Ultrasound and fire truck update

Well, the spotting increased to full-on bleeding Wednesday afternoon, so C and I both canceled each of our evening plans and stayed home to mope. The bleeding slowed overnight, then started again Thursday afternoon, this time accompanied by cramping.

Ever the pragmatist, I emailed Dr. R before driving home from work:

“In the last hour I’ve started cramping and bleeding more heavily. Do you think I should still come in tomorrow if it continues/increases? Should I try to save any tissue for testing?”

She replied that I should still come in, and that I should save any tissue if I could.

Again the bleeding slowed that evening and overnight.

On Friday I got up and got ready for work. I taught my class (OChem II), replied to emails, prepped for Monday’s class, and represented my department at an event for prospective students. As I realized that it was time to leave, a feeling of dread settled into the pit of my stomach. I said a grim goodbye to my friend/department assistant (who is ‘in the know’ about everything going on), and drove home to meet C.

C and I drove to Kaiser, making small talk. I mentioned Dr. R’s email, and speculated that she might recommend a D&C so we could test the embryo and see if there was a genetic reason why things went wrong.

We arrived, checked in, and waited. A nurse took me back in to get my weight, blood pressure and urine sample, then brought me back to the waiting room because Dr. R was behind schedule and she thought I’d be more comfortable waiting there.

Eventually the nurse came back for us and as we walked down the long hallway to the very last exam room, I leaned over to C and told him it felt like we were walking to the firing squad. I undressed and sat on the exam table, feeling both literally and figuratively naked.

Dr. R came in and hugged us both. She said how nice it was to see us, that it had been too long. She asked if I felt pregnant, and I explained that the only pregnancy “symptoms” I had were feeling weepy and very tired…both of which could easily be attributed to depression over our apparently failing pregnancy.

Mercifully, she suggested that we postpone the usual prenatal visit stuff and skip straight to the cervical exam and ultrasound.

Dr. R did her thing as gently as humanly possible. She realized that the probe was disconnected from the ultrasound machine and had to start over. She tried again and focused in on the dark oval (the gestational sac) and said, matter of factly,

“I see a heartbeat!”

What?!

She carefully showed us – skeptical as we were – what she was looking at. She checked the rate and declared it to be a normal heartbeat, then she measured the embryo, twice, and showed us that it was measuring 6 weeks 5 days. (We were at 6w6d by my count.)

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Dr. R was so visibly happy; she just about started crying. Meanwhile, C and I displayed no emotion at all. We were (and still are) dumbfounded.

I had already been anticipating how I would tell my department chair that I needed to change my fall teaching schedule back to a normal schedule. (I had jumped the gun and moved some courses to accommodate a November due date, prior to student registration starting last week…) I had planned to console myself with a delicious cadillac margarita at the Mexican place behind our house, watch the depressing movie about stillbirth I’ve been wanting to see, and ugly cry on the couch by myself…

That I could still be pregnant was, and is, so unreal.

Of course, we know we’re not out of the woods – that we will never be out of the woods.

But that doesn’t stop this me from feeling like getting this far is a miracle.

Dr. R suggested I lay off the aspirin for a couple days and then start back on it again Monday and see how it goes. She said I could go to a ‘normal’ prenatal visit schedule and come back in a month…or that I could come back sooner if it would help me feel less stressed. C answered for me that of course I would want to come back. (He told her I’d just move in to the clinic if she’d let me!) So Dr. R set up an appointment for next Friday, and said we could “play it by ear” after that. It sounds like she plans to let me come in as often as I want!

We talked about other things, including how (and when) I should deliver, but it was pretty much consistent with what she had already recommended when we met back in September.

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In other news, on Thursday I heard back from the sales rep for Kompan, the Danish company that we contracted to make Jane’s memorial fire truck. He said he had just confirmed that the pieces of the truck had arrived at our local Parks & Recreation office! We don’t know when they’ll get around to assembling it and removing the current fire truck, but this was unexpected good news!

He went on to say that while he didn’t know all the details, our story had touched the hearts of many of the people at Kompan who worked to make it happen. He shared that many years ago, he had lost an adult son (age 25), and that he was honored to be able to contribute to Jane’s memorial. ❤

Here were the plans for the memorial again. We can’t wait to see it in place at our local park!

Spotting

Thanks to all of you who wrote reassuring comments. (Thanks to those of you who left empathetic “Oh, shit!” comments too! Validation of my feelings is always welcome!)

