15 weeks

Today is 15 weeks.  Since 12 weeks we’ve had an appointment with both our MFM and our regular ob. I also graduated from the infertility clinic and have weaned off all those meds.

At ten weeks I started to wean off my infertility meds. The first to go was the oral estrogen. Simultaneously, I started stepping down the estrogen patches. Over the next two weeks, I stopped all the estrogen and progesterone (first the shots and finally the vaginal suppositories). While I was excited to be off the medications and the stringent timeline, it was an anxiety-inducing time. What if something went wrong? What if my body and the placenta weren’t really ready to take over hormone production on their own? Thankfully everything went smoothly even if the injection sites on my backside are still tender.

At 12w6d we went to the MFM (Maternal-Fetal Medicine) specialist in Wichita.  We were referred to him because our pregnancy is high-risk. As I am 36, my pregnancy is considered “geriatric” and brings with it increased risk of complications (like pre-eclampsia, miscarriage, gestational diabetes, etc.).  As an extra layer of precaution, our local ob asked us to see the MFM at least once.  That way if something happens, she can call him for advice or transfer us to his care in Wichita.

At our appointment, we had an ultrasound.  As usual baby Sanger was all wiggles.  He/she looks like a seahorse bobbing around. 

The baby was still measuring several days ahead of gestational age and had a strong, regular heartbeat.  We also had a few additional labs run to test for viral immunities (like parvovirus)–tests most obs don’t routinely run.

We also met with our doctor.  He mostly went over the risks of our pregnancy.  He explained that he is very aggressive as his goal is to minimize miscarriage and stillbirth.  He also gave us a run-down of the protocols should we need to deliver early (at which weeks they give which meds to help prepare the baby for survival).

We decided to go ahead and have our anatomy scan in Wichita (Feb. 28) since they have more advanced equipment and techs who do fetal ultrasounds all day every day.  We also scheduled another appointment for a few weeks later to do a fetal echocardiogram.

My husband’s family has a history of IHSS (idiopathic hypertrophic subaortic stenosis).  His aunt died from the heart defect in her early teens.  Although no one else in his family has been diagnosed with the condition, our doctor is also very aggressive in addressing heart concerns as one in 100 babies is born with a congenital heart defect and 2 in 100 IVF babies will be. 

At the fetal echo appointment, it is unlikely that they will be able to detect a defect; however, it does make us patients of the pediatric cardiologists in Wichita.  So, after the baby is born, we can come back and have another echo done.  He also suggested having an echo every year for our children.

The MFM also requested I have an echo as well since I have had a heart murmur in the past. That appointment is next Wednesday.

While in Wichita, we also made a trip through Buy Buy Baby–my first time looking at any baby paraphernalia. Needless to say the sheet number of car seat, stroller, rocker, crib, etc. options was overwhelming, and I’ve looked at nothing since. I’ve not started a registry (even though my husband asks me almost every day if I have), and I’ve not bought any baby-related items. I did demand we stop at Motherhood Maternity where I purchased three pairs of pants.

Yesterday, at 14w6d, I had an appointment with my ob.  As usual, I had an ultrasound followed by a brief meeting with the doctor.  This time (I’ve never had the same ultrasound tech twice) my tech was an older gentleman who was very experienced and very thorough.

In addition to measuring the baby (which is still a few days ahead of schedule), he showed me all the limbs (including the feet and a big toe and a thumb), the kidneys, all four chambers of the heart, a cornea in an eye, and the stomach.  He also checked out the entire spine and the mouth, chin and palate.  Then he studied the placenta, found the placement of the cord and verified that it was three-part (which is good).  So we learned that, so far, the heart, organs, skeleton, and face all look good even though the baby has reached the creepy “skeleton”-looking stage. The heart rate was 152.

In other news,

  • The nausea has subsided for the most part.  I only really feel bad when I need to eat (which is still about every two or three hours),
  • but I still can’t breathe, so my ob switched me from the lowest dose Advair to the highest.
  • I also sent away blood to be tested for the Alpha-1 antitrypsin deficiency (it’s a pulmonary condition).
  • I gained six pounds in the two weeks between the two appointments (but I maintain that numbers on two different scales can’t be comparable).
  • Maternity pants are way more comfortable than my regular pants, but contrary to what the saleswoman said, that elastic band does not keep them up.
  • My ob measured my belly.  At 14w6d, I’m measuring 20 weeks.
IMG_3619
Advertisements

12 weeks

This week we hit our first milestone: the end of the first trimester, 12 weeks.

Some days it’s starting to finally feel real.  I don’t pause in confusion when someone asks me how I’m doing or how far along I am.  I talk about the baby in casual conversation.  We’re still trying out baby names.

