baselines

Last week was my cervix baseline ultrasound. I’d be lying if I said I wasn’t nervous, in particular since I’ve been feeling a little pelvic pressure/soreness on and off since 8 weeks – the only time when I didn’t have this was on holidays. Clearly, I should spend more time there… Nevertheless I was quite calm riding up the hill. We had the same lovely tech as last time, though she didn’t remember us. She asked me to guide the probe, which after countless fertility-related transvaginal ultrasounds I found funny. Then she said I could see the cervix on screen, while I just saw a gray mass (and something wiggling in the corner that probably distracted me a little). It wasn’t until she started measuring across it that I realized the gray mass was my cervix. Wonderfully long and closed, measuring longer than I had dared to hope – 4.3cm. Next the tech asked me to put pressure, “as if to push out the baby”. Well, I put some pressure, but not quite enough to actually push out a baby. It doesn’t seem like a good thing to do, so far from term… My cervix was unimpressed. She explained that a truly incompetent cervix will suddenly get very short when pressure is applied, even though it may seem long when relaxed. (I’ve never heard of this before – while it makes sense intuitively, this would mean there is a predictive test for IC, making me wonder why not all pregnant women are tested for this.) As a final test, she put (gentle) pressure on top of my uterus, again without any apparent effect. Then, lucky me, she wanted to look at Strawberry Baby via abdominal u/s – actually I think she spent at least as much time looking at our wiggling little one as at my cervix. Little (big?) Strawberry is doing well, measuring a few days ahead (15w1d when the calendar said 14w4d) and has heart and stomach and other organs all in the right place. Good news all around!

Yesterday I had an OB appointment. My doctor was happy about the cervix length but a bit concerned about my blood pressure. It often goes up at doctors visits, so I wasn’t too surprised, and of course losing the twins didn’t help – my anxiety issues have become much better, but they’re not completely gone, and I will be worrying about losing Strawberry Baby until we reach 28 or 32 or 36 weeks (and probably beyond that, but in different ways). Nevertheless, he is a very careful guy and wants baseline checks of my liver enzymes and a 24h urine collection, and for me to keep track of my blood pressure at home so that we can discuss it at the next appointment. I genuinely appreciate his proactive approach, and will try to follow his advice not to worry about it.

The next cervix ultrasound is in a week, so I hope we’ll get to see Strawberry Baby again! Soon we might even be able to see if it’s a boy or a girl… which I think will be bittersweet either way, given that the ultrasound when we found out the twins were girls was also the one when my cervix was so awfully short and things started to go downhill. I’m so hoping for a better outcome this time, and so glad that, for now, things look great.

a call and a hug

It was the only day during the week after we lost our babies that I actually had to be somewhere: we had to visit the mortuary to arrange the cremation.^* I got out of the shower in the middle of the day (don’t judge a grieving mother) a few minutes before we had to leave the house when my phone rang, indicating Palo Alto as the area code. That’s odd, I thought, I don’t know anyone from there who has my cell phone number… but picked up anyway. “Hi CC, this is Dr. RE” I recognized the voice and, even in my grief-addled state, was somewhat amused that she referred to herself as “Dr. RE”. I was surprised as I hadn’t expected this at all – she’s an MD/PhD and sees patients about once a week, if that; getting an appointment takes a month easily. She told that she had heard of our loss and was terribly sorry, and that both Dr. Head of RE (who did my retrieval) and Dr. Head of MFM (who saw us after C’s amniotic sac ruptured) had talked to her about me, and she had promised them to call me. Now, considering that I had sent an email to her nurse about whether I should to back on my drugs to prevent endometriosis earlier that week I cannot be entirely sure that they thought of me all by themselves, but regardless, it was nice to feel like an actual person and not just patient #1234567.

Dr. RE talked a bit about the psychological support systems the hospital offers, to make sure I knew that these were available to me, and proceeded to ask if we had frozen embryos (yes), how many (7), and which day (3). Given what had just happened, she said she’d definitely recommend single embryo transfer, and that of course there would be a lot more monitoring in any future pregnancy, and that the clinic had several excellent MFMs (it’s a big teaching hospital). I mentioned the doctor I had seen at my anatomy scan and selected for my follow-up appointment, and she immediately raved about how brilliant he was and where they had recruited him from. We also talked about whether I should take any medication to prevent endometriosis, but agreed that it might be better to give my body some time to recover and heal.

