Is this real??

You guys, I swear to god someone is messing with me. There hasn’t ever been a pregnancy in history that has had more ups and downs than this one. Our ultrasound today was either a very cruel joke or the best news I’ve had in years.

We showed up for our ultrasound this morning feeling pretty pessimistic. It’s not that I didn’t have any hope. I haven’t had any bleeding for weeks now, so I was kind of thinking that the embryo/fetus/baby was still in there plugging along. But the most I had ventured to hope for was that there would still be a heartbeat, but a slow one. I thought the best I could ever expect would be a continuation of the limbo I’ve been in.

The ultrasound tech was merciful and rather than starting with measurements of my ovaries and my peri-ovarian mass like she usually does, she went straight to the baby. It was immediately obvious that it had grown. It looked distinctly different than the last time, much more baby-shaped. And before I had a chance to even look, G said “there’s still a heartbeat”. The ultrasound tech agreed, and right at that moment I saw it kick. I immediately started to cry, and said “this is just too hard”. I thought, how can we be tortured like this with a moving baby that won’t survive? I hadn’t even ventured to hope yet that it could be okay.

She measured the CRL (crown-rump length), and it was 9w3d. I’m technically 9w5d, so that sounded a little low to me, but since it’s measured a little small every time, this probably isn’t anything to worry about. Then she measured the heart rate. You guys, it was 171. This is after a 117 and a 106 two weeks ago. I mean, how??? How does this happen?? I said, “Is that real???”, and she had a big smile plastered on her face. At this point, G dissolved into a full on crying fit. Not a few tears, but a full on snot-fest. I’m honestly not sure if I’ve ever seen him cry that much.

She took a bunch more measurements and couldn’t find anything to be worried about. The whole time the baby was squirming around like crazy. I don’t even know how to express how shocked I am. I never ever ever expected that I would make it this far in a pregnancy, and all of a sudden there’s a little thing that actually looks like a baby squirming around inside me. It doesn’t feel real at all. These things just don’t happen to me. In fact, I can’t help but think that this is just a cruel joke. We can’t help but be invested when we see a moving baby, and it will only be that much harder to have it ripped away if it doesn’t work out.

We met with Dr. O, and he agreed that there’s nothing visible today that looks worrying. He also agreed with me though that this is still a high risk pregnancy. He said there’s no one thing that’s happened so far, or in my history in general, that would make it high risk, but the whole package raises the risk level. So, we are by no means in the clear here. I wouldn’t kid myself that we are out of the woods and this is just a normal pregnancy. Since I’m now almost 10 weeks, he’s sending me to a high risk OB and a maternal fetal medicine doc asap (I graduated!). I’m really glad about this because it seems like the high risk doctors will give us the best chance of success. I’m definitely not comfortable being treated as a ‘normal’ pregnant woman at this point. We will schedule an anatomy scan for a week or two from now, and that will definitely give us a lot more information.

I’m having trouble even organizing my thoughts at the moment. I’ve barely even been thinking of myself as pregnant up to this point, and suddenly now I’m 10 weeks pregnant. My belly is sticking out for real, and I now need to look in to getting some bigger clothes. People are probably starting to suspect I’m pregnant, and I haven’t been hiding it that much because I figured they’d just think they were wrong when nothing came of it (they’d just figure I gained some holiday weight). I will actually be going to see an OB for the first time, and will actually have an anatomy scan. All of these things I never thought I would get to do.

For right now, I’m feeling really great. I know that the nerves will set back in soon, and I’ll start to worry like crazy. Given the way things have gone over the last few months, there is every reason to think the next scan will be bad. I know I will be freaking out about that soon. For right now though, I’m just feeling very very lucky. So lucky to still have a chance with this pregnancy, and so lucky to be having these experiences of pregnancy. Even if this ends badly, I never thought I would have the chance to see that little life moving around inside me, and to wear maternity clothes, and to share good news with people. Over the last three years I would have given anything for those experiences, and I wouldn’t have gotten to have them at all if we had adopted. No matter what happens, I’m getting to experience pregnancy. That is enough for right now.

So I hope you all have a wonderful new year’s. I’m thinking of all of you who could use some freaking good luck of your own. I sincerely hope 2014 is a better year for all of us. Thank you so much for your support the past few weeks, you have no idea how much it has meant.

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Well that was unexpected, Part II (aka, weird experiences with the in-laws)

Thank you all for your sincere messages and concern the past few days. I’m trying to hold things together and keep from thinking too much about the situation until we know more, but it’s pretty hard to not think about it with the constant reminder of the nausea and other symptoms. In the meantime though, we decided it was time to finally tell G’s family. I told my mom pretty much right away and have kept her updated along the way, but I left it to G to decide when he wanted to tell his family.

