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?

The First Year

Hard to believe it, but the first year of my son’s life is past.  No longer an infant, he’s officially a toddler.  He decided to take his first four steps on his birthday, and watching him wobble from the kitchen island into my arms was an amazing moment — literally walking towards me, but figuratively taking steps away from his babyhood and into the little boy he is starting to become.

What a year.  It’s been hard, of course… but not as hard as I feared.  Mostly, it’s been amazing and surreal.  I still look at my son every so often and marvel at this little human, this creature who now exists and didn’t before.  This person who grew inside my body.  I wonder what’s going on in his mind.  I wonder what his life will be like as he grows.  I delight in watching him discover the world, discover his new capabilities, discover communication and connection.

He is his own little person, developing his own quirks and preferences.  He snuggles by rubbing his forehead against us (where “us” refers to my husband and me, our dog, his stuffed animals).  We discovered on his birthday that he has a healthy skepticism of helium balloons, which appear to defy all the laws of physics that he has come to know through experience.  All week we’ve watched him come to terms with the unnerving balloon in our living room, first glaring at it while pressed into my shoulder, then eyeing it warily while he played, then gradually moving closer, then touching it and recoiling as it drifted back towards him, then eventually grabbing it and giving it a good shake.  He’s cautious, but becoming an explorer.  Those first steps have been followed by an occasional one or two here or there, but he still prefers the speed and certainty of crawling.  He’s not saying any words yet, but he’s demonstrating that he understands a surprising amount of what we say to him.  He knows who Mama, Dada, Goldie (our dog), and Nana (my mom) are, he knows how to clap his hands (even if we just tell him without showing him), how to shake, how to dance, how to put one block on top of another, how to give us a toy (even if he doesn’t always want to), how to “come here,” how to “go get it,” how to snuggle, and how I ask if he wants to nurse.  He makes his wishes known if he wants us to read a book again, or press the button so that his stuffed elephant will sing again.  He is eating a wider variety of solids, and strongly prefers to finger-feed himself, generally refusing a spoon (unless it’s mommy’s spoon with mommy’s food on it). This week he ate blueberries, kiwis, clementines, quesadillas with beans, cheese, and avocado, polenta, toast with peanut butter, graham crackers with cream cheese, and a ton of fruit and veggie puree.  He is still skeptical of squash and green veggies that are not in pureed form.

My attempt at gentle night weaning has been a rousing success this week — after his birthday, I started nursing him for one minute less each night, and after the night when I fed him for only three minutes on each side, he just… stopped waking up.  Last night was night three of a solid 11-hour night without a feed, and without any fussing that required us to go in to comfort him.  All of a sudden my little guy is sleeping on his own, and it’s glorious.  He seems better rested and is sleeping longer too!  Now if only he’d nap longer than 30 minutes at daycare…

I love this little guy to the moon and back, and can hardly remember life without him.  Sometimes it takes my breath away how much I love him.

And… we are officially trying to have a sibling for him.  That’s probably a subject for a whole other post, but I am fully expecting it to be a long haul.  So we’re getting started now, planning to try on our own for a while before going back to the RE when he’s somewhere around 18 months.  I’m approaching this attempt much more like a marathon than like the furious, desperate sprint to get pregnant as quickly as possible after his sister died.  I just turned 34, so we don’t want to wait forever, but we can afford to take it slowly for a little while.  To be honest, I’m not exactly eager to jump into having two kids right away, even though we know it’s something we want in the longer run.  We’ve just hit our stride with one, and rewinding back to the newborn days looks daunting, to say the least.

In the meantime, we have an amazing little boy to enjoy and to care for, who fills our lives and our hearts to the brim.  We are so fortunate.  What a difference a year makes.

Breastfeeding and Trying Again

OK, here’s the thing… we are three weeks away from my son’s first birthday.  There are many amazing things to reflect on at the end of this first year.  I am acutely feeling the parenting cliches: on the one hand, it feels like only yesterday that I was holding my wide-eyed newborn son in my arms, and on the other hand, it feels like he’s been with us forever, and I can hardly remember my life without him.  There are many more things I hope to write about as his first birthday approaches and passes, but another thing I’ve started thinking about as his first birthday approaches is our strategy for conceiving the  living sibling we hope that he will one day have.

Surprisingly for me, my thoughts on trying to conceive our third child are all tangled up with my feelings about breastfeeding my son.

Conception and pregnancy have never been easy for us.  It took 2.5 years from the time we started trying to conceive to the birth of our son.  There were two pregnancies along the way, including the loss of our daughter in the middle of the second trimester.  Both pregnancies involved consultation and testing with a reproductive endocrinologist, and the second time around the RE had recommended moving onto IVF due to tubal factor infertility, which we were in the process of preparing to do when I became spontaneously pregnant with my son.  I am not expecting conception or pregnancy to be easy the next time around either.  Tubal factor infertility (in my case, due to the infection and scarring that occurred after the loss of our daughter) does not tend to get better with time, and it might have gotten worse since the birth of our son.  It is likely, though not definite (we might get lucky again!), that IVF is in our future.

What does all of this have to do with breastfeeding?  For one thing, breastfeeding influences menstrual cycles.  My period returned when my son was 10 months old, but it’s been irregular.  While I’m breastfeeding, it may remain irregular, but I won’t know whether the irregularities are due to breastfeeding or some other hormonal imbalance.  Muddying the waters, I had wildly irregular periods for 11 months before conceiving our daughter, and then clockwork regular periods for 8 months before conceiving our son.  We’d like to try for a while on our own before going back to the RE, but it’s trickier while my periods are irregular.  There are also some data indicating that breastfeeding might impede implantation and reduce the likelihood of pregnancy.  Finally, most REs make a blanket recommendation that you should cease breastfeeding before starting fertility treatments, although it’s not clear how evidence-based that recommendation is.

Many women think of it as a tension between their living child and their hoped-for child: do I prioritize the breastfeeding relationship with the child I have and love, or do I wean in order to maximize the probability of conceiving the child I hope to have?  I suspect there’s a middle-of-the-road option I might be comfortable with, but I’m not yet sure what that looks like.  My breastfeeding relationship with my son is still going strong as his first birthday approaches, but he doesn’t seem to be as attached to breastfeeding as some of my friends’ children.  He doesn’t really ask to breastfeed very often, and he’ll often refuse when I offer because he’s much more interested in seeing what’s going on in the world around him and doesn’t want to take any time out to nurse.  So a bit of mama-led weaning might be well received.  At the same time, I love our breastfeeding relationship and am not sure I’m ready to encourage its end, plus I know that my son derives comfort from it, especially when he is sick or tired.

So, what does our plan going forward look like?  When he was first born I thought “We’ll start trying when he’s a year old, and go back to the RE at six months.”  Now, with no end to breastfeeding in sight (and, honestly, with sex still kinda uncomfortable thanks to the breastfeeding hormones), I’ve started to think “Maybe we’ll start trying when he’s 18 months and go back to the RE when he’s 2.”  I don’t want to wait too long, because I’m not expecting the road to be easy, and I’m not getting any younger.  I’m turning 34 next week, and staring Advanced Maternal Age squarely in the face.  I know that timing can make a huge amount of difference in IVF cycles, and that waiting to even go back to the RE until I’m already 35 (when my son turns 2) might be risky, especially since we’d love to keep the option of a third living child open if we are lucky enough.   I feel sad contemplating the end of our breastfeeding relationship.  But the experience of having our son in our lives has only made our desire for another living child stronger, and my husband and I don’t want to wait too long.