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.

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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.

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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.

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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!

 

 

PUPO

PUPO is a infertility phenomenon.  It operates on two levels, allowing infertile couples (and women especially) to hope and celebrate while simultaneously acknowledging the fragility of our pregnancy experiences.

PUPO is Pregnant Until Proven Otherwise.

Today, according to my nurse, I am “very pregnant.”  Any Human Chorionic Gonadotropin (HCG) level over 30 is considered pregnant, and my clinic considers anything over 50 to be good.

My number is 542, and we’re at the first level of PUPO–celebration!

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I’m also 4 weeks pregnant today.  Traditional calculations rely on menstrual cycles, adding two weeks to the date of the last period (since ovulation typically occurs about two weeks after one’s period).  My embryo(s) is 15 days old (we transferred 5 day embryos on November 20).  Then we add the two week cushion as with natural conception.  (It is important to use the same calculations and be on the standard timeline to measure growth; this is also why pregnancy is calculated at 10 months rather than 9 1/2.)

With an HCG result greater than five, the lab was also to run a progesterone and estradiol test to make sure those levels are appropriate to sustain a pregnancy.  I just called the local lab because my clinic hadn’t received those results, only to discover that the lab misread the orders as “less than.”  They’re running those tests now.

In the meantime, we’re making only one minor change to my meds.  I’ll stay on my daily thyroid medication, baby aspirin, and vitamins.  I’ll also keep changing my four estrogen patches every other day and doing those very fun progesterone injections every other day.  (My nurse, the best nurse ever, is mailing me more short needles–she rocks!)  The only change is increasing the vaginal progesterone from twice daily to three times.

Saturday, I have another HCG test.  The number needs to increase by 53% (essentially doubling every two days), so we’re looking for 829.26 or higher.  We’ll also test my TSH level to make sure my thyroid is behaving.  Should everything go well, my first ultrasound will be around Dec. 17, with the second two weeks later.

However, the second layer of PUPO is still here; those who struggle with infertility always live in the shadow of what-might-go-wrong:

  • The numbers might not double because the embryo(s) could still arrest.
  • Or one of two could arrest.  (We transferred two, but there’s really no way to know what’s going on in there until the ultrasounds.)
  • We could have a blighted ovum (when the embryo attaches and the yolk sac that provides nourishment to the embryo until the placenta develops grows but the embryo does not,
  • or a chemical pregnancy (when early cells that will become the placenta attach to the uterus and start producing HCG, but the placenta and embryo fail to develop,
  • or an ectopic pregnancy (when an embryo implants somewhere outside of the uterus –usually in a Fallopian tube but sometimes other places like the cervix),
  • or a heterotopic pregnancy (when one embryo attaches in the uterus and another, outside).

But, for the moment, I’m PUPO.  And we’re celebrating, y’all!

When all You Want is to Test

I’m 7dp5dfet (7 days post 5 day frozen embryo transfer) and two days from my beta (first pregnancy blood test), and all I want to do is take a home test.

Clinics routinely tell patients NOT to take home tests during the two week wait.  HCG (human chorionic gonadotropin–the pregnancy hormone) levels are often too low for a home test to detect, resulting in a false negative. They don’t want you to be disappointed when the result isn’t guaranteed.  (It is almost impossible to get a false positive. However, a positive does not guarantee a viable pregnancy.  It could be a chemical or ectopic pregnancy or a blighted ovum or could miscarry.)

p-3017-early-pregnancy-test-strips-49.png.pngThat said many, many women test at home.  Several of the women in the various online infertility support groups I frequent share their HPTs (home pregnancy tests), some showing positive as early as four days post transfer.  Others are insistent that a positive result will be visible by day 7 or 8.  Yet others report that they still had negative home tests even after their positive beta.

With our two previous transfers, I didn’t want to test at home.  I was fine waiting until the official result, and even then, I didn’t really want to know.  This time, I just want to know its negative (again), so I can just quit waiting and wondering.  I just want it to be over with.