Telling them has been stranger than we could have imagined. In the past two days we’ve had  two of the most surprising and/or strangest interactions we’ve ever had with them. G called his parents on Thursday night, but he happened to catch his dad on his commute, so he ended up telling them separately. FIL was sweet, if a little in denial. He kept telling us how he’d pray for us (which doesn’t do a lot for me since we’re atheists, but I appreciate that it means something to him), and that God would fix this. Again, I appreciate the thought, but I don’t want him to end up more let down later because he didn’t beleive how serious this is.

Then G called his mom, and she had a similar reaction, if a little less in denial. She said she’d pray, but she understood how unlikely it is to work out. Then she went on to tell us about how we could still do this, it could still work for us eventually. We made it clear that we don’t really think it’s an option to keep trying if we can’t figure out what’s wrong, and she eventually said she could understand that.

She also suggested that maybe surrogacy was the best option, and maybe my parents could pay for it. This offends me a little because they seem to think my parents are rich, which is far from the case. They own a small business that may or may not go out of business in the next year after they put all of their funds into it (leaving aside some for retirement). That’s a sore spot for me I guess, but we made it clear that we wouldn’t be asking them for money. Then MIL started to get into how much she has saved, and maybe if we were okay with only having one child, they could help us. My initial reaction to this was, wow, coming from her that’s crazy generous. She’s insane about saving money, which is why she might have enough to pay for maybe 2/3 of the cost of surrogacy despite the two of them having very modest incomes.

I really really don’t think we would take their money to do surrogacy, and honestly I’m not even sure surrogacy is something I’m interested in anyway. But, I was impressed that she would be willing to give us her hard-pinched pennies at all. Then, it came out why. We said we think that adoption is probably a better option for us, both because it costs less, and for other reasons as well, and she says, “Well, I just don’t know if that’s a good idea. You have to be so careful. We know so many people who’ve had problems with adopted kids. And look at all the problems they have when they grow up”.

Now, first of all, this is only sort of true for them. They do know a few people who’ve had serious problems with adopted kids. But these were people who chose to adopt very high risk babies. One had a very serious physical disability, and the other was born addicted to drugs. These are amazing people to be willing to take on those challenges, but it isn’t remotely a fair way to judge adoption as a whole. In her own family, MIL has three adopted nieces. One is very well adjusted, albeit a little annoying, and the other two have dealt with addiction. They are both extremely lovely women who just ran into some challenges (arguably partly due to the way they were raised!!). And lets not ignore just how many problems there are in the family amongst the people who are NOT adopted. I just despise the fact that she’s judging, rather openly, members of her own family for being adopted. The bottom line is, she’d rather give us all her hard earned money, that she won’t even spend to go out to dinner once a month or buy a functional coffee maker, on a surrogate for us, rather than have us take in one of those dangerous problematic adopted babies. This is so not what I need to hear right now, when I need to know that if pregnancy is not an option, I still have a way to have a family. I don’t need any additional reasons to be worried about adopting (my child’s grandmother talking about him or her as a family problem).

So, Friday morning I wasn’t in the greatest place anticipating having to go visit them. When out of nowhere, G forwards me this email:

Hi G – I have been thinking about you and J(me). We would love to have you come for Christmas. I want you both to feel comfortable about coming, so if you think it wouldn’t be a good time to travel, we understand. You know when you stay at our house, you can relax whenever you want. If you come and would like me to change any plans, I can. We are having the Christmas Eve dinner at K’s (SIL) and Christmas Day at Aunt K’s. You could drive separately on that day and go back to our house early if needed. Thursday was the brunch plans and (cousins with new baby) and (pregnant cousin) can’t come. Talk this over with J. I could cancel these plans for Thursday if you would rather not have a bunch over.  We can talk over the weekend. I said my prayers for you and J. This would be great if things turn around. Love, Mom

Wow. Just wow. I’m so shocked that these words came out of her mouth (well, hands). I never would have thought she could anticipate how hard it would be for us, particularly to see the cousins with the new baby, who are specifically the ones I wrote about here. I’m overwhelmed by the thoughtfulness of this email, and I feel so so much better about going to visit (doesn’t hurt that we no longer have to see the baby/pregnant cousin). It even inspired me to think that if she could surprise me about this, maybe she can surprise me and be supportive if/when we adopt.

Then comes this morning, and we get a call from SIL. G never got a chance to tell her himself, but we assumed his parents would tell her. They live down the street and talk every day. SIL calls today to ask us what we want to drink on Christmas eve (an odd question in retrospect since she did know I’m pregnant). It was probably just an excuse to talk though. I didn’t hear the whole conversation they had, but I could tell from the odd look on G’s face that it was going very strangely. After he hung up, he said, “my sister just offered to have a baby with your brother”.

