfectly-timed academic pregnancies in a row, it figures that the awfully timed one would be the one that sticks, amirite?  I’m also trying not to freak out about the fact that this baby and my tenure packet are due exactly the same week.  But hey, cross that bridge when I come to it, right?  These are really very good problems to have, in the grand scheme of things.

And that’s the update!  Hopefully, my updates will be similarly boring and normal from here on out.  Wish me luck!

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Houston, we have a heartbeat!

It’s been three years and three pregnancies since I last saw that little flickering on the ultrasound screen, but the good news is that today I got to see it again!

Since I love me some stats: I’m 6w6d, both according to LMP and ovulation date, and the fetal heart rate was 125 (anything over 120 is great).  The CRL and gestational sac both measured 7w0d, so right on target.  And there was only one embryo in there (phew).  As a point of interest, I’ve now gotten pregnant four times in a row on the right side, which suggests that that’s the only functional side left thanks to the scarring from my first pregnancy.  The summary: everything looks good so far.

Given my history, the RE wants to see me weekly until I graduate to co-management by my local OB and MFM.  So after the ultrasound today I called both of those offices to set up my first appointments.  I’m also supposed to re-start Lovenox, and possibly progesterone depending on the results of my blood test today.  Fun, fun, fun!

I also sent in the waitlist form for campus daycare.  We never sent in the form for either of my last two pregnancies, since we figured there was no point before seeing a heartbeat, so it felt like kind of a big step to do it today.  But with spots as hard to come by as they are (since they only take four infants each year), it’s important to do it as soon as possible.  It’s a little awkward now that we’re part of that tiny community — the director will see the form, and she knows us now, but I’m sure she deals with knowledge of early pregnancies (and losses) all the time.

So, even though my face is pounding with the Sinus Infection That Will Not End, I’m pretty excited.  Not too excited, mind you… I’ve been here twice before, and only one of those ended well, but it’s a really big step in the right direction to get past the point of my previous 1st-trimester losses.  And seeing that flickering little heartbeat… well, I can’t help but think about that tiny little life just starting to take shape.  It’s hard not to get just the slightest bit attached.  I hope we get to meet it some day.

Good betas

Well, I’ve got good betas.  Friday’s number: 926.  Monday’s number: 2500-something.  Doubling time: just under 48 hours.  Right on the money.

Of course, I’ve been here before.  At least three times, to be precise (we didn’t have betas drawn for the fourth pregnancy, so I don’t know if they were good or bad).  One of those times resulted in a live birth, and the others didn’t.  So, while this is an encouraging development, I’m not exactly counting any chickens just yet.

I also wanted to record a conversation that has been bugging me all day.  I was walking to a faculty meeting in a different building with my department chair, who also happens to be the closest member of my department to me in age, and with whom I am friendly.  He is currently the only person in the department who knows that I have had three miscarriages, including two since S’s birth.  As we headed over to lunch he said: “Oh, I just sent you an email about this, but remember my recent postdoc X and his wife Y?  Well, X just sent me the news that Y is 9 weeks pregnant and wanted me to share it with everyone!”

I said, “That’s great. [pause] Wow, 9 weeks… oh, to be that optimistic… But, good for them.  I’m happy for them.”

And he just kept talking, as though it was nothing.

Now, I know and like this guy.  I don’t think he meant to upset me.  But it was upsetting.  I was able to handle it OK in the moment, I think… I only expressed the twinge of wistfulness about feeling confident enough to announce a pregnancy to an entire department of your former mentors and colleagues at 9 weeks(!).  But… I would much rather have gotten the news by email, in the privacy of my office, where I could work through my feelings without needing to respond in the moment.  There was no reason for him to bring it up with me in person, other than general cluelessness surrounding my feelings about early pregnancy.  I get that he was excited for his former mentee — my colleague is a father of three young kids, and just loves babies and little kids.  I just wish he had been even a little bit sensitive to the fact of my previous losses, when clearly it didn’t even occur to him that this news might hit a nerve for me.  It made me feel lonely, and reinforced the reality that most people, perhaps especially men, don’t understand the emotional impact of pregnancy loss, particularly recurrent pregnancy loss, on women.  What it communicated to me was that he doesn’t see my losses as a big deal, and doesn’t even understand that they might be a big deal for me.

