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.

 

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Holding pattern

I’m 7 dpo, and the antsiness is setting in hardcore. I keep opening up my ovu-tracker app or looking at the kitchen calendar wondering if by some miracle another few days have passed while I wasn’t looking. I was doing so well being patient during the tww the past few months, and all that appears to be out the window this month.

The problem is I’ve put a lot of pressure on this month. The longest it’s taken me to get pregnant in the past is 5 months, and this is our 5th month of trying this go-around. I remember very clearly that by the 5th month last time, I was going totally crazy, positive that my reproductive organs had crapped-out completely. So, the only way I’ve been maintaining some form of sanity (a meager one) this time is by reminding myself it’s taken this long before and still happened. If it doesn’t happen this time though, we’ve moved into entirely new territory. The territory of ‘oh shit, there’s something else wrong here’.

5 months has become an important landmark to me because of this, but when I started doing some reading it turns out its not completely arbitrary. From everything I’ve read, if you’re putting all the things in the right places at the right times so to speak, it should happen within 4-6 months. I’ve done everything I could possibly do this month, bbt and CM charting, minimal caffeine, extra folic acid (on top of a normal prenatal), acupuncture, full-fat dairy, I even started eating fish once a week or so for the omega-3s, despite being vegetarian for 15 years (yup, apparently I’m even willing to bend my principles a little if it will get me a baby). The stars aligned and we tried 3 whole times during my fertile period, and my CM did its grossly fertile thing. If it doesn’t work with all of that, things are just not looking good.

Rather than being totally depressed or anxious about what it will mean if this month fails, I’ve actually been pretty darn optimistic for most of the month. I even went so far as to promise G I’d be pregnant by his birthday (in December). I know, what was I thinking putting that kind of pressure on myself? It happened when we were laying in bed after our last ‘attempt’, knowing we’d done all we could. The topic turned to his birthday, and what he might want as a gift, and I, apparently in a post-sex high said “I know, I’ll get you a baby for your birthday!”. Dumbass. Well, at the time we both thought it was funny, but he’s brought it up a few times since, as if he believes it’ll happen. I had to put a stop to it eventually, explaining that it just feels like a lot of pressure for something I can’t control at all.

In the middle of all this, a friend from a local support group sent me a link to an article about a way to investigate miscarriages. I’d never heard of it, and immediately gears started turning in my head. Basically, what they do is after you’ve had a missed miscarriage (I suppose you’re sort of out of luck if it happens suddenly), they go in with a camera and actually cut through the sac and look at the embryo itself. I’m sure there’s a lot of factors that go in to whether you can do this or not, and whether or not it will work, but this article made it sound like a very simple procedure that theoretically any doc could do.

And what they see is whether the embryo looks essentially normal or not. If it looks normal, you’d assume that the problem was something external, like an implantation problem, or an immune issue of some sort. If the embryo has clear malformations, then you’d assume that the problem is probably genetic or developmental. Now, I’m not sure you’d know exactly what to do with this information, because it doesn’t really tell you much about how to treat it, but I would DEFINITELY want to know at least this much information if I could. It would make an enormous difference in my mind to have some clue about even what type of problem we have. For example, it would suddenly open the possibility of donor embryos or surrogacy. Not that I’m saying I would necessarily jump to doing either of those, but they’ve always been off the table in my mind because we have no idea if my problem is me or the embryos, so how do you know which one to even consider?? This would open doors to start considering if they should even be on the table at all.

Another reason to do this type of procedure is that you can be sure to get cells from the actual embryo for karyotyping, without having to worry about maternal contamination (ie, when you accidentally get the mother’s cells instead and the test comes back normal female, but it isn’t representative of the embryo). In my case, both of my embryos that have been tested came back normal male, so whatever our problems were, they weren’t chromosomal. What they found in this article though is that only something like 40% of the time when they observed a malformation in the embryo that was likely caused by a genetic problem it was picked up by karyotyping! This shouldn’t be shocking because there are just so many things that could go wrong genetically, and aneuploidy (the wrong number of chromosomes) is just one. What was shocking to me is that no one ever talks about this! When my embryo’s karyotypes came back normal, my doctor was surprised, but then basically wrote off the possibility that we have a genetic problem. I’ve even asked before, couldn’t it be something genetic besides a chromosomal problem? His answer is always, well yes, that’s possible, but basically shrugging it off as unlikely. Well, if this data is correct, karyotyping only ever had a 40% chance of finding a genetic problem if there was one!