Yep, you heard that right. Her solution to our problem is to use my brother’s sperm and do artificial insemination. I just. I don’t. I don’t even know what to say. I wanted to laugh, but my stomach was turning at the thought of it (not that it doesn’t do that constantly anyway). I just said “Honey, hug me, I’m scared”, and started laughing. I mean, ewwwww! There is nothing good about this idea. I would never ask that of my brother, knowing how weird it would be for him. Plus, there is no chance in hell I would let SIL carry for us. I couldn’t handle it. We’re not exactly close, first of all. Her pregnancies have never been easy, she seemed to barely survive the second one. I guess I should be honored that she’d offer given that, but I just honestly think I wouldn’t survive the experience knowing she was suffering that much for me when we aren’t even close. That doesn’t even get in to the level of awfulness I would feel having to watch someone else (someone who has everything I’ve ever wanted and I struggle with jealously of to begin with), do the one thing I can’t do, for me. I would feel so unbelievably powerless, and useless. The whole thing is just so awkward I don’t even know what to say.

I know the appropriate response to an offer like this from SIL is to be appreciative. I do appreciate that she wants to help. But, it’s very hard for me to beleive or accept that she could be doing it from a generous place. I feel like an awful person for saying it, but the bottom line is she has never once said she was sorry for our losses. She’s never implied that she cares about how hard this is for me. She’s generally done the opposite. For example, she came to visit when I was going through miscarriage number 4. She was about 7 months pregnant. I told her how I was pretty miserable and I had just had an awful experience of bleeding so heavily I almost passed out while teaching a class full of undergrads. Her reaction was “yeah, me too, I don’t know how I’m going to make it two more months”. Just wow. Last summer when she was visiting with her 3 month old and we were talking about our situation, she said “yeah, I can’t imagine if it ever happened to E (the baby, meaning if E was infertile, not if she’d had a miscarriage with E)”. What???? In what universe is even this about your baby?? I just don’t know how to ignore all of that, and take this as a generous and sincere offer. Either way we will have to have a talk with her at some point. G left it that he appreciates the thought, but we need to let this pregnancy play out before we make any big decisions.

So, that’s been my last few days.  It certainly has been an eventful two weeks of pregnancy purgatory so far, we’ll see how the rest goes…

8 week ultrasound. And the verdict is…

I wish I had a better post to write today. After last weeks good news, I was in shock and could hardly wrap my brain around the idea that things could work out with this pregnancy. This last week has been interesting. While not exactly optimistic, I had really started to think of myself as pregnant in a different way than I ever have been before. I pulled out my old embryology textbooks and checked out all the pictures of 7-8 week embryos, and I calculated a due date. I even did some google-searching for maternity clothes. This isn’t totally premature, I’ve already got this protruding belly that probably looks further along than I am, and all my clothes are too tight. I would never dare to actually buy maternity clothes while in pregnancy purgatory, but I might need them sooner rather than later.

I went in to this mornings appointment hesitant, but open to the possibility of good news. I duly dropped my pants and hopped up on the table, as if waiting for a judge to pass judgement. G was in a great mood, pretty confident of the outcome. He was making small talk with the ultrasound tech while I shot him death glares. As soon as she got the wand in, she said, “well we have a baby with a heartbeat! I don’t know anything else yet, but I know that”. After which she proceeded to check my ovaries, and take a million measurements of my peri-ovarian mass (more on this later). When she finally returned to the pregnancy, she had this happy look on her face. Remember, the last time she did an ultrasound for me, there was no embryo at all, and they were thinking there might not ever be one.

She started taking measurements, all the while smiling. She even made a joke (so cruel) that G would have to be more patient when (she said when!!) he was a dad. At this point I started crying. I figured, she’s never acted like this for any single other ultrasound we’ve had (like hundreds at this point, and she’s done all of them). Clearly she thinks this is good! G was squeezing my hand with all he had.

Then, she went to measure the heart rate and my heart dropped out of my chest. The number that popped up was 117. At 8 weeks, the heart rate should be 140-190, which I knew in advance because I made sure to google it this morning so I would know what to look for. I said in a quiet voice “it’s too low”. She said, yes, it’s pretty low. She waited a few minutes, then took the measurement again. 106. There was no more smiling or joking about when we would be parents.

As always, after the ultrasound we had to wait a good hour for Dr. O to show. The longest hour of my life (well, one of them since I’ve done it a hundred times now). He didn’t have anything surprising to share. He agreed that the heartrate is too low, and it doesn’t bode well. Especially since we know that last week it was higher (124). When asked explicitly he said he’s seen a pregnancy like this survive before, but it’s extremely rare. More likely, the heart will just keep slowing and eventually stop. If it does survive, there is an elevated risk of developmental defects.

