Tag Archives: infertility

One Month of Testing Becomes Three…

Well, so much for “One month of testing and you’ll be done!”  I haven’t yet seen the RE for a follow-up appointment, but apparently after reviewing my SHG and endometrial biopsy results, she wants to also do an HSG.  But since she didn’t realize it until a week into my current cycle, I have to wait another cycle to get it done.  I guess technically we can try to get pregnant this cycle, and if it works, great… but I’m not optimistic.  At least the HSG doesn’t prevent us from trying next month, so it’s not as though we really lose time, but I was just hoping to be done with testing and ready to move on to planning.

Here’s the recap on the testing results that are in so far: apparently everything is pretty much normal.  The endometrial biopsy was negative, all my blood tests were normal, the SHG showed nothing weird except for a slight thickening of the lining on the anterior wall, which I already wrote about — and if it were anything serious, the endometrial biopsy should have picked it up.  So no answers, but also no identified problems.

So then, what triggered the HSG, you might ask?  I’m not actually sure, since I didn’t get a chance to talk directly to my RE (I was supposed to have an appointment this coming Tuesday, which she suggested over electronic messaging that I cancel and reschedule for after my HSG).  But here’s the story as I see it:

Before the HSG, the APRN doing the test did a baseline ultrasound.  Everything looked just as expected, but she did point out an odd cyst-like thing near but not on my right ovary.  She said it might be a paratubal cyst, and that it looked like it was in the location of my right fallopian tube, but didn’t seem too concerned.  After the test, I mulled it over and remembered that during the 6w ultrasound where we found out I was miscarrying my last pregnancy, the ultrasound tech had seen the same thing, although she didn’t mention that it might be tubal — she just told me that it was a cyst-like thing that wasn’t on my ovary.  Just to back up a step, these two ultrasounds were actually pretty close together in time — we found out I was miscarrying the first week of November, and then the testing cycle and SHG took place right after I had my first post-miscarriage period in December.  So it’s clearly the same cyst-like thing, which was not there in June when I was going through my second miscarriage, but was there immediately after my third (most recent) miscarriage.

Now, combine this with the fact that I had high hCG levels in my most recent pregnancy — the last measurement at 5w was 2700 with a doubling time of less than two days.  At those levels, you’re supposed to be able to see a gestational sac on ultrasound.  But at my 6w ultrasound, there was no gestational sac… just two small irregular lumps in my uterus that the tech said might be bleeds.  And I know that the right side is the side I ovulated on for the pregnancy, and it’s also the side that this possible tubal cyst is on.  So, after remembering all of this, I wondered… is there any possibility that my most recent pregnancy could have been an undiagnosed ectopic, and the thing on my right tube is not a cyst but rather the missing gestational sac?  Obviously I wasn’t in any danger, since the RE did follow my hCG levels back down to zero, so if it was ectopic it resolved on its own (like 80% of ectopics, apparently).  But it seems like it would be an important thing to know to figure out how to proceed — and I already knew I had elevated risk for an ectopic since my second HSG showed scarring of both tubes.  Since I’d been seeing my local OB for the miscarriage, and then went back to the RE for RPL testing, nobody had all of the information, so it makes sense that the RE wouldn’t have considered it.

Anyway, I wrote a message to the RE’s office containing this question, and asking whether I should have the records from my most recent two pregnancies sent to the office.  The RE replied that an ectopic pregnancy was plausible, though difficult to know for sure, and that I should have the records sent over… and that’s when she suggested an HSG to assess tubal patency.  If you’ve been reading my blog for a while, you already know that my tubes were somewhat damaged during my first pregnancy, which we found out during my second HSG.  But since I then proceeded to get pregnant three times on the right side, it’s pretty clear that at least my right tube was still functional.  However, apparently now this cyst thing (or possible gestational sac?) is weird enough that she wants to make sure it’s not blocking my right-side tube.

