Fertility Now!

Christmased

This week was hard.  Really hard.  And I was grumpy pretty much all week.  Really grumpy. 

Early in the week, I was a bit frantic, but felt like things were mostly under control.  My in-laws were in town for the week, and Steve and I had to work more than we'd planned, but we were treating it just like any other normal Christmas week.  I found myself being mildly envious of the people I knew with recognizable physical conditions--a bad knee; a slipped disc--that let them just lie on the couch and do nothing, as that was pretty much what I felt like doing all week.  But of course, we hadn't told Steve's family, so they were left wondering why, exactly, I was being such a bitch.

I like to think that the week would have been perfectly manageable, if not for my RE follow-up appointment on Tuesday.  I woke up in a terrible mood on Tuesday, and it was only mid-way through the day that I realized why:  I really didn't want to go to that appointment. 

Steve and I went together, leaving Andrew with my in-laws, and taking a plate loaded heavily with my homemade cookies and candy.  They waved us into the ultrasound room (a bit of a surprise; had I expected it, I wouldn't have worn my horrid Christmas socks under my boots) and a quick ultrasound showed that my uterus was now utterly, completely empty.  They gave me a lab slip for an HCG test, to make sure that my levels were decreasing appropriately.  (The Christmas Eve results:  23.  Spreading Christmas cheer!)  They told me that the results for the genetic testing on the embryo were not back yet, but should be soon.  Finally, I talked to the nurse, briefly, about what we wanted to do next. 

Not miscarry was my first thought, but they wanted a little more specificity than that.  We talked briefly about my general fertility--three pregnancies in a calendar year, we agreed, was pretty close to normal rates of fertility--and then a bit about that nasty miscarriage business. 

The nurse mentioned, as my doctor had months previously, the possibility of IVIG therapy, given my diagnosis of antiphospholipid antibody syndrome, and the fact that the heparin/aspirin treatments don't seem to be helping much.  She gave me the information for a local doctor who has performed the therapy for some of their patients, and suggested that I talk to him to see if he thought it would help, and also to get a sense of how insanely expensive it would be.

When I got home, I googled the therapy to see if it was as witch-doctory as it sounded.  I recalled, from looking into it three years ago, that at the time it was seen as pretty far-fetched and scientifically unsound. 

All of my googling this time, however, led me to this study on IVIG therapy for secondary recurrent miscarriage, which looks like it would pretty much fully answer my questions about whether or not this therapy would be  helpful to me.  Of course, (a) it's not enrolling new subjects; and (b) they haven't published their results yet.    They're supposed to complete the study in 2010, but the "primary completion date" is January 2009, which they define as the "final data collection date for primary outcome measure."  I am hoping that means that I might be able to contact them next month and see if they would be able to give me a sense of whether I should even try to follow up with this. 

Meanwhile, I'm just a bit adrift--waiting for my HCG levels to drop to 0, waiting for another cycle to start, waiting to see if the genetic testing yielded any results.   Waiting, and hoping that this next year is just a bit easier.   

Making merry

Last Tuesday, the day after my surgery, I woke up feeling fine:  no cramps, minimal bleeding, the hazy drugged state of the prior day mostly gone.  So after an hour or so of lounging, I decided to get up off the couch, and make myself some eggs, plus three kinds of cookie dough for my holiday baking. 

Halfway through the third batch, when the cramping started, I realized that it was actually a terrible idea.  I then spent most of the rest of Tuesday on the couch, and went back to work on Wednesday, which was probably the most difficult day I've had, emotionally.  I had cramping, on and off, throughout the week, but by Friday, both the cramping and bleeding had stopped.  I was able to get through the week with nothing stronger than ibuprofen and wine, and I go back to the doctor tomorrow  for a follow-up appointment.   

Now, I have my in-laws in town, Christmas breakfast to cook, and about a million gifts and stocking stuffers to wrap.   We told only my parents and two friends about this whole ordeal, and so I have had to slap on a happy face and make muttered excuses, trying not to bring anyone else down at a time that is otherwise so bright. 

I do get sad, sometimes:  when I think about how my cravings for artichoke hearts and salami have disappeared; when I look at pictures of our Thanksgiving vacation, and think, "I was pregnant then"; when I realize that I can lend my friend our car seat, after all, as there won't be a new baby in it in July.   

But I'm trying to move through it, trying to truly enjoy the many delights and joys in my life, and keep some sort of small faith that this is just another ugly plot twist on my way to another happy ending.  Because at least now I know, in a way I didn't know before, how very worth it all of it is in the end. 

Out of it

It's done.

I'm home now, on the Big Red Couch, looking at the snow-blanketed yard outside, the fire sparkling in the fireplace, and the lights on the tree.  Andrew is at my parents' house for the night; last I heard, he was helping them put up their tree (too busy to talk to me, as he was "doing very hard work"), and dictating where ornaments should go. 

The surgery was fine, overall--the anasthesia was general, but they started me off with a shot of my old friend, sweet Versed--and I came out of it pretty quickly.  I had stayed on prometrium til last night (after seeing some slight spotting yesterday), and just started light cramping and bleeding shortly before the surgery, after I'd taken the cytotec/misoprostol they'd prescribed me (apparently, they've found it helps control bleeding/hemorrhaging during the surgery itself). 

I did get to eat a small breakfast early this morning, so that helped a bit.  Most of the nurses were very kind, a thankful change from the woman who did my intake last week ("What is this for?"  A miscarriage. "When did that happen?" You want to know when its heart stopped?  I'm sorry, I don't know the exact time that happened.  It was diagnosed last Tuesday.  "Okay, what medications are you taking?"). 