Since we will be out of town for the holidays next week (good god, the horror of a week with the in-laws in the middle of all this), we can’t re-check until the 31st. That’s almost two more weeks of living in pregnancy purgatory. If the constant nausea, headaches, heartburn, constipation, and exhaustion wasn’t enough to deal with, I will have to do it all in the company of my in-laws. Oh! and all without any alcohol. I guess I should consider myself lucky that there are only 2 babies and one pregnant woman (that we know of)  in the family at the moment, some of you have much more.

So here goes another two weeks of pregnancy purgatory. It promises to be a very merry christmas.

 

I don’t know how to say this.

I don’t know how to begin to say what I have to say today. It’s already taken me almost a day to process before I could write anything at all, and I’m still in shock. Yesterday I had my appointment with the new doctor, Dr. A, and I also had an ultrasound. Here’s what I don’t know how to say: the ultrasound was good. Not just on the fence like my past ultrasounds have always been, but according to Dr. A, everything looks normal in there.

There is a strong heartbeat of 124 bpm, and the fetal pole measured 9mm, exactly 7 weeks. The sac looks normal, no poor margins or just plain weird stuff like in the past. I just. I don’t even know how this is possible. I don’t know how this can be the same pregnancy. The same pregnancy with no fetal pole at 5w6ds, that Dr. O described as ‘not optimistic’. The same pregnancy where last week Dr. O and the ultrasound nurse wouldn’t even look me in the eye. Dr. O is not a pessimistic doctor. He has always told me there was hope in the past, despite bad ultrasound results. He didn’t do that this time. I don’t know what to make of this, maybe he was letting my history affect his impressions (like it has mine, where to me blood = miscarriage)? Clearly I’m in shock here, I feel like I’ve jumped in to a different pregnancy than the one I was in two weeks ago.

Here’s how it all went down. We showed up for our appointment, and for the first time ever at an RE’s office, we were brought back to Dr. A’s office right on time, by Dr. A himself. Already I’m liking this guy. We had an awesome conversation, that I PROMISE to write about soon, because he said a lot of things that really clicked with me, and I think will be of interest to you guys. One of the things we talked about was that the vast majority pregnancies that end in first trimester miscarriages look unusual in some way on ultrasound by 5-6 weeks. That’s not to say that all pregnancies that look weird at 5-6 weeks will be a miscarriage, but the opposite is rarely true (pregnancies that look totally normal by 7 weeks miscarrying). Obviously it happens, but it’s much more rare, and potentially indicates a different kind of problem.

This fits my history very well. By 7 weeks, none of my pregnancies have looked normal. This makes a lot of sense because of how many thing are happening before this time, essentially all the parts of the embryo are getting in to place. We all know that embryos start from a single cell, then if you think of how many things have to move and arrange for an embryo to be sort of ‘baby shaped’ by 7 weeks, its just insane how much can go wrong. From 7 weeks or so on, things are in place, and the organ systems are forming. So, problems before 7 weeks tend to be problems with embryo formation. This all goes back to embryoscopy, because these problems with embryo formation result in embryos that look malformed when you do embryoscopy. There’s SO much more to say about this part of the conversation and I’m not explaining it as well as I should right now, but my point for now is that recurrent miscarriages that happen before 7 weeks (or missed miscarriages that begin before 7 weeks) mean something different from miscarriages that happen after 7 weeks.

At the very end of our conversation, Dr. A says “so, why don’t we just take a quick look at this pregnancy? I’d like see what your pregnancies look like”. We’d been talking about it as if it was miscarriage #7, and as per the conversation above, he was thinking that it would help him understand what kind of problem I have to see how things are going wrong at week 7. I wasn’t even nervous really, I was just thinking, hmm, I wonder if it’s over already?

Dr. A does all his own ultrasounds, there was no nurse or tech there, we just walked in to the ultrasound room and he flipped on the laptop that runs the equipment (very different from my current REs office!). He pops the wand in, and all I could think was, I hope he’s not looking at my super hairy legs (I wasn’t expecting to be getting naked in front of him!). And there it was. All I can say is it looked very different from any of my other ultrasounds. Right away he turned on the sound, and a heartbeat starts thudding. Very clear and strong, measuring 124 bpm. Guys, I’ve never seen a heart rate this fast before. I think the fastest we’ve ever had is 105 or something. That’s partially because of the timing, a slow heart rate is okay very early on, but our heart rates have never sped up enough. The measurement was right on track, no sign of the slow development at 5w6d. He looked for the ‘asymmetrical thickening’ of my endometrium noted on last weeks ultrasound, and it was there, but Dr. A said it didn’t bother him in the least. In fact, my bleed is even located as far as possible from the embryo, right at my cervix. This is about the best place to have a bleed if your going to have one because the blood basically just comes out, it’s not near or behind the embryo, causing pressure or shearing on the embryo.

