Tag Archives: pregnancy

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.


So Long, 2017!

I’ve rarely been happier to say goodbye to a year, but the flip side is that I’m looking forward to a fresh start in 2018.  Here’s the Cliff’s Notes version of 2017, and what I’m looking forward to in 2018:

The Good

  • My son.  He continues to delight and amaze me every single day of his life.  This week at home with him has been truly lovely.  He’s starting to have the patience for longer books (Dr. Seuss’s ABC, Angus and the Ducks, and Do You Speak Fish? are three current favorites), and his sense of humor is just wicked (this week it’s all about the yes/no questions and giggles: Is this hairbrush your dada?  NO!!!!  Is this pillow your dada?  NO!!!!  Is that doggie your dada?  NO!!!!  Totally cracks him up every time).  We have a Solar System rug in his playroom, and he loves running from the Sun to Jupiter to Neptune upon request, and playing Solar System Twister by trying to stand on as many planets as possible at the same time.  He likes to play hide and seek, mostly by hiding in plain sight and dissolving into giggles as we pretend to search for him (Is S under the table?  Is he in the bathroom?)  I could go on and on, but I’ll stop. 🙂
  • Work stuff.  My first postdoc got a job offer!  This was a huge deal, since I have been worried that he would not get an academic job and would be forced out of academia after which I would have been convinced that I ruined his career by bringing him to my rinkydink little college for a non-traditional postdoc opportunity.  Instead, he was offered a potentially permanent job that he would most certainly not have been qualified for before working in my group for four years.  I am so happy for him.  And I shouldn’t jinx it, but my year of supervising three thesis students isn’t going as badly as I feared, and I think they’ll all have high-quality theses come May.  There’s also a light at the end of the tunnel for a really big invited review paper that I’ve been working on for about a year now — it should be done by the end of next week.  It’s a ton of work, but will have high impact, and I’m pretty proud of it.  And as I wrote a few days ago, I totally rocked my 5th-year pre-tenure review and am optimistic about the tenure process that will start next fall.
  • My support network.  Having difficult years really makes you notice all the wonderful people in your life who are around to help you through the crumminess.  First prize goes to my amazing husband, of course, but I’ve also got prizes to hand out to other relatives and friends as well — the list is long enough that it makes me feel good about where I am in life right now.  Having a kid hasn’t totally squelched my important relationships as I feared it might.  I’ve been leaning on them a little more than usual of late, though, so I’ll have to make sure I’m giving back in the new year.

The Bad

  • Two miscarriages.  Recurrent Pregnancy Loss diagnosis.  Ongoing testing with no answers yet.  Coming up on a year of TTC living baby #2.  Oh, and the due date for my first post-S pregnancy is coming up this week.  Blargh.
  • My father died.  I had a complicated relationship with him, which has made it tough to sort through my feelings about his death, but the short version is: it sucks.  I think my grieving process has been largely focused on morbid thoughts about the mortality of my son and husband (also myself), which is not fun.
  • My mother had major surgery two weeks ago (a hip replacement).  Recall that I am ruminating on mortality, so it freaked me out emotionally right from the start.  My mom also lives a two-hour drive away, which is better than a plane flight away, but since she lives by herself she really needed help.  I made three round-trip drives in a week (one overnight stay the day she came back from the hospital, plus two day trips).  Thankfully, she’s on the mend now and I can relax a bit.  But I’ve really been feeling the whole “sandwich generation” thing this year.
  • Work-wise, this fall was a survival semester, in the sense that I phoned it in on a lot of teaching stuff and was kind of a crappy collaborator on a couple of projects.  Mostly I managed not to be too crappy at any one thing, which I feel like I can be at least a little bit proud of when you consider how my semester went.  Another part of my grieving process seems to be occasional irritability, which is out of character for me, and there are a couple of emails I wish I hadn’t hit “send” on — although I have to say that the people on the receiving end did basically deserve them, even if I am usually more diplomatic.  Oh, well…. I don’t think I burned any bridges too badly.  And I did an OK job of circling my wagons and prioritizing critical stuff like my research group and paper drafts, so hopefully I managed to mostly insulate my professional list from my personal problems.