I’m not actually sure what to hope for in this case.  Part of me is just sick of endless trying to get pregnant and miscarrying, and as I’m turning 35 I’m sort of thinking… I kind of hope it’s blocked, because then we can just do IVF already, and then they’ll do PGD and make sure they’re implanting chromosomally normal embryos and maybe it’ll finally work.  Of course, I’m not exactly excited about doing IVF, so in that sense I hope my right tube looks no worse than the last time they did and HSG and I can just get pregnant the old-fashioned way again.  I’m also just generally feeling grumpy about doing a THIRD freaking HSG, right after I’ve just done an SHG and an endometrial biopsy.  Enough messing around in my uterus, already!

Anyway, much as I’m not wild about the idea of another HSG, I am a sucker for information, and I do want to know whether my tubes have gotten worse or not.  So, I’ll go along with it, and wait for my next period, and do the HSG, and see what happens.  But that means I probably won’t have the results of the HSG and meet with my RE until, like, late February or even March.  UGH.  I hate the slowness with which this sort of testing and treatment moves.

And in other news, I’m currently away for three days at a conference (in Washington, DC), and I miss my little guy something fierce.  I felt so guilty leaving him, especially since he had a fever the day before I left and was super clingy and only wanted his mommy.  I hope he doesn’t think I abandoned him!  I cannot wait to snuggle that little munchkin tomorrow afternoon.

So, that’s where we are now.  I hope all y’all’s new years are off to a better start!

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Still Trying… With Some Perspective

After four cycles of trying, still no luck.  I know that especially since my tubes are crap this is still well within the range of normal, but I’m starting to contemplate when to go back to the RE.  The decision is complicated by the fact that my ovulation pain reached new heights of awful this month and sent me back to my OBGYN basically asking “This is not normal, right? Is there anything I can do about it?”

To give you an idea, this month for five days leading up to ovulation I experienced pressure and abdominal pain.  For the ~2 days around ovulation, everything hurt.  It hurt to sit down, it hurt to walk, it hurt to have sex (which is just adding insult to injury), and the pain was so bad that it woke me up in the middle of the night.  I mean, I know some level of ovulation pain is normal, but this just seems beyond normal.  I had brought up ovulation pain at my last annual visit and my doctor brushed it off, but it was so bad this month that I decided to go back.  So I made an appointment, which wound up being with their midwife who I haven’t met before (I thought someone told me she had retired, but apparently she’s back).

I ran through my symptoms and she basically said that she’d be happy to order an ultrasound but didn’t think she’d see anything — I agreed that she was probably right, particularly since I just had two ultrasounds in May/June during my miscarriage, which also didn’t show anything weird about my ovaries.  She said it’s probably either endometriosis or adhesions — I know I have some scarring from the first pregnancy when we lost our daughter at 18 weeks and I developed an infection that I later found out had scarred my fallopian tubes (worse on the left than the right, which is probably why my two subsequent pregnancies have both been on the right).  She said that there’s basically nothing they can do about those things: “Well, I mean, there’s surgery, but…” she said with a little laugh.  I was sitting there thinking: why are you laughing about surgery?  It was as though she thought it was ridiculous that I might consider surgery for pain bad enough that it affects me for a whole week of every month and wakes me up in the middle of the night.  I mean, that’s bad, right?  So the upshot of the appointment was that I declined another ultrasound, and she told me that my best option was going back to the RE — she thought maybe another HSG would help break up some of the adhesions and relieve the pain a little (which sounds sketchy to me, but what do I know?).  I left totally down in the dumps, wondering when I can finally put this phase of life behind me, because it’s just so unrelentingly awful (except for my son, who is the best thing in the Universe, which is the only reason I am willing to keep putting myself through this crap to try to have another one).

Fast forward two weeks to today, and my period arrives.  I’m feeling like crap, thinking I’ll never get pregnant again, or if I do, the baby will probably die again.  Then I had a meeting with our colloquium speaker.

