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.

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Back on the Roller Coaster

It has now been two full months, or about 9 weeks, since my (2nd) miscarriage.  I’ve honestly been pretty numb to it all… except the last few days.

It’s a very different experience, having a 1st trimester loss after (1) a previous 2nd trimester loss, and (2) the birth of a living child.  Everyone’s experience of grief is different, and I know that if I hadn’t experienced those two key events in my life, this event would have been much, much harder for me to process.  As it is, I’ve mostly just been able to write it off as bad luck.  This is my 1 in 4 pregnancies that probably had some chromosomal defect that my body rejected.  We’ll move on and try again.  That’s that.

Until the last few days.

I’ve had highly significant ovulation pain every cycle since the birth of my son, so I’ve been able to tell pretty clearly when I’m ovulating.  I knew that I had ovulated about two weeks ago.  But as the days ticked by and my period didn’t arrive, I started feeling that roller coaster of TTC emotions that I remember so well.  It’s like there’s a constant subprocess looping in the back of my brain:

Could I be pregnant?  It’s too early to tell.  I could take a test!  No, that’s a waste of money — if I still don’t have my period by Monday, then I’ll be pretty sure and I can just take the test to confirm.  Let’s google when your period returns after a miscarriage.  Mine sure seems late!  But I think I know when I ovulated, and that was less than two weeks ago.  Let’s google about getting pregnant before you get your period after a miscarriage.  It’s a thing that happens to people!  But it probably won’t happen to me, because we don’t tend to get pregnant easily.  But we did this last time.  But I really shouldn’t get my hopes up.  Chances are I’m not pregnant.  But could I be pregnant?

And repeat, with increasing intensity, for three days.  UGH.

I won’t keep you hanging any longer — I got my period yesterday.  I’m not pregnant.  I didn’t really think I was.  But boy, did I hope!  I was so mad at myself for hoping, too — or really, for caring so much.  It was so nice after my son was born to just not obsess about my cycle endlessly, and I’m annoyed that now I’m back to doing it even though I really don’t want to.  I guess it’s a good thing that I got my period, since it hopefully means my hormones are back to normal (or my body’s best approximation thereof) and now we can really start TTC again in earnest.  But it’s also a reminder of just how much time it’s taken to go through this miscarriage — this is my first period since March.  Four months of lost time, and another lost baby (albeit a very small one).

Well, I knew that getting pregnant again was likely to be a long haul, so it’s good that we started trying early.  And we’re still in the zone of inconvenient timing relative to my tenure clock, so from that perspective it’s OK if this takes another 6 months or so.  Just not much more than that, please.  I’m not sure I can handle the emotional roller coaster for another two years.

Hopefully the approaching onslaught of teaching and advising and committees and meetings will distract me from the TTC roller coaster.  Hopefully I can just turn that subprocess down to a dull roar in the back of my mind while we keep pushing on with our quest for another living child.  Hopefully it won’t eat up too many more years of our lives and hopefully there won’t be too much more disappointment and heartbreak to come.  Hopefully it’ll be a smooth journey and another uneventful pregnancy.  That’s a lot to hope for, but hopefully at least some of my hopes will come to pass.

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.

Update

It’s been a few weeks since I posted an update, so I figured I’d put up a brief post.  I think the two main pregnant-physicist-related news items are:

• I’m still waiting for my period.  It’s been 6 weeks since I stopped bleeding, so I’m starting to get impatient (they say to expect your period 4-6 weeks after a miscarriage).  I’ve got a follow-up appointment with the OBGYN in August, so hopefully it’ll show up before then, but I’m still in limbo otherwise.
• According to the pediatrician, S is officially a late talker.  He’s a 16+ months now, and we can self-refer to our state early intervention office anytime — the pediatrician recommended waiting until 18 months (even though he’s officially late already), so that’s what I’m planning to do for now.  Lots of people tell me it’s too early to really worry, that boys talk late, etc., etc… but I’ve got to say that unlike some of the other milestones, I really don’t see any signs that talking is even on the horizon.  He’s still missing things that he was supposed to be doing at 12 months — trying to mimic words that we say, babbling with a wide variety of consonants and vowels (if anything, I hear less variety now than I did at 12 months), no mama/dada, etc.  I’m not actually all that worried yet — his comprehension is great (so much so that we’ve had to start spelling certain words), he makes his needs known, including through a couple of signs, and he’s super-social.  If anything, I suspect it’s limited to a production problem rather than a comprehension problem or autism spectrum issue (I filled out the M-CHAT and he scored just fine).  But it’s one of those situations in which you’ve got to strike a tricky balance between being laid-back and letting your kid develop at his own pace while not missing out on opportunities to help out your kid if they need it.  Language seems to be one of those areas where early intervention can really help (and isn’t going to hurt), so I don’t want to wait too long, but I also suspect he’ll be just fine in the long run.

Otherwise, we’re having a nice, busy summer.  I just started parent-baby swimming classes with S at the YMCA last week, and I count it a success since he didn’t cry the whole time. 🙂 I invited a friend whose daughter is in S’s daycare group (she’s a few months younger) to join us, and I think that was a great idea — the kids clearly enjoyed seeing each other in this otherwise scary new situation.  We also took S to the beach when we visited my mom this weekend, and after some initial skepticism, he loved playing in the sand and knocking down the sand castles that we made by filling buckets with sand.  He is SUCH a happy kid these days — really goofy and giggly, still snuggly and velcroed to his mama in new situations but warming up pretty quickly, and I have to say that I am loving these early toddler months.  It is amazing how much he’s learning and doing, his sleeping schedule has settled into long nights and a chunky midday nap, and he’s still got a huge dose of baby sweetness combined with toddler curiosity, a sense of humor and emerging personality — there’s never a dull moment, and it’s so much fun (most of the time).

Well, that’s all I checked in to say… I hope I’ll have more news to post here sometime soon once the miscarriage waiting game is finally over.  Happy summer to all!

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!

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.