The New Year

  • Getting back on the TTC wagon.  In a way, it feels good to have a fresh start after this most recent miscarriage, and to know that I’m back with the RE who will keep a really close eye on everything and do whatever she can to help us conceive the living child that we’re dreaming of.  I had visions of being a normal pregnant lady at my local OB’s office, but the silver lining of being abnormal is that I get more support and reassurance and can work on developing a plan.  I’m optimistic about our chances of success, since S is proof positive that my body is capable of carrying a baby to term.  I wish I could see the future and know how long it will take and what we’ll have to go through to get there, but I’ve been through enough at this point that I’m also feeling relatively calm and confident that I can just go with the flow for a while.  I am definitely in a much better place than I was three years ago after the loss of our daughter.  It seems like I shouldn’t be, since I’ve had three times as many losses by now, but for one thing I have S, and for another thing I’ve developed a certain amount of resilience.  I have hope for 2018.
  • The push to tenure.  There’s a certain narrowing of focus that happens when you’re less than a year from putting in your tenure packet. I’m in a good place right now: I already have a really solid portfolio of work, and I have a bunch of things in the pipeline, and I know what I need to do before next fall.  I’ve already done most of what I need to do, and the rest is in process.  Some of it is dependent on other people (like my students), but not too much.  I’ll be working hard this year, and I’ll have to prioritize like crazy, but the tenure process is another thing that I’m optimistic about for 2018.  I am so looking forward to submitting my tenure packet next fall and knowing there’s nothing more that I can do.  I think I’ll feel good about the body of work that I’ve accomplished on the tenure track.
  • The adventure of parenting.  I know people say the twos are terrible, and plenty of people will tell you that threenagers are worse, but you know what?  I’ve loved every age and stage of S’s life so far, and while there are certainly challenging moments/days, the thrill of seeing this little person growing up into himself more than outweighs the difficulties.  I am more crazy in love with this kid than I ever knew I could be, and I am looking forward to seeing what new skills and interests and ideas he develops in the new year.  I’m looking forward to getting more insight into his odd little mind as his communication skills improve.  And I’m looking forward to more snuggles and giggles as the toddler years wear on — I know that all too soon he’ll be too grown up for mama snuggles, so I’m soaking up every moment of it while it lasts.  I also love watching my husband surprise me with his parenting ninja skills, and I fall in love with him again every day as I see him growing into an amazing father.  He is so creative and funny with S that it just melts my heart.  Our family is so beautiful right now, and I hope that it will always stay that way — or perhaps even grow in love with a new member on the horizon.

And that’s the year!  Happy 2018 to everyone.  My hope for you all is for a brighter year full of love, laughter, new memories with your loved ones, and wishes coming true.


Bad Luck Math

Because I’m me, I’ve been doing the math on my bad luck.  And because this is my blog, I figured I’d share it with you.  If you hate math, this might be one to skip, but I find it to be a helpful perspective.

My question: Among all women who have been pregnant four times before, what is a typical outcome, and how common is my type of outcome?

Assumptions: I’ll assume that first-trimester miscarriage has a ~20% probability, since that seems to be in the middle of the 15-25% estimates.  It depends a bit on week of gestation, but mine have been in the 6-8 week range, and I think 20% is probably about right for that gestational age; I also think first-trimester miscarriages at that gestational age are pretty typical. As for 2nd trimester losses, it depends a little bit.  The overall risk is something like 1%, but the risk of losing a chromosomally normal fetus like I did is about half that, or ~0.5%.  If I were being totally self-consistent, I’d make the probability of live birth ~79% and first-trimester loss ~19% to account for the ~2% of pregnancies that are lost in the 2nd and 3rd trimesters, but it won’t change my answer much so I’ll keep using round numbers for at least these initial back-of-the-envelope calculations.

What is a typical outcome for a woman with four pregnancies? 