This colloquium speaker and I have known each other on and off through meetings, talks, and conferences for a number of years.  I think we have sort of a little mutual admiration society going on. I remember meeting her for the first time when she was a grad student and I was visiting her university as a postdoc to give the colloquium.  She had just had a baby a few weeks before, but came to campus specifically to meet with me.  I was equally as interested in her science as in what it was like to have a newborn — we had a ton to talk about.  She just seemed so put together, was doing such awesome science, was interested in science education, was thoughtful, and appeared to be super-mom on top of it.  My career was a little farther ahead than hers, but she was a little older because she’s a non-traditional student who started her PhD a little later in life.  So, we kept tabs on each other a bit, as we both bounced around and wound up in our dream jobs as physical scientists at liberal arts colleges only an hour’s drive apart in New England. I started my job four years before she did, which means that she just started her job in January of this year.  I had a kid about three years after she had her first.  She invited me up to give a colloquium her first semester on campus, and this semester I invited her down to give a colloquium at our campus.  Today she’s visiting, and we started off our meeting with the usual excited back-and-forth about what we’re both up to — how her first year of teaching is going, how my approach to tenure material submission is going, etc.  Then, she changed the subject.  She mentioned that she was 22 weeks pregnant.  I congratulated her, quite genuinely, but couldn’t help feeling a small pang of self-pity that she was pregnant and I had just gotten my period for the fourth time after miscarrying, seven months into the journey to conceive our second living child.

But then, she kept going.  She remembered a conversation we’d had a while ago — she had shared that she had two miscarriages in a row, and I had shared about the loss of our daughter in the second trimester.  Well, it turns out that two weeks ago, at their 20 week anatomy scan, she got some bad news that their baby is much smaller than expected.  She is in that heartbreaking waiting phase where they’re trying to figure out how bad it is and whether they will be able to make it to viability, but there is much talk of early delivery and long NICU stays and potential long-term health issues.  Apparently they can’t yet tell whether it’s a placental issue or a chromosomal issue, but neither outlook is good.  She won’t know more until her next ultrasound in two weeks, but she’s been thinking a lot about how to handle it.  She wanted to know if I had any advice based on what I’d been through before (with weirdly similar timing relative to my tenure clock — we are truly living parallel lives in some ways).

My eyes immediately filled with tears for her.  And I silently kicked myself for allowing that earlier pang of self-pity.  It was an important reminder that we never, ever know what other pregnant women are going through, even when it looks from the outside like everything is perfect.  Advice.  What advice do I have?  None, really.  I don’t think I handled my 2nd trimester loss particularly well, but I also don’t think there is a good way to handle it.  I told her a few things:

  • Please accept offers of help.  I didn’t and I made things unnecessarily difficult for myself.  This is a huge life event, and it’s a small fraction of your time on the tenure clock and your life overall, so be kind to yourself while it’s happening.
  • If doing work feels therapeutic to you, go with it.  I couldn’t function for my own sake while I was going through our loss, but I could force myself to function for my students’ sake.  So if it feels right to work, work.  If it doesn’t, don’t.  You need to do whatever you can to get through this.
  • She wanted to know if I had thoughts about when she should tell her department — should she tell them soon so they could plan for the possibility that she might need to take medical leave?  I don’t know if this is the right answer, but I said no.  She doesn’t know what will happen.  Possibly nothing will happen, and she’ll be able to get through the rest of the semester without any issues.  Nobody can plan for this right now, so she has no responsibility to tell other people if she doesn’t want to.  They will figure it out.  They will not blame her for not telling them the news sooner.  There is really nothing to tell right now other than that her baby is sick and she doesn’t know what’s going to happen.  I advised her to wait until she knows what she needs so that she can ask for what she needs.  Unless she wants them to know for emotional support purposes, but my experience was that people really don’t understand pregnancy loss, especially in the second trimester, and having everyone know is often just a higher emotional load to deal with.

That was pretty much all I could think of.  I also told her that I am so, so sorry, and that I am here to help or if she just wants to talk — I told her that when our daughter died, I was just desperate to talk to people who had had second trimester losses, especially those who had gone on to have healthy pregnancies afterward, so if she has the same desire I am absolutely here for her.  I just wish she didn’t have to go through it, especially not this tortuous period of not knowing what’s going to happen.  She sounds pretty pessimistic about having a healthy baby at the end, but I will be hoping upon hope that it’s another case of unreliable ultrasound and that everything will be fine.