That said, I haven’t and won’t take a home test.  Not because I’m holding out hope for a positive or because I don’t want to hear that it’s negative.  No, I’m too practical for that.

I won’t test because I still have to go work on tomorrow and Thursday.  They’re the last two class periods before finals, and I have to help my students prepare.  If I get a negative result, I’ll want to be in bed for days.

So I’ll wait for my beta on Thursday.  I’ll go to the lab at 8 a.m. and be in class by 9:30 (before I can cheat by checking the results auto-released into my online patient portal) and well before my nurse calls with the result (which is usually later afternoon).  I won’t get out of class until 1:30, and if, by some chance, she calls during class, I’ll let it go to voicemail.  Then, I can go home.

I’ve already warned my bosses that I may be sick on Friday.

“How Are You Feeling?”

Today is 3dp5dfet using de (three days post five day frozen embryo transfer using donor eggs).  And every day since our transfer, I’ve been asked, “How are you feeling?”

From the sometimes brief, sometimes elaborate conversations that ensue, most people are asking about my physical well-being.  Some assume that I’m in some kind of discomfort or pain from the transfer procedure.  I’m sure this is because they don’t really understand how the transfer works, and when they hear “Valium,” they assume it is for pain.

In all reality, the transfer itself is no big deal, especially compared to all preceding tests which include vaginal ultrasounds (requiring the use of a quite large internal ultrasound wand–think large adult “toy” minus the fun), repeated labs (leaving arms bruised and bloody), tube dye tests (blasting dye through the uterus and Fallopian tubes which can be excruciating for women with any kind of a blockage–so painful, in fact, that some clinics perform the test under general anesthesia), and the ever-wonderful ERA (a uterine biopsy where they literally pull out a chunk of the uterine lining for testing) which is the only test to ever leave me in tears.

The transfer itself only takes about ten minutes.  The ultrasound tech uses an external ultrasound to make the uterus visible to the doctor who threads a tiny catheter through the vagina and cervix.  Once the catheter is in the exact right place (which may require some adjusting and readjusting) the fluid (sometimes called embryo glue) containing the embryo (or multiple embryos) is injected through the catheter.  The catheter is then removed and checked by the embryologist to ensure that the embryos have cleared the tube.  Then, the next hour is spent on one’s back slightly declined.

The worst parts of the transfer are the speculum (which is inherently uncomfortable regardless of procedure) and the ultrasound pressing on the partially full bladder.  The Valium isn’t for pain.  It’s to help patients relax and prevent the uterus from contracting, allowing the embryos to (hopefully) settle in before the mother-to-be leaves the clinic.

“So how are you feeling?” also refers to my physical condition post-transfer.  There’s not much to report other than the daily game of pregnancy symptom or hormone side-effect. My boobs are sore although less than previously, but now the swelling has spread to the patch of tissue above my boob next to my arm pit–my arm pit fat?–(pregnancy swelling or hormone reaction?).  My estrogen headaches are gone, but the nausea still comes and goes (too many meds and not enough food or morning sickness?).  I do have some minor cramping and my joints hurt (burrowing embabies or pre-menstrual symptoms?).

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“How are you feeling?” can also reference my emotional and mental well-being, but no one asks that specifically, especially when I follow-up the question with the explanation that there aren’t really any noteworthy physical effects or symptoms.

This version of the question, though, is less straight-forward.  One moment I’ve completely forgotten that I’m in the two week wait, and the next it’s all I can think about.  One minute I’m grabbing for something heavy before I catch myself and remember that I can’t lift more than ten pounds.  Most of the time I’m living my daily life, grading papers, reviewing textbooks, doing house chores, and then I randomly cough or laugh and worry for a split second that I might have jostled the embryos loose.  Sometimes I’m planning how to manage upcoming events with all my restrictions, and then I remember that none of them may even matter by the end of next week.  One minute I’m wondering how in the world we would manage twins (and what in the hell we’re going to do if they’re girls since we only have boy names), and the next I’m steeling myself for what feels like yet another inevitable negative result.

Asking a woman in the two week wait “How are you feeling?” is a question that’s answer literally changes second to second.