The highest-probability event in any pregnancy (other than mine, that is) is a live birth, with a probability of ~80%.  The probability of having four live births in a row is (0.8)^4, or about 41%.  So, fewer than half of women with four pregnancies will have all live births.  That jives with my experience — most women I know with three kids had one miscarriage along the way.  So let’s explore the probability of three live births and one miscarriage.

There are four ways to have one miscarriage in four pregnancies: either your first pregnancy can result in a miscarriage, or your second, or your third, or your fourth.  So the overall probability of having one miscarriage among four live births is 4*(0.8)^3*0.2 = 41%.  That means that just according to the typical probabilities, 80% of women who have been pregnant four times will have either one or no miscarriages, and it’s more or less a coin toss between those groups.

What about the other 20%?

The other 20% are women who are less lucky.  They might have had two or three or even four miscarriages, typically in the first trimester.  But which fraction is which?  The easiest to calculate is having four miscarriages in a row: (0.2)^4 = 1.6%.  So, how unlucky do you have to be to have four miscarriages in a row, just by chance?  Unluckier than 98.4% of other women.  If you somehow manage to collect 100 women who have been pregnant four times in a room, you would expect about 2 of them to have had this outcome by chance.

But what about the other 18 women who had more than one miscarriage?  Most of them will have had two miscarriages.  There are six ways to do that (1st and 2nd pregnancy, or 1st and 3rd, or 1st and 4th, or 2nd and 3rd, or 2nd and 4th, or 3rd and 4th), so the probability is 6*(0.8)^2*(0.2)^2 = 15%  So a whopping 3/4 of the 20% of women who had more than one miscarriage had two miscarriages, and there are only 5 women in our hypothetical room of 100 G4 women who had three or four miscarriages out of four pregnancies, just by chance.

That’s actually more than I might have expected.  I mean, I don’t know very many women who have had four pregnancies, but of the ones I know, they mostly had one or two first trimester miscarriages along the way.  I think the largest total number of pregnancies I know of in my normal everyday life (not counting blogland, which is a very biased sample), is a grad school mentor of mine who once shared that it took her six pregnancies to have her three kids.  (I was appalled at the time, but now I’m 2/3 of the way to her total number of pregnancies and I only have one kid to show for it, so there’s that.)  But the point is that if you somehow collect 20 G4 women in a room — this is the size of a typical seminar course that I might teach at my college — you would expect only one of them to have had more than two miscarriages just by chance.

What about later losses?

So far I’ve ignored 2nd and 3rd trimester losses, because they are so improbable that they make up a pretty tiny fraction of all pregnancy outcomes.  For example, the chance of having one late loss out of four pregnancies is 4*(0.98)^3*0.02 = 7%.  That’s not nothing, unfortunately, but it’s also fairly small — it’s about the same as the chance of having 3 or 4 first trimester miscarriages out of four total pregnancies.  The more times you get pregnant, the more likely you are to have an improbable outcome like a late loss, alas.  The good news is that for a typical woman, even if she gets pregnant four times, she has a 93% chance of never experiencing a late loss — and probably it’s actually significantly better than that, since I’m assuming that all pregnancies are equal, whereas the research shows that women who have had one late loss are more likely to have another, so in reality it’s almost certainly skewed so that women with generally poor reproductive outcomes account for a larger-than-chance share of the late pregnancy losses, and a truly typical woman is less likely to ever have a late pregnancy loss.

So, how unlucky am I?

Let’s explore the probability of my particular reproductive outcome: four pregnancies, one late loss, two early losses.  We’ll assume that the order is random, although it might not be — for example, the adhesions from my first pregnancy could conceivably have contributed to my early losses in later pregnancies, or I could have some sort of weird immune-mediated thing that got worse after a live birth.  But those are fairly speculative possibilities, so I’ll just assume that the order is random.  In that case, the probability of having an outcome like mine (one late loss + two early losses, random order) is something like 12*0.02*(0.2)^2*0.8 = 0.8%.  So, if you got 100 G4 women in a room, maybe one of them would have a history like mine, but maybe not.  You’d need a thousand to get me some buddies for sure.