These childbearing years are the hardest thing I’ve ever been through, and it breaks my heart the more I learn how awful they are for so many women.  I wish there were a better way.  I wish it were easier.  I wish people talked about it more and were better at supporting each other through it.  I wish we could just wish children into our lives.  When they do come, they’re amazing, but it doesn’t seem like we should have to endure so much suffering to get there.  I will be holding this friend in my thoughts, and checking in with her in two weeks to see if she needs anything after their next ultrasound.

Day 3 labs and my dad’s memorial service

I swear I’m not as much of a grumpy gus in real life as I am on my blog, but I sure do feel like I have plenty to be grumpy about these days.  I thought I had left most of the bitterness of pregnancy loss and infertility behind me, but we’re now six months and one miscarriage into trying to conceive our second living child and I just today saw the second pregnancy announcement from a friend/acquaintance who is five months pregnant (which is how pregnant I would be right now if I hadn’t miscarried), and my dad’s memorial service was last Saturday, and we’re heading into midterm season which is no more fun as a professor than it was as a student, and I am GRUMPY about it all.

As part of the conversation with my OB about how to go forward with trying to conceive after my miscarriage in May, she offered to repeat my Day 3 labs, which I haven’t had done since before my daughter was conceived — I figured that if they were normal, I’d be more comfortable trying on our own a little longer, but if they indicated low reserve I’d want to head back to the RE sooner rather than later.  The results came back this week, and my FSH and estradiol are both normal (8.8 and 49, respectively).  My FSH was 8 before, so things don’t seem to have changed much there (although I do always worry about inter-cycle variability).  My AMH was a bit on the high side — good for egg quantity/quality, but apparently a potential indicator of cysts or PCOS.  Which makes total sense to me, because it seems like every time I get an ultrasound someone tells me I have a cyst and they’ll “keep an eye on it” and then they never do and then I mention it whenever they do another ultrasound and they’re like, “oh, huh, you do have a cyst… well, it looks normal, but we’ll keep an eye on it,” and then nothing happens.  I also wonder if my borderline high AMH levels are related to the fact that I get wicked ovulation pain these days — I don’t even really need OPKs anymore, because I can tell 2-3 days before the OPK turns positive that I’m starting to ovulate, and by the time I get to ovulation day it hurts to sit down.  Anyway, who knows?  My OB mostly just brushed it off (I didn’t actually get to talk to her; she left a message and said to call if I had questions and I haven’t gotten around to it).  But at least my eggs aren’t rotten, which was my main concern.  So that leaves us in purgatory of trying and trying and wondering when to go back to the RE.  I think I’ll probably wait it out until January — that would be seven cycles of trying post-miscarriage (since it took me >2 months to get my period back after the miscarriage), 10 months since we started trying after our son was born, and it would also be past the window of inconvenient due date timing (since I’m planning to submit my tenure materials next November).  Seems like a good time to step up our efforts.

In the meantime, I held my dad’s memorial service last Saturday.  It was so strange.  I still don’t really believe that he’s dead.  Most of the family got together, and it was nice to see everyone.  In a way, it was one of the more pleasant family funerals since nobody was really all that sad, since nobody was really that close to my dad — sounds weird to say it that way, but it’s the silver lining of my dad’s depressing life during which he worked hard to alienate himself from pretty much everyone in the family.  My uncle is a minister, and he planned most of the service.  He did a nice job — told some stories about my dad that were funny but didn’t totally whitewash the seedier sides of his personality.  It’s got to be disconcerting for my uncle that he’s now led funeral services for his parents and two of his three siblings, but you’d never know it from the way he was up there talking and laughing and playing Grateful Dead songs (which my dad definitely would have appreciated).  My son, S, was the star of the show, if that’s a thing that one can be at a funeral.  He was dancing along to the Grateful Dead songs, peeking over my shoulder at a family friend and saying “Boo!” during the service, and when I got up to give the eulogy he held out his arms yelling “Mama, mama, mama!” until I just picked him up and let him sit on my hip while I spoke and he tried to disassemble the microphone.