All of this is to say that no matter what happens here (I still can’t wrap my brain around the idea that it could be okay), this is different from all my other losses. We’ve never made it this far, and according to Dr. A, the fact that we’ve made it this far means something. In fact, he thinks it means an awful lot. I still can’t manage to type out just how high he things the odds are for us with this pregnancy,  but it was high. I’m keeping my expectations lower than his, but even if I admit that there’s, say, a 50% chance of this working out, this is distinctly different from every other time. I think I might be as happy about that as I am about anything else at this point. We’ve broken the pattern!

My brain feels very very confused about what to think and feel right now. On the one hand, I just can’t wrap my brain around the idea that it could be okay. When Dr. A told us how good our odds were in his opinion, my reaction was, you can’t tell me these things. I might get hopeful, and then it still won’t be okay. On our drive home yesterday I was barely speaking, and G kept saying, “you don’t seem to realize what just happened!!”. He’s right, I don’t realize it, I’m confused. It isn’t even that I’m really trying to protect myself from getting hurt, because the more I thought about it, the more I realized that if this goes badly I should be upset. If I made it this far and I have a 124 bpm heart beat inside me now and it dies, I should be upset about that. It would be wrong to think that didn’t matter and I don’t need to be upset about it just because I expected it. If this goes badly, I have a right to be upset and I won’t take that right from myself.

It took me until this morning to figure it out, but the real reason I’m afraid to be or admit to being hopeful is good old superstition. I’m afraid that if I show that I’m optimistic and things could work out, the universe will catch on and rip it all away from me (because it has a history of doing that, you know??). It feels like I need to not admit any hope in order to protect myself from the evil universe that hates me and wants to steal everything I love. That sounds totally rational, right :)?

So, this morning I’ve started to re-engage in this pregnancy a little. It’s so odd, I feel like I jumped right in to this pregnancy at 7 weeks. I was not paying attention to much of anything from the day I started bleeding. I never calculated a due date, I never thought about what was happening in there on a given day. I hardly even thought of myself as pregnant. Suddenly, now there is a 7 week embryo inside me with a heart beating away. I don’t want to get carried away, there are still a million and one things that can go wrong. Part of me even thinks that we’ll go in to our ultrasound with Dr. O next week and none of this will have been real. There will be a sac with no fetal pole, and this will all have been some sort of bad joke (the universe messing with me again).

There are 6 days until my next ultrasound, at which point this will either start to feel a little more real, or it will be clear that this was just a little blip on the road to a miscarriage. Right now, all I can do is try to stay calm and appreciate the fact that for now I’m still pregnant.

A new day, a new doctor

First of all, I want to start by saying thank you to all of you amazing ladies out there who have posted such thoughtful and helpful comments this last week. I feel very different this time around, and I think a big part of that is having so much support. I know how many people go through infertility and loss with little to no support, and I feel like I’m beyond lucky.

Emotionally I might be doing pretty well (at least for now), but physically I’m doing HORRIBLY. The nausea has hit full force and I’m barely keeping it together trying to function. It starts before I get out of bed in the morning, as I’m woken up by waves of nausea. It’s always worst when my stomach is empty, so first thing in the morning is a huge struggle. I force myself out of bed and brush my teeth half doubled over (because it’s worse when I’m standing up straight). Somehow I make it through a shower (the heat has a negative effect too) and to the kitchen to eat breakfast. I always feel a little better with a full stomach, but it only lasts for an hour or two. No matter how much I eat, the nausea will be back an hour or two later, and I have the choice to stuff myself with more food and face gaining enormous amounts of weight, or suffer. I’ve been falling on the side of stuffing myself with more food, consequences be damned.

If I could just be curled up on a couch all day (like I am today), I think I could manage okay. But having to get dressed and go to work, where I have to pretend everything is totally peachy, is really pushing me to my limit. I count every single minute until the day is over, then start dreading the next day. I’ve finished 4 of 10 work days before my next ultrasound, and I’m barely holding it together. I’m not sure what I’d do if I wasn’t working part time, maybe I’d have to consider unpaid leave.