And I’ve also been generous in defining what “like mine” means.  If you narrow the definition to the loss of a chromosomally normal fetus in the 2nd trimester (plus two early losses), that brings the numbers down by a factor of 4 to 0.2%, which means that I’d need a room full of 1000 G4 women to maybe have one friend who’d been through something similar.  This thought experiment is also interesting because it brings the probability of having an outcome like mine below the threshold of 0.3%, which means that my outcome is 3-sigma bad, or that there’s a 3-sigma probability that my obstetrical history is not just due to bad luck, but rather to some other contributing factor that predisposes me to poor pregnancy outcomes.  That’s significant enough to get you publication in a journal in my field (though not in all fields).

Now, of course, when you get down into the weeds of these small-number probabilities, there are a lot of outcomes that look similar.  Another outcome that has a probability of 1-2 women in a group of 1000 G4 women is having two late losses and two full-term births, and you can add a bunch of different permutations that also give you similar answers.  But the point is, by the time we get into the land of both late losses and multiple losses, we’re down in the tenths digits of the percentages, which is a fairly lonely land to be in.  It’s also increasingly absurd to be told that your problems are due to “bad luck” and told that you should just try again — when you’re out in 3-sigma land, while it’s certainly true that your outcomes could be due to bad luck, the probability is low enough that it seems like any reasonable person with at least a slight grasp of statistics would want to do more investigation.  It’s easy to say that investigation is a waste of resources when you’re talking about two first-trimester losses out of four pregnancies (roughly a 1 in 5 chance), but not when you’re talking about an outcome that only a few in 1000 or even 10,000 women will experience (since most women don’t get pregnant four times and therefore aren’t even represented in the above numbers — you actually expect overrepresentation of poor pregnancy outcomes in G4 women for exactly this reason).

So there you have it.  I am so statistically significantly unlucky that it seems unlikely that my issues are due to random chance (i.e., they are probably more than just “bad luck”).  However, I’m not as dramatically unlucky as I guessed going into this exercise (I guessed that I’d be 4-sigma unlucky, but I’m not that unlucky).  So, that’s good news, I guess?  The other good news is that I live in a time when the internet exists to connect me to all the other women having a tough time out in 3-sigma land, so it doesn’t feel as lonely as if I’d been a prairie mama trying to deal with this all in isolation, never knowing another woman who had been through something similar (waving at you, blog friends!).  Though in that case I’d probably already be dead and/or completely infertile from the infection I contracted after my 2nd-trimester loss, or from hemorrhaging due to retained products of conception before the infection — huzzah for 21st century medicine!  It’s keeping me alive, even if it’s not telling me how to keep my babies alive.


So long, pregnancy #4

We had our 6-week ultrasound today for pregnancy #4.  It did not go well.  There wasn’t much of anything to see — a bunch of irregular lumps that might have been bleeds and might have been products of conception but no gestational sac, yolk sac, or fetal pole.  The OB gave me the option of waiting and coming back in a week for another ultrasound, but admitted that she thought there was basically no chance that it was a viable pregnancy, so she gave me a prescription for misoprostol to take this weekend.

I knew, going in.  I’d had some extremely light spotting on and off, and zero pregnancy symptoms.  Even with the encouraging betas last week, I’ve been pregnant enough times now that I just knew something was off.  I usually get stretchy round-ligament-type feelings, and I’d gotten them the week after the positive HPT, but then they tapered off.  I’d had some tenderness while nursing, and it tapered off too.  But even though I expected it, it’s not much easier to deal with.

I just feel the overwhelming weight of needing to (1) get through this miscarriage, (2) go through the whole long process of trying to conceive again, and (3) going through another anxious pregnancy where I’ll be freaking out at every stage.  It just feels like too much right now.  But there’s no getting around step 1 — my only hope is that it won’t drag out too long (like it has the other two times, says my pessimistic self).  I can’t say I’m really looking forward to step 2 either — I just hope that awful ovulation pain doesn’t come back.  And while step 3 is a necessary mile marker on the way to the goal of having another living child, I’m really not looking forward to it either.  I’m just so tired of everything conception- and pregnancy- and miscarriage-related.  God, I can’t wait for this phase of my life to be over.