This has all been swirling around in my mind the past few days, and honestly there’s not much I can do with the information yet. I’ll either be pregnant this month or not. I’ll either have another miscarriage or I won’t. So, what we’ve decided is that if I am pregnant this month, then awesome, we’ll take that for what it is and try to be optimistic about it. We will hope that either the things that have changed since my last miscarriage (less stress, acupuncture, thyroid medication, higher dose of progesterone) will make a difference, or that for some unknown reason that has nothing to do with those things,  it will go differently this time. If not, and I have another miscarriage, we will start to ask questions (and possibly be really pushy) about considering this procedure. If it gives us any sort of half answer that will be amazing.

And, if I’m not pregnant, we’ll call the doctor and see about figuring out why. I’m not sure if they will take me seriously since the standard is 6 months (or maybe I’ll just bend the truth and say it’s been 6 months), and I’ve been pregnant naturally so many times already, but I simply do not have the patience for another month of the same. Either way, things will be moving forward in one direction or another next month. So yeah, now I just have to manage to make it through the next few days….

***Update: In case anyone would like to read the article about embryoscopy, here it is. Also, there are other articles out there I’ve found today searching for ’embryoscopy’ and ‘miscarriage’ on google scholar ***

 

All the gory details (part 1)

My story in numbers:2625357982_d9efbe18bb_b

6: years married
2.5: years trying for a baby
7: positive pregnancy tests
4: times we heard a heart beat
4: times there was no longer a heartbeat
5: surgeries
2 (or more): chemical pregnancies
0: explanations
0: BABIES

 

The long and short of my story is basically that my uterus spits out babies as fast as I make them, and there’s no justifiable reason why. The purpose of a blog I guess is to tell you how this all makes me feel, but the bottom line is pretty simple. For no apparent reason, my body does not comprehend the concept of pregnancy. So, that’s the short version. Here’s the longer version if you have the patience for it:

My husband and I met over spring break our freshman year in college. It’s actually a pretty embarrassing story for me, definitely not my proudest moment, but that’s a story for another time. He went to school near our hometowns in the midwest, I was out on the east coast. When I came home for the summer, we spent almost every day together, but assumed that long distance doesn’t work for anyone, right? So we broke up before I went back to school. It was only a few weeks later that we decided breaking up was boring, and figured we’d give it a shot. We’ve been together ever since. Our first three years together were long distance, then we moved in together after college and got married six years ago.

My husband is loving, brilliant, and extremely goofy. He would do just about anything for me and wants so badly to make me happy. One of my favorite things about him is how much he adores our cats, so I always knew he would be an amazing father. He talks to them like babies and spends hours cuddling with them. It doesn’t sound manly, but he’s pretty secure with his manliness so its not a problem :).

After we got married I was in grad school, and in a program that would likely require me to do some long term traveling, so we didn’t start trying to get pregnant until December of 2010. I was still a year or two away from finishing my PhD, but others in my department had had babies during grad school, and it seemed to work out pretty well for them. I figured, better to get it done now before I have to worry about the tenure clock (puke, thanking god I don’t have to worry about that crap anymore).

Our second month of trying we took a pregnancy test and shockingly, it was positive. Needless to say we had all the emotions normal people have when they see a pregnancy test: excitement, terror, etc. We told our families pretty much right away, and since they didn’t have any idea we were trying they were shocked and unbelievably excited. My parents especially were beyond happy, I’m the oldest and my brother may never have kids, so I’m sort of their only hope. My mom admitted that she hadn’t wanted to bug me that we waited so long since she was so proud of me for getting a PhD, but she’d been dying to have a grandkid (thinking of this now in retrospect, OUCH).