Of course, it helped that I was able to hear the news while I was pregnant, rather than two weeks ago when the testing and treatment seemed to be dragging out interminably.  It’s amazing what an emotional roller coaster every pregnancy is for me, even the fifth one.  You can bet I wasn’t in the mood to tell my chair that I was pregnant (I mean, 5 weeks is basically like 9 weeks, amirite?!), but at least I was able to feel a little bit hopeful, and then getting the news of good betas later in the day helped me feel even more hopeful.

Now I have to wait two weeks for that all-important heartbeat ultrasound, since I’ll be traveling from the 12th to the 16th of the month.  Please keep sending good wishes, especially until then!

The two-week wait after the two-week wait

I’ve gotten pretty good at the two-week wait over the years.  I am a model of patience and restraint: I never test before a missed period anymore (why would I?  It’s just a waste of a pregnancy test that I most likely wouldn’t need if I just waited for my period to come in its own time).  I’ve been pregnant five times, which means a heck of a lot of two-week waits, so I guess I’ve finally worn down my anticipation.

But the two-week wait after the two-week wait?  That’s a whole different story.

In my four previous pregnancies, I’ve always had an ultrasound at 6 weeks.  In our first pregnancy it was because we’d had some difficulty conceiving and were being followed by the RE, and after that it was because I was supposed to start Lovenox at the first sign of viability.

That first six-week ultrasound was magical.  We saw a heartbeat right away.  There was a living creature.  Inside of me!  It was amazing!  I was elated!  I cried!  I fell in love at first sight.  It was just incredible.  Later we found out it was a daughter, and that was a magical moment as well.  There was so much anticipation in that pregnancy.  Which probably made it all that much harder when it ended at 18 weeks.

Since then, the six-week ultrasound has been a different story.  I am more wary, guarded, less attached to that little bean, less surprised whether I see a heartbeat or not, more clinical as I interrogate the ultrasound tech.  In my fourth pregnancy, I warned the ultrasound tech before she started that pregnancy didn’t tend to go well for me, so I wasn’t expecting good news.  Why did I feel like I needed to warn her?  Indeed, when she had nothing but bad news to give me after that ultrasound, she was fine.  I was the one who held it together until my doctor asked how I wanted to end the pregnancy, and then I lost it.  The six-week ultrasound has gone well for me twice, and poorly for me twice, and even in the cases where it has gone well, only half of the outcomes (i.e., one) were positive.

Same with betas.  I’ve had betas drawn in three pregnancies: my first, second, and fourth.  They’ve always been great — I’ve never had a bad hCG draw.  (I say, knocking on wood, waiting anxiously for the second round of betas for my current pregnancy.)  Yet 2/3 of the pregnancies with good betas have ended poorly.  So you’d think I’d be over them by now.  But here I sit, the night after my 2nd hCG draw in my 5th pregnancy, unable to concentrate on putting together my lecture for tomorrow because I’m wondering what’s going on with my betas.

After everything that’s happened, I don’t trust betas, and I don’t trust the six-week ultrasound.  But… I still get so obsessed with waiting for the results!  I’ve been thinking and worrying about them all day.  The two weeks after the two-week wait, while I wait for blood test results and ultrasound results, feel like the longest weeks of the whole pregnancy.  (Except for the days after my due date in my pregnancy with my son — those were truly the longest days of the entire pregnancy.  Each one felt like a week!)  I torture myself: have they not called yet because the news is bad, and they want to wait to deliver bad news tomorrow?  Even if everything’s fine with the betas, it’ll be two weeks before I can have the ultrasound, due to some poorly-timed travel… how will I make it that long???

At least if the news is bad, I won’t have to wait long to find out what’s going to happen in this pregnancy.  The only way I was able to make it through my pregnancy with my son was through continuous distraction.  So I’m just going to try to distract myself like crazy for the next two weeks.  Traveling to the conference next week will help.  Afternoons with a toddler who demands all of my attention will help.  What else will help?  How do you survive the two-week wait after the two-week wait?

Pregnancy #5

It’s been quite a week at our house.

Sunday and Monday we started to notice a weird rash on S’s face.  I put Aquaphor on it and forgot about it until I picked S up from daycare on Tuesday, and his daycare teacher told me he’d been scratching himself all day and seemed really uncomfortable.  “I think he has allergies,” she told me.  Then it clicked.  I’d been on amoxicillin for a week, courtesy of a nasty bout of bronchitis / sinus infection, and we’re still breastfeeding twice a day.  S had a reaction to amoxicillin when he was four months old, but his pediatrician had downplayed it and told us it was probably just a viral rash and not a true allergy.  Well, apparently it was a true allergy.