Other days it’s still not real.  I mostly feel fat not pregnant.  We still haven’t bought a single baby item.  Between us, we sometimes talk in hypotheticals still.  We’re afraid we still might jinx it.

This is another part of infertility that others just don’t get.  Just last night a new acquaintance congratulated us, and when I said I was 12 weeks, her response was something along the lines of, “Oh!  Then you have nothing to worry about.”

My immediate response, however, was, “You don’t understand….”

I do pretty well for the week after an ultrasound.  I’ve seen the baby and feel pretty confident that things are okay for the moment.  The next week, however, I start to worry and decide that the baby is gone.  It’s perpetual seesawing between hope and fear.

Even the ever-present nausea isn’t comforting.  Sure it’s an indication that very likely everything is still okay, but mostly living on the verge of vomit is tiresome.

And here is where the chorus singing how “ungrateful” I am starts, especially from the infertility community.  How many posts have I read from women struggling to conceive complaining about those who struggle with pregnancy or parenthood–those who complain they are tired or sick or uncomfortable or just need a break.

While I have always understood where these posts come from (it’s hard to listen to someone complain about problems that you’d literally do anything to have), they have always struck me as unfair.  It’s not fair to call those who struggle with pregnancy or parenthood ungrateful.  It romanticizes being pregnant and  a parent too much.  It ignores the reality of both: that they’re hard.

It’s also too black and white.  It’s entirely possible to be both overwhelmingly grateful (and know exactly how lucky you really are to finally have conceived) and to be simultaneously exhausted and sick and afraid and in need of just a moment’s peace from the never-ending wave upon wave of nausea.

Pregnancy is not the magic cure to infertility.  It’s another stage we navigate the best we can.  There’s no one right way to do it or feel about it.  We do the best we can and must be patient and generous with ourselves and each other.

Ultrasound #3: 10w6d

Wednesday, at 10 weeks 6 days, I had our third ultrasound.

IMG_3591.JPG

Our gummy bear measured 11 weeks 2 days (3 days bigger than the actual gestation and one day bigger than the previous measurements).  One of the ultrasound machines was down, so we had to use the “old machine” (and thus, the picture quality isn’t as good as before).

The baby was also messing with the ultrasound tech.  In addition to wiggling and waving, it was also doing all kinds of flips and turns and refusing to stay in the same position for very long.

After my ultrasound, I saw my ob.  Unfortunately, I can’t breathe, so in addition to the Singulair she put me on at the first appointment, she’s added Advair.  Now I’m sucking on an inhaler two times a day.  Fortunately, it seems to be working.

IMG_3597.JPG

My next appointment is with our MFM in Wichita at the end of the month, and then two weeks later, I go back to the ob here.

I’m also starting to show as my wonderful coworkers keep pointing out.  We’ve had more than one game of, “Hey so-and-so, come in here and see how big Sam is!”  I’ve also had to sort my closet into pants I can’t wear, pants I can wear if I want be uncomfortable all day, and pants formerly known as “too big.”

This picture is from 11 weeks 2 days.

Ultrasound #2: 9w1d

Today we had our second ultrasound at 9 weeks 1 day.   Our tech was excited because she doesn’t do many fetal ultrasounds this early.

Apparently most women don’t have ultrasounds until later in their pregnancies.  We’ve had two early on the orders of our fertility clinic.  They check to ensure development and placement of the embryos (to make sure the pregnancy isn’t a chemical–without a fetus developing–or isn’t extrauterine–implanted somewhere other than uterus).  The second ultrasound is to make sure the fetus continues to develop appropriately.

I also had labs to check my progesterone and estradiol levels because I will begin weaning from those medications in the next couple of weeks as the placenta develops and takes over the production of the needed hormones.

Our tech took a lot of time to “show us around” the baby which is about the size of a gummy bear.  We can now see where the forehead and rump are as well as the beginning of the umbilical cord and the appendages.  She also spent a while letting us watch the baby wiggle.  We also got to hear the heart beat for the first time with a rate of 175.

IMG_3579.JPG

Our next appointment is a regular monthly appointment with our ob-gyn on Jan. 16.  Then we see the Maternal-Fetal Medicine specialist in Wichita on Jan. 31.

On a side note, a cool advantage of working at a college means I have access to all kinds of fun props.  So, here’s our baby and a model of a two-month fetus.

img_3578

 

 

Pregnancy Denial

I don’t really know what finding out you’re pregnant is like for other women, but at least in the pregnancy test commercials and tv shows, there’s hugging and crying and joy. Everyone is excited, most of all the mother to be.