I had some really nice moments with my dad’s old friends who told me stories about the good old days when my dad was actually a functional human being and did some really important welfare reform work — like, welfare reform that influenced policy decisions across many states and also the platform for one presidential campaign that my dad worked on.  It was all before I was 5 years old, so I don’t really have any memories of those days, but it was nice to hear about how he used to be really driven and dedicated to helping other people.  I don’t know what happened — part of it was being diagnosed with Multiple Sclerosis, although that’s clearly not all of it.  As I mentioned before, there were drugs and alcohol and abuse involved, and I’m pretty sure there were some undiagnosed mental health issues too.  Not depression/anxiety so much as narcissistic personality disorder with perhaps a touch of sociopath, if I may armchair-diagnose my deceased father.  Anyway, it was good to hear his friends remember how he used to be, and to hear stories about him that I hadn’t heard before.  Since he died a lot of my sadness has been related to the empty life he led, particularly towards the end (I won’t elaborate on some of the things I found while cleaning out his apartment, but they were incredibly depressing) and so it was nice to hear that there were other parts of his life that were more fulfilling than the parts that I had the front row seats for.

So, that’s where we are now.  Making arrangements for the funeral and my dad’s affairs has been eating up my life since he died ~3 weeks ago, and with traveling back home on the weekends and my phone ringing off the hook I’ve been very behind on work and it’s been very stressful.  I’ve still got a stack of grading to be done, but I’m keeping up on the essentials, and now I finally feel like I might have a tiny hope of catching up — not that any academic is ever truly caught up, but at least I hopefully won’t feel that I’m constantly dropping balls and letting people down.

One sort of interesting thing that happened this week is that on Monday I was apologizing to one of my masters students for not answering an email that he had sent on Friday — I said that I didn’t want to play the sad card, but I did want to explain that my father’s funeral was Saturday so I just didn’t look at my email all weekend.  He said, “Wait, your father’s funeral?!” and I realized I hadn’t actually told him that my father had died, even though it had come up with all the other members of my group at one point or another.  But after that student found out, nice things started happening all week — the grad students in our department all signed a sympathy card for me and chipped in on a gift certificate to a local restaurant, and then “the students” brought surprise baked goods to our research group meeting today.  When I walked in and said, “Well, this is nice!  What’s the occasion?” they said, “We just wanted to do something nice since you do so much for us,” and it just about collapsed me into a weeping puddle of goo right then and there!  I have strong suspicions that this masters student who found out late goaded the other students into action — it fits his personality, and he’s a non-traditional older student, already married, so he’s significantly more mature than the other students in our program.  But it is clear that all the other students eagerly piled on once someone initiated, and I am grateful to all the students in our program — and my research group — for their kindness this week.  Even though it’s a little awkward, it’s nice to be treated like a human with feelings and shown a bit of appreciation occasionally (not that that’s why I do what I do, but it’s still nice when it happens!), and at a time like this it means even more than it otherwise would.  Our tiny department has all the pros and cons of small town living, but the way people support each other is one of the biggest pros there is.

Plan G

I think I’ve written about 5 or 6 blog posts by now about our newest fertility plan developed with the help of our doctors, so I think we’re on about Plan G by now, right?

This week marked two important appointments in our family life: (1) the 3-month follow-up visit with the OBGYN after my miscarriage in May, and (2) an official evaluation of S’s speech by our state Early Intervention program.

With the OBGYN, basically it was just a discussion of whether or not my periods have resumed normally since the miscarriage (answer: yes, although it took a while so I’ve only had one), and discussing a plan for moving forward.  Since I got pregnant so quickly last time around, my husband and I are a little more relaxed about trying on our own for a while.  But, also since I got pregnant so quickly the last time around, we didn’t have time to do the tests the RE had suggested to check my hormone levels to help figure out a course of action.  Since I’ve still got at least two conditions potentially affecting my fertility (irregular periods, which I’ve had for a while and have now gotten pregnant with three times so they don’t seem to be that much of a problem, and my scarred fallopian tubes, at least one of which is clearly still functional), it’s a little hard to know how to balance trying on our own with upping the ante on the infertility side of things.  Our fertility history is neither the greatest nor the worst, so it seems likely that I’ll eventually be able to carry another pregnancy to term… but I’m also approaching 35, so we don’t want to mess around too much.  The OBGYN said she’d just run the Day 3 labs herself, and I thought that sounded good because assuming they’re normal I’ll feel a little bit more relaxed about ovarian reserve and might be more comfortable trying on our own even as I cross the magical age 35 line into Advanced Maternal Age (gasp!).   Since we’re traveling to visit our in-laws this week and I’m expecting my period sometime in the next couple of days I might have to wait until next month to do the labs, but no biggie there.  So, at least for now, the plan is for us to try on our own for 6 months assuming the Day 3 labs are normal, and then if nothing happens head back to the RE for a new plan.  We’ll see how it goes.