I frantically called the pediatrician’s office and my doctor’s office and after a couple of hours.  From the pediatrician: give him Benadryl for a couple of days, no breastfeeding for 48 hours after my last dose of amoxicillin, and bring him to the ER if he gets worse.  From my doctor: don’t stop the amoxicillin since your bronchitis was so bad (although the next day they called back to say that I could stop it after all, ugh).  By this point, we were already looking at a minimum of three days without breastfeeding, only a week and a half before I was to leave for a five-day trip.  It was unfortunately abrupt and not at all the way I’d wanted to do it, but it seemed like weaning was in order.  It’s after his second birthday, and I didn’t want to confuse him or stress him out with an off-again, on-again breastfeeding relationship.  After one evening of extreme weepiness and irrational irritability towards my husband on my part, I’ve been OK.  S has taken it well.  Surprisingly, he is more insistent about asking in the morning than at night, but there has been no crying or tantrums.  He accepts it when I say, “Mama has a boo-boo and can’t nurse.”  The first time I told him that, he looked really sad, but then I said, “big boys who don’t nurse get an extra story at bedtime,” and he brightened considerably.  So, I guess we’re doing this.

OK, OK, clearly I’m dragging out the punch line of the post.  I’m really glad I decided not to risk the MRI contrast this week after all.  My period was due on Wednesday, which came and went with no signs of a period at all.  I know my cycles inside and out at this point, so I was pretty sure yesterday, but I waited to make sure it wouldn’t start today, and then stopped by the drugstore to buy a test on my way home.  Lo and behold, two strong lines, right away.  Here we go with pregnancy #5.

After I told my husband, I called my mom.  I told her I was pregnant, and her immediate response was, “You didn’t tell me!”  Oy. 🙂 (I went on to point out that I was in fact telling her at that very moment, and I had only found out myself about five minutes before, so I’m not sure when exactly she would have liked me to tell her!)

At the moment I’m just sort of going with the flow (though not literally, thankfully!).  I’m not really excited yet, I’m not really scared yet… it’s just another positive pregnancy test.  My fifth.  I’ll feel a little sheepish when I call my RE’s office tomorrow, because she had told me to hold off on TTC until the hysteroscopy was completed, but she told me the day after the OPK turned positive, so it was just a bit too late.  Hopefully I haven’t doomed myself to another preventable miscarriage and the delay of the surgery that would have fixed the problem.

With every positive pregnancy test comes a little bump of hope. Smaller each time, I think, but still there.  Wish me luck.

Delayed gratification

I used to think I was pretty good at delayed gratification.  I mean, I have a PhD, which means that after college I basically said, “You know what, 17 years of school isn’t enough.  Let’s sign up for more school, which gets harder and offers less and less specific feedback as you go, with no promise of success or a lucrative job in the field that you love at the end.”  I took that leap of faith, and there were times that were hard, but ultimately it has worked out pretty well.

I think the difference between doing a PhD and being in the long haul for fertility tests and treatments is that I really loved what I was doing when I was doing my PhD.  So, sure, there were setbacks and difficult times, but in the end, I knew that I was doing something that I found challenging, awe-inspiring, and worthwhile with my time.  The journey was worth it, even if I didn’t reach the destination I wanted to reach.  Having pregnancy-related issues is a horse of a very different color.

Or is it?  I mean, yes, it’s a slog.  Much more of a slog than grad school ever was.  I go from panicking about my ticking biological clock to the physical discomfort of tests and treatment to disappointment after disappointment as my period arrives or the next miscarriage starts.  Every positive pregnancy test brings a cocktail of elated hope and terror and resignation.  Every two week wait is an exercise in patience and acceptance.

But, would I choose anything different?  My options are either this, or giving up on adding another much-wanted member to our family, or pursuing a totally different mix of hope, terror, elation, stress, and cost to add another family member a different way.  And while this happens, I’m going on and living my life.  I’m working hard at a job I love.  I’m being the best wife and mother I know how to be.  I’m raising my one living child with all the joy and commitment and love that I’ve been saving up and bubbling over with.  It’s hard.  But it’s the path that feels authentic to me given the choices I have.

Cultivating acceptance, cultivating patience, cultivating cautious hope in the face of setback after setback.  This is the work of the current phase of my life.