The other set of decisions I’m having to make is how aggressive to be with follow-up.  I put in a call to my RE’s office this afternoon, although I haven’t seen them in 8 months so I don’t know if they’ll get back to me quickly or have me come in for an appointment before they’ll talk to me.  I need to decide whether or not I want to ask for testing of the products of conception, for example (probably, since I always think that more data are better).  I had a lot of testing after the 2nd-trimester loss of our daughter, but I will probably make an appointment with the RPL clinic at my RE’s office for a consultation to make sure there’s no other testing they recommend (they encourage consultations after two consecutive losses).  For example, it seems like it wouldn’t hurt to have my thyroid and some other things checked again, since they haven’t been checked in several years.  My guess is that everything will come back normal, and they’ll just tell me to quit breastfeeding and send me on my way, but you never know.  My OB did tell me she’d recommend progesterone next time as a precaution (the RE had me on it for my pregnancy with my son, so I’m no stranger to it).

Breastfeeding is a whole other can of worms.  I know that it probably makes sense to wean before we try again.  While there’s no really good evidence, there’s circumstantial evidence that it can lead to difficulties with implantation, and so it seems like a sensible step to take now that my son is 20 months old.  But… he doesn’t want to wean, and I don’t want to wean, and the whole idea is just making me feel a lot more miserable.  It’s like, on top of dealing with dead baby #3, I now have to face the prospect of making my one living baby miserable and bringing an end to one of the few things that has gone perfectly right during my reproductive years — depriving myself of a beautiful part of my relationship with my son just on the off chance that it might help me not kill another baby.  It’s just not fair, dammit.

Well, as many of the readers of this blog know all too well, even with recurrent losses the odds are still reasonably good (though not great) that next time will be a success, so probably the main thing to do is just move on with getting un-pregnant and then trying to get pregnant again.  I can only hope that it will go quickly and not drag out for another eternity.


Good betas

Just checking in with a quick update: good news for the week is that my betas are high and rising fast.  At 19dpo they were 1200-something and two days later they were 2700-something.  So, looking good!

My emotional response to this news has been all over the map, but breaks down into a few categories:

  • Huge anticipation.  I saw that my doctor had left a voicemail on my phone as I was leaving a meeting and going to start class, and I really didn’t have time to listen to the message before starting my long 2.5-hour block of Wednesday afternoon teaching.  But my brain was buzzing with anticipation the whole time I was teaching — I was so tempted to check between classes, but I really didn’t have time, so I made myself wait until after my classes were over.  I was actually shaking a little by the time I picked up the phone.
  • Getting annoyed with myself for being so excited about betas.  I know as well as anyone that betas are just one extremely early step in an extremely long process in which a lot of things can go very wrong very suddenly.  I should be over it at this point.  I should be in it for the long haul.  I should be stoic, because the more I allow myself to get excited about betas, the harder the fall will be if the pregnancy ends later.
  • Score keeping / putting things in context.  This is my fourth pregnancy.  I’ve had betas taken for two of the other three, including the pregnancy that resulted in the 2nd-trimester loss of our daughter and the pregnancy that resulted in the birth of our son.  Both of those had great betas, and only one of them had a great outcome.  So, from my personal point of view, pregnancies with high betas have a 50% chance of success.  I’m also still 2-3 weeks shy of the point at which our early miscarriage happened in my last pregnancy, so this is still the shortest pregnancy I’ve ever had, which means that two thirds of the pregnancies I’ve had that lasted longer than this one had bad outcomes.

So, I’m trying to just take the news in stride, and to see it as a good sign that at least for today, I am pregnant and things are looking good.  I am also trying really hard not to google “fever in early pregnancy,” since I got a daycare fever from my son this week — my temp never got above 100.8 that I saw, but I’m pretty sure fevers aren’t good for embryos.

Anyway, I’m cautiously optimistic, and at least this week, things are looking good.  Next week we have an early ultrasound, and if the pregnancy looks viable I’ll start back on Lovenox at that point.  Wish me luck!