The Early Intervention evaluation also went well.  The two evaluators who showed up at our house Tuesday afternoon were lovely — clearly experienced, comfortable with each other and with kids, and very thorough.  They ran S through a whole battery of tests checking every area of his development.  Other than a brief intervention from me when S decided it would be a good time to chug-chug-chug his train into the dog who was minding her own business sleeping on the living room floor, he behaved very well and wasn’t too shy with the evaluator even though he’s usually shy with new people.  The upshot is that he has a mild speech delay, something to keep an eye on but not bad enough to qualify for state services.  The tests confirmed what I’d thought, which was that there’s an enormous gap right now between his comprehension and his production.  He scored 95th percentile in receptive language, but only 9th percentile in expressive language.  The evaluator told us that there’s some evidence that having good receptive language skills is one positive predictor of a kid who will just outgrow a speech delay with time, although of course it’s not guaranteed.  They are sending us some materials in the mail about how to help encourage his speech development, but she said we’re already doing a lot of the big things like encouraging communication with sign language, reading to him, and exposing him to the rich environment of daycare where he’s around other kids who are talking more.  They also recommended that we talk to our pediatrician about having his hearing tested — the evaluator said that even though his receptive language suggests that he’s hearing just fine, she’s seen other kids that “fooled” them in the sense that even though they understood a lot, just a little tweak in their ability to hear got them to distinguish much better between different speech sounds and really set them off on a language spurt.  So, we’ll work on getting that set up when we visit the pediatrician next week.

Otherwise, we are having a lovely visit this week with my in-laws in the Midwest.  Traveling with S this year is just infinitely easier than traveling with him as a 6-month-old last summer — seriously, after our visit last summer I wasn’t sure we’d ever come back, but now that he’s a curious toddler who just wants to soak up every bit of attention from his doting grandparents and play with all the toys that Grandma has been scrounging off of Craigslist and enjoy zoos and parks and other such outings… he’s having a blast, which means I’m much more relaxed too.  I still find it really hard to let Grandpa and Grandma take charge, especially where safety is concerned.  They wanted to take him for a ride on the train this afternoon, and I just couldn’t stand seeing Grandma holding him up quite *that* close to the tracks while the train was pulling into the station, and then when we were walking through a really crowded place later I just didn’t want to be more than arms reach away from him because I was afraid he would get lost in the crowd, and I couldn’t help but grab his hand anytime he wandered more than a couple of steps away from them.  I know Grandpa and Grandma are very careful with him, but somehow I just can’t keep myself from worrying all the time.  I mean, I worry about leaving him at daycare, but (a) I do it every day so I’m kind of used to it, and (b) usually I don’t have to watch other people take care of him while I hang back.  I also know Grandpa and Grandma aren’t as quick or steady on their feet as my husband and I are, and they don’t know all the ways that a toddler can be quick and wriggly, so I hover.  They freak out about all the wrong things (like when he’s walking in a goofy way down the sidewalk and Grandma thinks he’s going to fall over when he’s clearly not), and don’t know to worry about the actually dangerous things (like the fact that he has zero sense of self-preservation and is liable to fling himself out of their arms when they hold him out to see the train, or dash into an impenetrable crowd of strangers with no warning).  I try to control myself, but I can’t help it.  That’s been the hardest part of this visit, honestly.  But it’s still a major improvement over last summer when nobody was sleeping and S cried the whole time and then Grandma cried because she was so sad that he was so sad while visiting her.  Looking back, I’m pretty sure he was getting like four teeth at once and going through a sleep regression on top of the travel stuff, but at the time I was afraid we’d broken our baby and that this cranky miserable sadness was going to be his personality forever.  Ha ha, first time parent kookiness. 🙂 This year he’s back to being my sweet little boy, and I love seeing him so happy with his grandparents.