What’s motivating these reflections this week, you might ask?  I was supposed to have my MRI tonight, which was supposed to let me move on to the next thing, the hysteroscopic surgery to remove the adhesions and possibly fibroids that my RE thinks might be contributing to my recurrent miscarriages.  But my RE neglected to mention that she was ordering contrast for the MRI, which you can’t have if there’s a possibility that you might be pregnant.  And since I last saw her the day after a positive OPK result, there’s a possibility (a remote one, to be sure) that I might be pregnant, but of course it’s too early to tell for sure (my period is due on Wednesday).  So I called her office today, trying to find out whether the MRI might still be worthwhile without the contrast.  But she was on an international flight, and the nurse wasn’t helpful, and ultimately I just wound up having to reschedule the MRI for next week.  Then I called to reschedule the follow-up appointment with the RE, which I need to do before we can move forward with the hysteroscopy, and she doesn’t have an opening for another three weeks!  So there goes another wasted month.

I felt so frustrated today.  I wanted to complain to someone, but there’s nobody I see on a daily basis other than my husband who knows what I’m going through, and I try not to complain too much to my husband because I hate to stress him out on my behalf.  So instead I’m trying to put my frustration into context.  It’s not really frustration with this one test being rescheduled.  It’s frustration with the entire process of five years of four pregnancies and three miscarriages.  It’s frustration with watching other women get pregnant around me with their second or third living child.  It’s frustration with a medical system that feels so impersonal, with the uncertainty of never being sure that what I’m doing is a necessary or sufficient approach to adding another living child to our family.  It’s frustration with my life not going the way I want it to despite my very best sustained efforts over a long period of time.  And today it just bubbled over during the string of multiple phone calls with my doctor’s office and the radiology line.

I may be good at delayed gratification, but this is straining my abilities.  I just hope that there is, ultimately, gratification to be had, and that this journey is worth it in the end.

More procedures

I met with the RE again today to go over the month of testing that turned into three months of testing, and it did not go quite as I’d expected.

From what the nurse practitioner told me after my SHG, I thought there were a few irregularities with lining thickness that showed up, and that was all.  From what the radiologist told me at my HSG last week, I thought there were some hints of synechiae, but that it didn’t look like a big deal.  Apparently, taken together, my RE thinks that these results are a big enough deal that now I need an MRI and a hysteroscopy, and that my husband and I should hold off on trying again until both of those procedures have been completed.

The MRI is to determine whether or not I have fibroids.  Apparently the shape of my uterus on the SHG was irregular enough that she thinks there’s a possibility of fibroids — but she also said that the irregular shape could be caused only by adhesions, which it’s pretty clear that I do have at some level.  I don’t need to do the MRI, strictly speaking, since they could probably figure everything out during the hysteroscopy — but it will determine whether or not the irregularities are due to fibroids before I have the hysteroscopy, which is important mostly so that I know what to expect going into the procedure (since fibroid removal is a bigger deal that adhesion removal).  Then, the hysteroscopy is supposed to go in and fix whatever adhesions are kicking around in there, plus the fibroids if they exist.  Since I have a history of adhesions, and since adhesions can cause RPL, and since I now have two tests results pointing to adhesions in my uterine cavity, she says she thinks we should definitely do the hysteroscopy to remove them before trying again.

In theory, this course of action makes practical sense.  In practice, I am bummed that this testing/treatment process is just dragging out indefinitely.  What I initially thought would be one month of testing (in December) will now be a minimum of four months of testing/treatment, and it sucks.  And I don’t even know when we’ll be able to start TTC after that — it depends on whether it’s fibroids or just adhesions.

One step forward, two steps back.

So, that’s where I am now.  I don’t know a whole lot about timing at this point — I have to call to find out about MRI scheduling tomorrow.  She said she could probably do the hysteroscopy on my next cycle, but only if they can do the MRI *and* schedule a pre-op appointment before then, which means during the next 2-3 weeks.  So, things are a little bit up in the air right now — I have a treatment plan, but I don’t know how long it’s going to take or what to expect in terms of recovery time afterwards.  Ugh.

Anyway, I’m mostly managing to be zen about it — I’m really just discouraged by the long, slow timeline, but it’s nothing I’m not used to at this point.  Mainly I’m sad that we aren’t supposed to TTC until this is over.  It just feels like so much wasted time that I don’t have. But, all of my other tests looked good, including ovarian reserve, so I’m trying to remind myself that a few months here or there are unlikely to make a difference in the long run and that this currently looks like the best route to a new healthy pregnancy.

I’ll keep y’all updated.