On Monday, I got a nice message from Dr. R (my obstetrician for Jane, and for this pregnancy):

Hi, K! Please pardon the delay, I have been out of the office. Usually, the very earliest we can definitively see a heartbeat is when the fetal pole measures at least 6 weeks (your fetal pole measured 5+4 weeks). So, things can be totally normal at this stage, the ultrasound was just a bit early. The good news is that there is a tiny fetal pole and a gestational sac which is exactly what we should see at this stage. Also, the gestational sac measured less than 2 cm. This is usually the cut off when we can visualize fetal cardiac motion. So, once again, probably too early. As far as I can tell, your hormones rose great when checked and you have a pregnancy in the right spot (the uterus and not an ectopic pregnancy). When I see you this week, if all is progressing well, we should see a heart beat then. This week will seem like forever for you, please keep the faith! See you soon! 🙂 Dr R.

Have I mentioned how much I love Dr. R? (Pretty sure I have, but it bears repeating!)

Unfortunately, as the title of this post suggests, I started spotting on Sunday. It’s not heavy, but it seems to be most noticeable in the evening – presumably when the progesterone from my suppositories starts wearing off – which I think can’t be a good sign. While I’ve spotted in my previous pregnancies (with C. Samuel, with Jane, and even with this pregnancy), it’s only been at 4.5-5 weeks.

So here I am, still waiting for Friday’s ultrasound, hoping that I’m wrong to think that this pregnancy is all but over…

 

Inconclusive ultrasound

Today, at 5 weeks 6 days, I went in for my ultrasound. More precisely, I raced from work to my ultrasound, where I arrived 3 minutes late. C was out of town for a meeting in NorCal, and was texting me to see when he should step out of his meeting to Facetime me…

They got me back into the room quickly, and when the nurse practitioner came in, she said it was fine to Facetime with C, and I called him up. She said that my blood tests had looked really good, and she wished for good news for us, since we “have had enough heartbreak.”

The good news:

  • We saw the gestational sac.
  • It is located in the uterus.
  • It measured at 5 weeks 4 days (within the error range of the measurement, according to our nurse practitioner).
  • We saw something resembling an embryo, which had something resembling a yolk sac, and something resembling a fetal pole, which measured at about 5 weeks 5 days.

The less-than-good news:

  • We did not see a heartbeat. Our NP prepared us for this even before she went in, so we know it doesn’t mean anything…but with C. Samuel we saw the heartbeat at 5 weeks 5 days, and we would really have liked to see it today.
  • More alarming was the nurse’s demeanor. She clearly didn’t like the appearance of the embryo, saying “I would like to see it more defined at this stage.” She reassured us that “I have seen pregnancies that looked like this at this stage, and then developed into healthy pregnancies,” which, frankly, wasn’t very reassuring at all.
  • Ultimately, she gave us 50:50 odds that this pregnancy would progress.

So now we wait until next Friday, praying that this coin flip goes our way…

Telling Jane the news

Last week, I got two more betas. Here’s a summary:

Date/time DPO Beta-HCG Doubling time
Fri 3/17 10:30 am 13 66 mIU/mL  
Mon 3/20 11:30 am 16 370 mIU/mL 26 h
Wed 3/22 10:30 am 18 791 mIU/mL 43 h
Fri 3/24 12:30 pm 20 2165 mIU/mL 34 h

 

Everything looks good, so now we wait for my first ultrasound on Friday afternoon (at 5 weeks, 6 days past IUI).

As if it were a sign from Jane, the wildflowers (whose seeds we had as a takeaway from her funeral), which had previously been ravaged by caterpillars and drought, just bloomed for the first time last week.

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On Saturday, the three of us (C, C. Samuel, and I) went to visit Jane. My mom had suggested that lilacs would be lovely at this time of year, and she was right.

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C. Samuel also picked out an anemone to give her.

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We told her again how much we love her, assured her that no other baby could ever take her place in our hearts, and, as if to convince her, C. Samuel left her a few of his goldfish crackers.

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Blogiversary, beta update, and winter cuteness

After I posted our news on Friday, I got notified by WordPress that it was the four-year anniversary of my blog. That makes it five years – give or take – from when C and I first started trying to conceive!

That went by fast – sort of.

I feel a little bit sorry for that little newlywed me, who actually argued with my dashing new husband about when to start trying…so we could. Time. My. Maternity. Leave.

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Mr. Obama finds my naive ideas about family planning hilarious!

But early pregnancy loss, life-threatening motor vehicle injury, crushing infertility diagnosis, and stillbirth notwithstanding, I still can’t help but focus on the positive.

