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.