Don’t get me wrong. I was happy when our test was positive. And again when the second test doubled and when we saw the heartbeat on the ultrasound.  And everyone has been really excited–really excited.

Everyone but me. I’m not overjoyed or ecstatic. I’m not consumed by all things baby and pregnancy.  Most of the time, I even forget I’m pregnant. People congratulate me, and I have an “Oh yeah, it’s because I’m pregnant” moment. But, my next thought is always, “but I’m not really pregnant yet; I’m just barely pregnant. It doesn’t coun.  There’s too much that can go wrong still.”

I think it’s the result of the infertility and the years of trying to conceive.  In addition to developing a strong belief that it’ll never happen for us, infertile couples know all too well the transcience of hope and joy.  We’re always only one phone call or doctor’s appointment or bleed away from a frequently disappointing reality.

While those who conceive without struggle appear to bask in the joy of their pregnancies and babies, others hold our breath for agonizing weeks between appointments, hoping that no changes in the intervening time is good news but fearing it’s not.  We struggle to avoid the “what if” game and tragic self-diagnoses.

While other women plan baby shower and nursery themes, pick out necessities and gadgets for registries, and shop the maternity section, others avoid all things baby in fear of jinxing their precarious state or worse still, in fear of the room full of baby reminders should things end badly.

For while our friends and family are excited for us and can’t wait for cribs and clothes and maternity photographs and baby showers, I can’t help but worry that the next ultrasound won’t show a heartbeat or at which week the baby will stop growing.

And so I’m in pregnancy denial. I know that it’s a fact that I’m pregnant; I’ve seen the evidence. But I don’t feel like I’m pregnant.

And I know some women find the symptoms to be a comforting reminder (even when their heads are in the toilet), but I just feel sick–not pregnant.

Perhaps when we hear the heartbeat or my waistline expands or I can feel the baby move, I’ll really be pregnant. But I have a strong feeling that I won’t really believe any of this is real until the baby reaches viability or even until I hold him or her in my arms.

Ultrasound #1

Today we had our first ultrasound. Unfortunately, the tech from the women’s clinic is out after surgery, so we had to go through the hospital itself. The diagnostics area is usually quite busy, and now they’re covering all the ob patients as well, so needless to say, it was very busy, and the wait was considerably longer than we expected.

The tech, on the other hand, was fabulous. As I am 6 weeks 6 days today, our ultrasound was transvaginal which is usually a less than thrilling experience. Fortunately our tech had twenty-some years of experience, and it showed.

In addition, our doctor has given diagnostics permission to discuss ultrasound results with patients (we weren’t sure if they would tell us anything or not).

So after a few short minutes of “looking around,” she turned the monitor to us and starting pointing out things: the yolk sac, the embryo, and the heartbeat. Yes, we have a viable (at least for now) baby with a visible heartbeat of 157.  The embryo also measured at 7 weeks 1 day (two days ahead of my timeline) which puts our due date in early August.

IMG_3556

After the ultrasound, we headed upstairs to the women’s clinic for a blood draw and to meet with our doctor. After another long wait (they’re also very, very busy), our doctor did a quick exam, took a few cultures, and answered all our questions (most before we even asked).

She also gave me several prescriptions and otc meds to try to find the right cocktail to curb my nausea. Right now I’m wearing seabands and have taken 25 mg of b6 (which thankfully has stayed down so far).  I also took a dissolvable antacid to combat the volcano that has taken up residency in my stomach.

I have another ultrasound (requested by my fertility clinic) in two weeks and an appointment with my doctor in four. Because of my age (36), I’m considered high risk, so we’ll also have a fetal specialist in Wichita (just in case).

In the meantime, I’m taking my meds, taking it easy, and trying not to throw up.

PUPO?

A positive pregnancy test works a little differently for an infertile couple.  Immediately following the first positive BETA, the mother-to-be has additional blood work to check her hormone levels.  They are closely monitored, especially in early pregnancy, as too little of either major hormone can result in a loss.

With my Thursday’s HCG lab were orders for progesterone and estradiol levels (if the HCG was greater than 5).  At 542, it obviously was, so the lab should have run the additional tests.

They didn’t.  Thus began the chaos of my last two days.

Thursday, when my nurse called me with my pregnancy results, she mentioned that they hadn’t received the others.  She said she would wait another hour or so and let me know if they came through.  In the meantime, I decided to call the lab.  After arguing my way through the receptionist (if you’re calling for lab results, you need to talk to your doctor…), I got a phlebotomist on the phone.  I explained that I had been in earlier and that my doctor had received some, but not all, of my results.

The phlebotomist said, “We were supposed to run those if it was less than 5.”

“Are you sure it didn’t say greater than?”