  • I married a wonderful man who doesn’t have a self-pitying bone in his body.
  • We have a gorgeous son.
  • We have amazing friends and family who have supported us through everything.
  • Contrary to the predictions of three different REs, I have managed to get pregnant four times.

 

So while things have not quite gone according to plan, I’m proud of where we’ve come in the last five years, and hopeful for what the next five will bring!

 

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For those of you who are counting, my beta came back today at 370 mIU/mL. That corresponds to a doubling time of about 33 hours.

doubling time

Looks really good!

histogram 2

I take another test on Wednesday.

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Lastly, for your viewing pleasure, here are some sweet pics of C. Samuel from our ski trip to Park City over my Spring Break:

Look who has nicer ski gear than me!

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Enjoying the view from the lift.

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C. Samuel wanted to hold our hands while skiing. ❤

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Relaxing in the hot tub after a long day!

Bulletproof

My blog is semi-private; I try not to use names or give overtly self-identifying information, but I’ve also shared the blog with many friends and family ‘IRL’. This means that I sometimes have to make difficult decisions about what and when to share things on the blog…

Like when we find out that we’re pregnant.

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On Tuesday (10 dpo), I decided to take a pregnancy test. No line. Or maybe a whiff of a line. Could easily be residual trigger shot.

On Wednesday (11 dpo), same thing. Maybe a bigger whiff. Or maybe I was deluding myself.

On Thursday (12 dpo), same. Definitely not pregnant. But when I set it next to the previous two, and squint at it, I kind of see a line. I tell C. “Hey, we’re probably not pregnant, but there’s a whiff of a line. Pretty sure it should be darker at 12 dpo. It’s probably nothing, but I thought you should know.”

On Friday (13 dpo), there is a very faint line. Darker than the previous line, but lighter than I think it “should” be. I decide to use one of the expensive First Response tests. There is definitely a line. At work, I decide to email the nurse practitioner and Dr. Y to see if I should do the blood test a day early. Both reply and say I should.

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10 dpo (top) through 14 dpo (bottom)

In between afternoon meetings, I drive to Kaiser for a blood draw. Juan-the-phlebotomist draws my blood and explains that a courier will come and deliver my sample to the nearby hospital for testing, and I should get results in 2-3 hours. After drawing my blood, he lines the tape with a piece of gauze for pain-free removal later, and folds the tape into a little tab to make it easy to pull off. On my way out, I tell the receptionist that Juan is the absolute best phlebotomist I’ve ever had. I return to work and to my meetings.

After my meeting, I check my email and see that there is a new test result. My HCG is 66 mIU/mL. I check on betabase.info. It’s slightly below the median value for 13 dpo, but well within the expected range. I click on a link and discover for the first time that betabase has histograms of beta values for each day past ovulation! My beta value is comfortably in the middle of the distribution.

histogram

So, we’re pregnant.

Conventional wisdom says that we should wait to tell people, but how long?

  • Until we get a few beta values and see that the doubling rate looks reassuring? 
  • Until we see a heartbeat?
  • Until we get a ‘normal’ genetic test result?
  • Until we pass the first trimester?

 

We know better than most that none of those things are a guarantee of a healthy baby at the end. So do we wait until the baby’s out? Probably not practical.

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I thought of a scene from an episode of Speechless. (If you haven’t seen this show, go watch it on Hulu, or abc.go. It’s adorable – like Malcolm in the Middle with a special needs kid.)

Speechless

In the scene, the dad on the show (his name is Jimmy) is explaining to his middle son why he doesn’t care what other people think, and says that after getting the news that his oldest son will never walk and do other stuff, and then making it through and seeing that same son grow into an incredibly cool person…he’s kind of like, what’s the worst that can happen? Here’s the full scene:

 

I feel kind of like Jimmy. If we tell everybody we’re pregnant after the first pregnancy test, what’s the worst that can happen? We lose the baby and have to tell everybody our sad news?

Yeah, and?

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At this point, we’ve shared awful news with our friends and coworkers and family and bloggy friends. We (and they) survived.

We’re bulletproof.

Progesterone, 4 years later

The IUI went as planned on Saturday, and today I went in for a blood progesterone test. It came back at 15.1 ng/mL, not as high as my highest value back in April 2013, but well within the normal range. Yay!