One thing that helps is that he is finally saying “mama” (which is basically his only recognizable word other than “uh-oh,” “up,” and “yeah”) and it’s the sweetest sound in the whole world.  I mean, I know that seasoned moms can get annoyed by constant cries for “mama, mama, mama!” but for me, it’s still very new and incredible.  When he reaches for me and says “Mama!!!” it just totally melts my heart.  He knows who his mama is, and he makes it clear that I’m his rock (with Dada as an acceptable substitute most of the time).  Being his mama has been the most special relationship of my life, opening a completely new dimension into my understanding of love, and to hear him call for me and know that he feels towards me at least a little of what I feel towards him is just pure magic.  This is such a special time of life with our little boy.  Even as I navigate spending time with in-laws and plodding down the long and winding road to completing our family, every so often I step back and just marvel in amazement at the wonder of this little human we created.  He’s incredible.  He’s just a normal toddler, but to me, he’s the biggest miracle of creation.  Parenting seems to be an exercise in turning the most mundane things — diaper changes, snack time, waking up at 4:30am with a jetlagged ball of energy — into the most miraculous parts of being alive.  I know some moms are bugged by the old ladies who tell you to “enjoy every minute of it,” but when a checkout lady at Home Depot gave me that line last week, I was able to reply honestly, “Oh, I do… almost every minute!”  I really do.

Talking about Family Planning with Students

Last week the senior faculty member in my department hosted his annual 4th of July barbecue for our department — all the faculty, their families, and all the students who are here doing research for the summer were invited.  It was quite a crew (for a liberal arts college), with 30 or more people hanging out in his backyard, munching hot dogs and (veggie) burgers, and splashing in the pool.  It was a beautiful day with some really great people, and I love that my department is such a welcoming and family-friendly place (this is one of several regular events throughout the year at which partners and children are explicitly encouraged to attend).

I was sitting on the grass with my son on my lap.  He was contemplatively munching on a veggie burger.  We were surrounded by students.  They were commenting on how much he’s grown since the last time they saw him, how long his hair is (it’s in these amazing platinum-blond ringlets right now since we haven’t cut it yet), asking what new things he can do, etc.  Then, one student busted out with “Are you going to have more kids?”

I gave my stock response: “We’ll see!”

Another (perceptive) student said: “It sounds like maybe you say that a lot.”

I laughed and said, “You’re right!  A lot of people are curious.  Almost as much now as when my husband and I first got married and we got lots of questions about when we were going to have kids.”

Another student said, “It’s kind of a personal question, isn’t it?”

I said, “Yes, it’s personal.”

The student who asked in the first place apologized.  I told her I didn’t mind, that I was also very curious about things like that when I was her age.

It was a brief twinge of discomfort in an otherwise lovely day.  I kept turning it over in my head.  I almost wanted to tell them why it was personal — to tell them about the daughter we lost before our son was born, or the fact that I’ve been pregnant three times with only my son to show for it, but I didn’t want to spoil the festive mood.  On the other hand, I feel that we generally do our young people a disservice by being so closed-mouthed about the realities of pregnancy loss and infertility.  I teach my students lots of things, and sometimes they learn from me whether I want them to or not — I know that the students have been keenly interested in my life since I revealed that I was pregnant with S (the students were also keenly interested when I was pregnant with his big sister, although that generation has all graduated by now).  I also know that for all the young women, I am the sole example they have of a female professor in our field, which can feel like a heavy responsibility.  I want them to be encouraged by my example, not daunted.  But I also want to prepare them for challenges they are likely to face.  There were about 8 students sitting with me on the grass during this conversation — odds are that several of them will experience miscarriage sometime in their lives, and probably one of them will experience infertility.  Is it better to prepare them, or to let them find out for themselves?  I made a choice in the moment, a choice that felt right to me at the time, but I could imagine having handled it a different way.

For now, I educated them that asking questions about fertility plans is personal.  I’ll save the conversation about pregnancy loss for another time.

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.

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.