Well, we had all of about a week before things started heading south. At about 5.5 weeks, I noticed a tiny bit of spotting. I did the obligatory google search and found that lots of people spot in early pregnancy, not necessarily a big deal. And so I didn’t think that much of it. I happened to have a doctors appointment later that day for something completely different (not an OBGYN), so I brought it up, thinking why not just ask to make sure I shouldn’t be worried? The doc said its probably nothing, but why not go have an ultrasound at the ER just to be sure? HUGE MISTAKE.

We dutifully went right over to the ER, and proceeded to wait 6 hours to even get out of the waiting room. At one point they wanted to put in an IV, and I managed to have either a seizure or a vaso-vagal reaction (basically I just fainted, but the nurse freaked out because she thought I was seizing and called in a million people to stare at me). They took blood and my hcg was at 160,000. I keep thinking I must be remembering this wrong because it’s such an insanely high number for 5.5 weeks, but it’s pretty much burned into my memory. With that, they were actually talking twins (because higher hcg’s can sometimes mean twins). Finally, around midnight a doctor came in to actually do the ultrasound (transvaginally- if you haven’t had this joyful experience, its like having a giant plastic wand shoved up your crotch. Oh wait! that’s exactly what it is…) , and being that he wasn’t an ultrasound tech it took him around half an hour to figure out what he was looking at. He thought he saw two sacs, but he wanted to get a consult from an OBGYN to be sure (you couldn’t have done that to begin with??). Another two hours later after repeating the experience yet again, the OBGYN tells us that there is in fact no embryo at all. The second ‘sac’ is actually a bleed, and the first sac is apparently empty.

We were finally able to leave the ER around 3am, all our hopes crushed. The OBGYN told us to follow up with another ultrasound a week or two later, to confirm the diagnosis and see if I would need a D and C to end the pregnancy. You’d think this would be the end of the story, but of course it couldn’t possibly be that simple. We suffered through the week of waiting for the next ultrasound, and showed up at the OB’s office surrounded by happily pregnant women. All I can say is thank goodness for ultrasound techs who know what the hell they are doing, because transvaginal ultrasound number three was mercifully brief compared with the others. We were expecting to confirm the blighted ovum diagnosis (sac but no embryo), but instead the ultrasound tech turned the monitor and showed us a heartbeat. Yes, there was in fact an embryo and it had a heartbeat.

Being the naive people we were at that point, my husband and I looked at each other, started crying, and kissed. So, it could actually be okay, maybe this was all just a funny story we would tell when our baby was born. “A silly ER doctor told us you didn’t exist!” we’d laugh. I say we were naive because the ultrasound tech was not smiling when she told us there was a heartbeat. In fact it was extremely slow. She brought in the OB, who was really hedgy with us. She wouldn’t say it was bad news and she wouldn’t say it was good news. She just said we’ll take another look in two weeks. And the only thing we heard was “it could be good news”. Like idiots, we went about our lives for two weeks thinking surely this would work out fine. The heartbeat will speed up and next time it will be a perfectly normal US.

I doubt I need to explain that it was not a normal US. Two weeks later there was no heartbeat, and we scheduled my very first D and C. The fact that we were devastated is probably obvious. What wasn’t so obvious was how stupid I felt for not picking up on the fact that there was no way this pregnancy was ever going to turn out okay. A 5.5 week sac that appears empty is not normal, even if it eventually develops an (extremely slow) heartbeat. I wish that the OB would have been more upfront with me to begin with and saved me the weeks of thinking things would be okay just to be even more let down in the end. We had the D and C a week later, and besides the nerves associated with surgery, it went as smoothly as could be. In our minds we had gotten through the hardest part, and from there on things would be smooth sailing. We had a sucky first experience, but miscarriages happen and next time would be great. If only I could get back to a time when I believed that…

Well, this has been an extremely long winded beginning to my story, and I’m only two months in :(.  I’ll pick up where I left off next time, and I promise to keep it shorter….