Sigh.  “Let me look.” -audible eye-roll from the tech here-  “Oh, it does say greater than.  We’ll go ahead and run that.”

“Will the results be available today?”

“Yes.”

A little while later my nurse called to say she hadn’t received the results.  I told her about the intervening conversation with the lab.  She was glad I called and explained that depending on when the results arrived, I might not hear back until the next day (Friday) but that was okay too.

On Friday around 11:30, I got a call.  The substitute nurse (my nurse was off) said she had received my estradiol results but not the progesterone.  At 292 my estradiol was a little low (they want it over 300), so she added one oral estrace pill to my med schedule.  Since I was out of the office getting lunch, I decided to just go to the lab to sort out the mess in person.

I arrived and signed in and waited.  When the receptionist called my name, I declined to “check in” and explained my situation.  She was apologetic and went to the back where I could hear her (as could the rest of the half-full waiting room) explain the situation to the phlebotomists.  I could also hear one phlebotomist (a girl who used to be one of my students) replying and trying to identify who was working Thursday to screw all this up.  My former student, now phlebotomist, called me back, and we went through my record on the computer verifying the labs that had been run and identifying the missing one.  Then she called the other lab and had a tech check my remaining sample.  There wasn’t enough blood to run the missing test.

While we were checking things, I asked to see the fax number they were using.  Sure enough, it was wrong.  (Almost every time I use this lab, the results are sent to the wrong number first.  My clinic has a dozen fax lines, and rather than paying attention to the number on the orders, the local lab just clicks “send” to whatever number is in their system for my doctor.  This results in multiple argumentative phone calls where they refuse to believe they sent it to the wrong number.)  I pointed out the correct number, and she wrote it down.

I went back to the desk and signed in again.  Finally, I was called back.  Without thinking, I shoved up my sleeve.  My former student took a look and was a bit shocked at the bruise since I “have really good veins.”  So we switched arms, and I relayed my experiences from the day before.  Thursday’s phlebotomist struggled with the draw.  She didn’t tighten the tourniquet enough, so the blood didn’t want to flow through the tube (they use a butterfly needle because I have small veins).

My student and I continued to chat, talking about how often I was having blood work (she’s seen me off and on for several years).  We discussed my infertility and my positive pregnancy test the day before.  Understanding the significance of my labs, she made sure the progesterone analysis she was sending up was labeled STAT.

A few hours later, I called and left a voicemail on my clinic’s nurse line to make sure they’d received the results.  I was leaving town soon, and if there was still a problem, I wanted to be able to walk back into that lab.  A few minutes later, a nurse returned my call to confirm they had received them, and at 44, the progesterone level was “beautiful.”

Needless to say, I was nervous and less than optimistic about the blood work I had to have done this morning.  Today, two days after my first positive, we needed to see if my HCG level increased. Since it’s Saturday, I had to use the out-patient clinic through the emergency room at the same hospital.  Every single time I’ve used them, I’ve had to argue to get them to refax the results because the use the wrong number.

On my way to the lab this morning, I made myself paranoid.  I knew my nurse said the HCG level needed to increase by 53%, but all the online infertility support group posts talked about the number doubling.  So I posted the question to those groups (in retrospect, not the best idea).  Some women insisted it had to double.  Others said 53% or 60%.  My clinic-specific support group said both, but one woman said that when her number rose only very slowly, the nurse told her they follow the guidelines of the American College of Obstetrics and Gynecology which outlines a minimum 53% rise every 48 hours.

In addition to rechecking my HCG level, I had an order for my TSH level.  I’m on thyroid medication because my levels were slightly elevated for conception.  (I was at 3.2, and doctor wanted the number under 3.0.  The number immediately dropped and has stayed down since I began the medication years ago.)  However, during pregnancy, a woman’s thyroid can be affected by the changing levels of HCG and estrogen.

I checked in at the ER at 8:15.  The phlebotomist on call remembered me.  She did my levels on 11/18 before we went to Denver for the transfer.  She remembered the mess with the fax and wrong numbers, and we triple-checked today’s number.  I was in and out by 8:30.  Then the wait for the results began.

At 11 a.m., I checked my local patient portal, and my results were in.  HCG was 1365 (53% would have been 829.26 and double, 1084).  My thyroid was 2.23.  At 11:30, Denver called and confirmed that the HCG was good and the thyroid was normal.

While I’m breathing a little easier, this just means we’re on to the next wait for the first ultrasound.  The earliest the ultrasound can be is Dec. 17 when I’ll be 6 weeks 4 days pregnant.  That’s when we’ll know for sure if there really is a baby in there.

But, until then, I’m 4 weeks 2 days PUPO!