Tag Archives: pregnancy

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.

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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!

 

Pregnancy #4

So, remember how I said in my last post that I was just getting my period on Wednesday?  I was pretty sure, because it was the day my period was due, and I was cramping and I think spotting a little.  But then, it just… stopped.  My period never started.  This morning I took a test, and, yup. Pregnancy number 4.

But with cramping and spotting (which has mostly stopped), so, yeah.  I’m not counting any chicks just yet.

But at least for today, I’m pregnant again!  End of June sounds like a nice time to have a baby. Kind of in the same way that the moon Europa sounds like a nice place to visit.  (They both seem very far away and hypothetical at the moment.)

Here we go again!  Wish me luck!

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.

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.

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!