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!

 

 

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