I have to say though, the hardest part of feeling sick all the time is that I’m SO ANGRY that I feel this way. I’ve had to do this FIVE times!! Is it not unfair enough that I have to have miscarriage after miscarriage, do I also have to be punished with months and months of feeling like I have the flu too? I’ve done the equivalent of a full pregnancy’s worth of first trimesters, feeling more nauseous than most pregnant women ever feel. If I actually had the flu I could stay home, or if I was a normal pregnant woman I could get away with telling people. But instead I have to pretend everything is f*ing fine, and go about my life like nothing is wrong. It just feels like kicking me over and over when I’m already down.

In less angry news, I’ve spent a lot of time over the last few days thinking about my options, however few, going forward. As so many of you commented, there are options out there, and the question for me always goes back to just how much time and money am I willing to risk on a longshot? Adoption has always been our backup option, our plan B. And the thing about adoption is it’s close to a sure bet. It’s expensive and seems insanely hard, but we know that we could do it and in the end we would have a child. We’ve already done a lot of research, so we know what agency we would probably use, how much it would cost (we could set an upper limit), and most of what’s involved in the process. It would also feel like we were taking control finally, after 3 years of having absolutely no control over anything. Plan B doesn’t have to be the end of the world, maybe (maybe) I could even get excited about it eventually.

BUT. I can’t do any of that while I’m bogged down by unanswered questions. I’ve always said if I had some sort of explanation for my losses I could start to move on. When you don’t know whats wrong, it feels like an answer or a solution could be right around the corner. What if I just asked one more question? What if we did just one more test? What if we saw just one more doctor? Maybe the answer is just sitting there waiting to be found, and all the horror of the past 3 years will melt away as we suddenly have a miracle cure. There are always more articles, more blogs, to read and get ideas about possible explanations. I could truly fall down the rabbit hole and never come out chasing answers that ultimately might never exist. I’m already feeling the frustration of the having wasted this last full year on a single attempt. If we’d moved on after our loss last December, like we said we would, we could have a child by now. So, as badly as I want answers, I feel like I need to be careful not to be too drawn in to the possibility that one more (test/doctor/treatment/attempt) could be the magical solution. It’s a fine line, because I don’t want to give up too early when there are valid things left to try, but I don’t want to waste the rest of my life chasing a hopeless dream either.

With that in mind, we have decided to see just one more doctor. We made an appointment with a doctor who is a definite proponent of the embryoscopy procedure. We were super lucky to get in to see him so quickly, our appointment is next Thursday (the 12th), so it won’t be too late to still do embryoscopy if he convinces us there is information to be had from it. From his website, it’s clear that he has a different opinion about RPL than Dr. O., and as much as I respect Dr. O, I’m beyond fed up with the attitude that we have to ‘just keep trying’ because there are no more answers to be had. Ultimately he may be right, but I need to at least try asking one more person. I strongly suspect that this new doctor (Dr. A), will have something different to say, and then the question will become, who do we beleive? When all you have to go on is one person’s opinion versus another person’s opinion, how do you know who to trust? I guess we’ll cross that bridge when we get there.

So, today what I’m working on is the list of questions we want to ask Dr. A. The bottomline question is, what do you think our options are? But, to get to that point, my hope is that we can look at the ‘evidence’ so to speak, in the form of my history and the details of my losses, and see if they provide any clues to the type of problem we’re dealing with. From what I’ve heard/read of him so far, I think that he may be the type of doctor who is willing to think things through this way with us, rather than just saying ‘no way to know, just keep trying’.

All of you have been super helpful already by giving me suggestions for things to think/ask about. I’m going to list the ‘evidence’ and questions that I’ve got so far (with your help) below. If you can think of anything else that I should ask about, please let me know. I’m feeling a little more optimistic at the moment, hoping that either we can make some progress with this doctor, or if not, we will feel like we’ve asked all the questions and heard all the opinions there are to hear, and maybe this will help us move on.

Evidence:

  • Strong pattern with almost all losses: bleeding at 5 weeks, heartbeat at 6 weeks, no heartbeat at 8 weeks
  • Very heavy bleeding, starting early- what could be happening so early to start the bleeding?
  • Almost all were missed miscarriages, even by 9 weeks there has never been any sign of anything progressing naturally
  • Almost all embryos looked bad or ‘weird’ in some way on ultrasound (anything from no yolk sac to weird oblong shaped gestational sac)
  • No signs of fever/allergic reaction when pregnant (sometimes thought to be related to immune causes)
  • Very high AMH- most likely not an egg quality issue
  • ‘Wierd’ uterine stuff: asymmetrical lumpy lining with this pregnancy, former very small septum
  • Periovarian mass
  • Very slightly elevated TSH (2.92 pre-pregnancy) and hypothyroid symptoms during pregnancy

Things to ask about:

  • Embryoscopy- will it help us differentiate genetic versus uterine issues? In other words- will it tell us if it’s me or the embyros?
  • Could the bleeding itself be causing the losses (some sort of excessive bleeding issue? failure to clot?)?
  • Could this be a sperm quality issue (e.g. imprinting)? Is there any way to test?
  • Could this be related to my thyroid, even though I’m on thyroid meds now? *more on this another time, I’m feeling totally different this pregnancy, none of the extreme fatigue/low blood pressure/low pulse I’ve had in the past, so it certainly seems like the thyroid med is having an effect. But, the pregnancy is still failing, so it doesn’t seem like that was the cause.
  • In your opinion, without having done embryoscopy, is your impression that this is genetic or uterine (me or the embryos)?
  • Do you agree with us that the statistics about the odds of a successful pregnancy after this many losses don’t really apply to me? This is a tough one, but I feel strongly that my pattern is so strong that without figuring out whats wrong, I will never have a successful pregnancy. I think the statistics are more relevant for people who have had different kinds of losses, or something different has happened each time.
  • Should we do more thorough immune testing?
  • And finally, what do you think is our best chance of a successful pregnancy? If the answer to this is do nothing, just keep trying, then we have our answer. Adoption it is.

Anything else you guys can think of???

All out of options.

Without further ado, in the words of Dr. O, the outcome of our ultrasound today was “not optimistic”. Coming from him (the eternal optimist), this is basically the same as saying it’s hopeless. At 5w6d, there was a yolk sac, but no visible fetal pole. In a normal person, this could just be chalked up to it being too early. But for me, it’s ‘not optimistic’. There were some other lovely findings too, including a ‘periovarian mass’ and a weird asymmetrical thickening of my endometrium. His interpretation of these was they are ‘interesting’, and we shouldn’t ignore them. It doesn’t appear that they’re related to the pregnancy though (or what’s wrong with it), so it’s hard for me to care too much about them right now. He tried to reassure me that the mass ‘probably wasn’t cancer’ (probably?), but even that didn’t get a rise out of me. If it’s not related to figuring out what the hell is wrong with my ability to reproduce, it’s not much on my radar right now.

Honestly, I was super relieved to hear that the pregnancy was not totally normal. It sounds counter-intuitive, but I was really worried they were going to tell us that it looked totally normal and we shouldn’t give up hope yet. Then I would spend the next two weeks letting the hope sink in, and be extra special crushed when it (of course) wasn’t. Instead, now I get to spend the next two weeks before the next ultrasound feeling absolutely miserable with nausea (did I mention it’s awful now??) and dragging my feet to muster the energy to act like a normal human being at work all day. In fact, right after the appointment today I had to go back to work and stare at my computer screen, interact with other human beings, and basically pretend not to be a person-shaped ball of anger and frustration. That was fun.

Up until today, my emotions have been conspicuously absent. I went from being an emotional wreck in week 4 to being completely numb and emotionless the moment I started bleeding. I didn’t cry, I didn’t obsess over it, it just….was. But I knew that couldn’t last. And sure enough, my emotions chose the middle of our appointment with Dr. O to reappear. One minute I’m asking him logical rational questions, and the next my lips are shaking and I can’t eek out words. The thing is, I’d been keeping it together up to that point mostly by thinking about what comes next. As soon as I read the article about embryoscopy, the idea has been growing in my mind that we might be able to figure out whether my problem is uterine or genetic (assuming those are the main two options). It was a quick jump from there to, well if it’s genetic, we have options! We can try donor egg, sperm, or more likely, donor embryo. If it’s just our genetics screwing us over, we can fix that by throwing some other genes into the mix! The feeling of finally having options gave me such a feeling of lightness, it almost drowned out the pain of another loss.

I should have known better than to get my hopes up though (haven’t I learned by now???). We asked Dr. O about the possibility of doing embryoscopy, and he was not exactly supportive. He said he would be willing to do it if we really wanted to (and he’s done it before), but he doesn’t see any point. Basically, he thinks that it’s almost inevitable that our embryo would be developmentally abnormal, because, (duh) it didn’t develop. He doesn’t agree with the papers that I’ve read saying that abnormal development implies a genetic problem (karyotypic or otherwise). He feels that a uterine factor could cause the same abnormal development as a genetic factor. So, it wouldn’t give us any information if we did it. In fact, when really really pressed, he said he thinks my problem (and most people’s problems for that matter) are uterine, not genetic. This is just an opinion of course (he admits there’s no way to know for sure), but ultimately if we decided to do something like donor embryo it would have to be just because we beleive the problem is genetic not uterine. In other words, it would be an enormous roll of the dice.