I wrote about progesterone back then, so I won’t go into detail about it here. However, I did notice a significant packaging change since last time:


I like that the new packaging allows me to pack just the 6 suppositories I need for tomorrow’s trip to Park City. Now if I can just figure out how to keep it on the DL while sharing a fridge with all C’s residency buddies and their kids… (Not that I’m embarrassed about infertility; I just think it might be a tad awkward to explain that the bullet-shaped things next to their kids’ string cheese are going to go up my hoo-ha…)

Oh, and another fun fact: I recently learned that my trans friend takes progesterone as part of her hormone therapy. In each 28-day cycle, she takes 200 mg of oral progesterone on cycle days 14-23 (along with an injection of estradiol every two weeks). Yet another unexpected human connection, brought to me courtesy of infertility!

A bit of good news

Seven months after we lost Jane, it appears that my cycles have normalized somewhat, and we are on track for our first properly-timed natural cycle IUI. (Second IUI overall since Jane.)

Here’s a TMI TTC timeline:

Cycle start Notes Positive OPK Cycle length Ovulation?
July 24 Delivered Jane n/a 11 weeks ?
October  7 1st period postpartum CD8 and CD16 (!) 26 days In Europe, tried ourselves
November 2   CD24 35 days In Texas, tried ourselves
December 7   CD35 46 days IUI after positive OPK
January 22 CD15 26 days C out of town; office closed for holiday
February 17 Trigger Friday (CD15) ? This Saturday?

 

Our plan was to do as many natural cycle IUIs as Kaiser would let us get away with, but our travel plans got in the way twice, and my cycles got progressively longer and more difficult to anticipate (leading me to wonder if this is what perimenopause looks like…)

After a couple of disappointing mid-cycle ultrasounds, the nurse practitioner at Kaiser volunteered that I could call as soon as I got a ‘high’ or ‘peak’ reading on my advanced OPK, and she would squeeze me in to take a look. That’s how the IUI went down in early January (the day after an ‘oops’ positive OPK and same-day sonogram showing a mature follicle). And then Presidents’ Day went and mucked up the February cycle…

 

All that to say that this cycle things appear to be on-track:

  • On Sunday (CD10), I got a ‘high’ reading on my OPK.
  • I called Monday and got an appointment for a mid-cycle ultrasound today (CD13).
  • On ultrasound today, I had not one, but two nice-looking 16 mm follicles (one on each side).
  • My uterine lining looked “great” (9-10 mm?).

Since the clinic isn’t open Sunday, we scheduled an IUI for Saturday morning, with plans to trigger on Friday.

Wish me luck!

There Is No Good Card for This

This morning on my drive to work, I heard an interview with Emily McDowell on NPR. If you haven’t heard of her amazing Empathy Cards, stop reading right now and go check them out!

Seriously, I’ll wait.

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After I lost Jane, a coworker sent me this card:

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I went straight to emilymcdowell.com and ordered 20 cards the same day.

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I didn’t even realize until this morning that she has an infertility card too! (Although many of her other designs would also be perfect for infertility, pregnancy loss, or a whole bunch of other shitty things…)

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Anyway, the reason for the interview was that she just coauthored a book, titled – wait for it – “There Is No Good Card for This: What to Do When Life is Scary, Awful, and Unfair to the People You Love.”

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I live with my foot permanently wedged in my mouth, and have lamented the fact that I have been/would be pretty worthless at comforting a friend in the way my amazing friends (including several who read this blog) did for me.

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I just added this book to my Amazon cart. Can’t wait!

Staying the course…for now

My period arrived last Sunday. I emailed Dr. Y to double check our course of action.

In particular, I wanted to see whether he thought we should start using stims (like Clomid or Menopur) to stimulate regular ovulation. Since losing Jane in July, I’ve had exactly three cycles, which were 26, 35, and 46 days long. (This trend is not particularly reassuring…) We also did a progesterone test this last cycle at 7 dpo, which came back at only 5.7 ng/mL. (I’m pretty sure it’s supposed to be higher – say, 10 ng/mL or more. Previous values from when I was trying to conceive C. Samuel and Jane were 24.5 and 9.6 ng/mL.)

Dr. Y said we can try Clomid if I want, but he doesn’t think it will be any more effective than natural cycle IUI. He does however recommend supplementing with those awful progesterone suppositories. Given my ever-changing ovulation date, he said we could try waiting to schedule my next ultrasound until my advanced OPK gives a ‘high’ reading. So we’re staying the course for now.

On Monday, I spoke to students and faculty from the Biology and Chemistry departments about losing Jane Margaret (sharing what happened and what I did to cope during my leave). The talk forced me to organize my thoughts about several things, which should eventually find their way into this blog.

Tuesday was the 6-month anniversary of losing Jane.