I cried after I woke up, and everyone seemed desperate to comfort me--though my doctor's "it wasn't meant to be" was colder than he intended, I think--but I couldn't help but think,  fuck you all.   If I don't get to cry now, when IS  it appropriate?  I've been holding my shit together for HOW long now?     

I've got lots of trashy magazines and silly shows, pain pills if I need them, an attentive husband and phalanx of concerned animals, and a very quiet day planned for tomorrow.  I hope I'm through the worst of it. 

C'est fini

Our ultrasound this morning confirmed that it's over.  The sac was still there, as was the fetal pole, but there was no heartbeat, and it looked almost no different from last week. 

My D&C is scheduled for Monday.  (A point of annoyance here: because of my insurance, we had to coordinate it with the hospital across town from my doctor's office, and cannot just do it at the hospital attached to his practice.  So it's at 3:00 fucking p.m., meaning that I'll likely not be able to eat or drink anything all fucking day, and that right around the time I'll be out of recovery is when we'll have to pick up Andrew at the sitter's.  The fun never ends around here.) 

I got the sense that my doctor thought that asking for a D&C in this situation was a bit odd ("the fetal sac is not that big," the doctor kept saying), but I reminded myself that as a man, he's apparently never gone through any sort of miscarriage himself, so ultimately his opinion on how bad it would be was of very limited utility to me.  They suggested taking Cytotec as an alternative, and just waiting for it to happen at home, but that was exceedingly unappealing to me, and not a whole lot better than just waiting for it to happen, period.  Either I'd spend the day in the fetal position in pain, or I'd be so high on pain meds I would be otherwise completely useless.     

So now I'm just taking care of the pre-op details and getting through the next few days.  I think I can, I think I can, I think I can...   

Making peace

Last week, when we got the bad news at the ultrasound, I was really upset.  Upset, of course, that the pregnancy did not look good, but also upset that it meant longer on this whole ugly merry-go-round.  Since the beginning, this pregnancy has been so confusing, such a ride between elation and misery, that I dreaded yet another week of uncertainty.

And yet, I have found this week, in an odd way, to be a gift:  time to let the news sink in, to let me make plans, to adjust to thinking of myself as "not pregnant" before that is technically true.  In the first few weeks, I didn't allow myself to consider myself pregnant, but after the last good beta and the first good ultrasound, I relaxed into it.  If I wanted a nap, I got one--because I was pregnant.  If my stomach was unhappy or my breasts sore, it was because I was pregnant.  I let myself be reassured by this constant news, and thoughts of little else filled my mind. 

Now, I barely notice the symptoms, although they are still there.  I cannot tell if they are in fact muted, or if it's merely that my attention to them has decreased so dramatically.  But the biggest shift is that I no longer think of myself as pregnant--and while that thought made me weep last week, now it merely describes my current state of being. 

As crude as it sounds, I've spent plenty of my life not pregnant--I know how to do that (though this time, of course, with less alcohol and caffeine).  I'm not over my grieving, but at least right now I have gotten to a better place, more concerned by the pragmatic details than the full weight of the loss.   And thank God, I have not started bleeding or cramping yet, so despite my worst fears, I haven't had to face that yet.   

I would be ecstatic, of course, if I got good news tomorrow.  But as the chance of that is infinitesimal, I am ready for the next steps.  Now, I only hope that if it has to end, that it will be over this week, so I can work through the grief.  I am ready to move on and fully enjoy Andrew's joy at Christmas, and celebrate the hundreds of ways in which I am so tremendously blessed. 

Itemized

Thank you, all, for your stories and comments and kind words.   I can only guess how difficult it must be to go back to those sad hard times,  and I very much appreciate you doing that for me.  It will definitely help to know my options when I go back next week.

Right now, I'm getting by okay--it's hard to wallow with a two-year-old looking up at you and saying, "How about a KISS?"--but I'm still sad.

I'm sad that I won't get to have a baby on the same day as one of my best friends (our due dates were four days apart from each other).

I'm sad that when I get together with this friend in the spring, we won't get to take stupid pictures of our bellies together. 

I'm sad that I won't have this wonderful news to share with family at Christmas. 

I'm sad that yesterday, Andrew apparently answered his teacher's question about having brothers or sisters with, "No, just Mommy." 

I'm sad that my (few remaining) maternity clothes will stay hidden away in the garage for at least a while longer.

The baby clothes, too.

I'm sad that amongst all the wonderful parts of 2008, I will forever remember it as the year I lost three pregnancies.  

I'm sad that I got this far this time--but only this far. 

And less than sad, I'm also really mad that I have to deal with these  ultimately meaningless pregnancy symptoms right now.  Until this week, I'd been reassured by them; now  it just seems cruel.   

Downhill, fast

I walked into the doctor's office today with a diagnosis of "pregnancy, poor reproductive history." 

I walked out with the diagnosis of "threatened abortion."

At 7 weeks, 2 days, there was a sac, yolk sac, fetal pole and heartbeat.  This would be good news, except the sac was measuring about a week too small, and the heartbeat was extremely slow.  The doctor was very concerned, and I could see the difference between this scan and the one I had at roughly the same time with Andrew. 

I go back in a week, but I'm pretty sure it's not going to make it. 

If you could do me a favor, I would appreciate it--if you've had a D&C, or been in the position to choose beween a natural miscarriage at this stage and a D&C, could you please tell me about your experiences?  I don't know much about the D&C procedure--whether it's inpatient, or outpatient, how long it takes, etc.  I want to know as much as possible for next week's appointment.  Thank you.