So what’s wrong with rolling the dice? We’ve already done it 7 times, right? In my mind the difference is that with donor embryo (or donor egg, or donor sperm), it’s not just us involved anymore. The genetic parent’s of the embryos we’d receive worked insanely hard to create them, wanted them very badly, and donated them out of the generous hope that they would have a chance at life. Who am I to take their (probably perfectly viable) embryos and toss them in to my death trap of a uterus? It’s not a risk I’m comfortable taking unless someone can give me a decent reason to beleive it will work.

Given that, I’m now feeling like doors are very quickly being slammed shut in my face. Where last month there were at least a few doors left open (trying on our own, donor embryo), these are quickly becoming obsolete. I’m almost completely sure (lets say 99.5%) that we won’t be trying again on our own. I don’t care what the statistics say, I no longer beleive that I am capable of creating and/or carrying a viable pregnancy. Ever. I simply don’t beleive it anymore. The pattern is too strong. Every time I get pregnant it will happen the same way, unless we figure out what’s causing the problem and treat it.

Dr. O reiterated that there are simply no  more tests or treatments available though, and so trying on our own is pretty much out. If donor embryo is out too, we are at the end of our rope. The words I was trying to get out through the tears to Dr. O were “I just wish we had some sort of option left, we just want to have some chance”. So, I guess it’s the time we’ve been dreading. The time I spent years going through more wasted cycles and wasted pregnancies to avoid. The time when we have to accept that it is what it is and move on to the only option left: adoption. Now if I could just figure out how the hell to accept that, that’d be awesome.

 

The beginning of the end

Two days ago, at 5w2d, I started bleeding. Bright red blood along with some decently strong cramps. It only lasted for a minute or two, but it was enough to show that the process is starting. This is identical, practically to the minute, to my other miscarriages. Everything is peachy until 5w2d, and then it all turns to shit.

I have an ultrasound scheduled for Tuesday, which I expect will involve a heartbeat. The first one always does. But then the bleeding just continues to get heavier and heavier and we all know what the outcome is. It usually takes 4 weeks or so from the start of the bleeding before I have a dnc scheduled and the whole thing is over. 4 weeks of feeling horribly sick, depressed and hopeless. Here we go again.

I can’t say I was that surprised when I saw the blood. I had been checking religiously. Scrutinizing the tp every time I peed. But I had managed to convince myself that it was possible that it could be different this time. I wouldn’t say I was totally optimistic, but I was being negative either. I was even talking to the embryo, telling it to ‘please please please please be okay this time’. G was much more involved this time too. In the past he’s been so detached, not wanting to get his hopes up. But last week (after an emotional breakdown on my part) I convinced him we both needed to be present this time, even knowing it might go badly. I spent so long wishing to be pregnant again, I didn’t want to ignore the experience while I was having it. So G was asking me about every tiny symptom, and he even started calling the embryo peanut. It’s been a totally different experience, feeling like I’m not the least bit alone in this.

I don’t know why, but I haven’t cried or gotten emotional. And it’s not because I think it’s going to be okay. I’m 98% sure this is over. I think it just hasn’t hit me yet. When I saw the blood, I called G in to the bathroom to see (I know, gross, but he said he wanted to see), and we just sort of stared at it for a minute and said, ‘okay, well I guess that’s that’. We got into bed and had a long talk, but mostly we talked about what comes next. I have a feeling that at some point it’s going to hit me that this is happening now, and I will have to deal with it.

So what comes next? Ultrasound this week, more waiting and bleeding, then eventually another ultrasound with no heartbeat (I know I sound morbid, but it’s just the reality). Most importantly, this will hopefully give us the opportunity to do the embryoscopy procedure I wrote about before. The last thing I wanted was for this to happen again, but if it had to happen again I want to know as much as humanly possible about what’s going wrong. I know I’m getting my hopes up because there are a lot of factors that have to work out to do the procedure (doctor agreeing to do it, not having a natural miscarriage first, not having so much bleeding they can’t do it, etc), but I just so badly want to know what’s going on it’s driving me insane. I just keep thinking if I had some clue what was going on, I’d be able to come to terms with it. Not to mention having an idea of how to proceed from here. After my hopes get dashed over and over, it seems like too much to ask to even be able to get some answers.

On top of everything, now I’m getting sick. G has had a cold for the last week, and we tried so hard not to share germs, since I didn’t want to risk getting sick while pregnant. I managed to keep it at bay until today, but now I feel awful. Interestingly though, I don’t feel like I have a cold, I feel like I have the flu. My chest is super heavy, I’m dizzy and weak, and the nausea I’ve had for the last two weeks has increased dramatically. I don’t know if it’s just that the combo of morning sickness with a cold feels like the flu, or if there’s something else going on, but I feel like crap. I’m just SO not in the mood to be feeling so sick on top of everything else right now.