A few weeks later, I had my follow-up appointment with her. Given that the transfer part of my IVF had gone perfectly (we transferred 2 embryos and I got pregnant with twins), I didn’t expect there would much to talk about. Dr. RE was standing up when we entered the room, and declared that she’d first have to give me a hug. Another unexpected sweet gesture. She asked how we were doing, how I was doing (I think my poor husband felt a bit left out at times). We all agreed with trying single embryo transfer next, and worked out a timeline that would allow us to fit the FET in our contract to cover it. Then we learned that our embryos were frozen in pairs. I’m not sure this was ever mentioned before, but of course it was too late to change that now. Anyway, thawing two and re-freezing one seemed less than ideal. We essentially deferred that point for discussion with one of the embryologists when we got there. She also asked about Dr. MFM’s plan for the pregnancy (weekly progesterone shots starting at 16 weeks, biweekly monitoring, cerclage if cervix shortens below 2.5cm). “And perhaps bedrest, too?” she inquired, but I declined – there is no evidence that it actually improves outcomes. She nodded, but at the same time chuckled in what seems like a “young fools” way to me… that bit wasn’t particularly comforting, but I think we’ll cross that bridge when we get there.

Just a few days ago I had my lining check – the only appointment in this FET cycle, other than the transfer itself, much to my surprise. I had been worrying whether I’d been responding properly to the drugs (just because I tend to worry) but then started producing EWCM about a week ago, which seemed like a good sign. And indeed, my lining was trilaminar and 8.5mm, just perfect. Before getting started, the NP that does lining and pregnancy ultrasounds at my clinic commented how she’d seen us back in July and then now, how sorry she was for everything we had been through in the meantime, and that it must be hard for us to be back. While I appreciate the thought, and there is some truth to it, just minutes before I had mentioned to H how wonderful it had been to see our babies’ heartbeats in this room back then.

Then we met with the embryologist, who thinks that all our embryos are of similar quality – 8 to 10 cells, fragmentation and grades of 2-3. A & C had both been 822 and implanted and developed beautifully. According to the literature, she said, there isn’t much of a difference in pregnancy rates between grades 2 and 3, so we might as well thaw the lonely unpaired embryo to avoid having to re-freeze and thus potentially lose one. If a 10-cell embryo were to loose more than 2 cells in the thawing process, it’d be considered too damaged for transfer, and they’d thaw another (or a pair, in our case).

Long story short – my transfer is on Wednesday! I’ll take the day off to relax, go to acupuncture before and after if timing allows, and then I have a conference the following days to take my mind off things. Cell-division-and-implantation-supporting thoughts (however exactly these may look) will be much appreciated.

* A difficult task in an already difficult week, probably deserving its own blog post, but not today.

I may be overinterpreting this

Thanks for all your sweet comments! We are back home and H is doing better, and off to the doctor for longer-term plans for that blood pressure.

On New Year’s Eve, my dad pulled me into a tight hug and said he hopes that my biggest dream comes true. And that’s what I wish for you, too.

Too few hours later, I was waiting in the security line at the airport, caught sight of a young woman with a stroller in the family lane and remembered that I had been over there, only a few months ago, happily pregnant with A & C. And now I was here, a little sad, and feeling sick and hungry. But why was I sick and hungry anyway? I’d had some sort of breakfast (half a grapefruit, leftover pieces of gingerbread and some nuts and raisins… sort of, as I said) and I hadn’t had that many drinks. And there was really only one time when I’d been feeling nauseous and hungry simultaneously: in the first 3-4 months of my pregnancy last year.

The timeline for the FET was expecting my period to start in late December. However, I’m now thinking the bleeding after the saline sonogram sort of reset my cycle – I started producing cervical mucus around Christmas, and two days later EWCM was literally dripping out of me. And the in-laws were out* so we had the whole morning to ourselves… The next day I woke up with considerable pain low in my pelvis, which subsided as the day went on. I’ve had this before and think it is associated with ovulation. Which would put me to around 6dpo on the 1st. Rather early for feeling any symptoms, isn’t it?

Well, they’re still here. I took a test on Saturday – negative. I immediately dismissed it as too early, wondering why I took it to begin with. Not keen on seeing another negative, I decided to wait a bit… I was going for Tuesday, H thinks we should wait until Thursday, which should be 14dpo. Of course I have my nurse waiting for me to let her know about my period so that she can adapt the FET timeline… In the past when I was charting, my luteal phase was usually short, 9 to 10 days. I even have some progesterone left that I briefly considered using, just in case – but, as our IVF contract only covers the FET until February, if I’m not pregnant I’d want that period to arrive sooner rather than later. Another strange limbo.

Should I not miraculously have become pregnant on my own (and how I hope I have!), the plan for the FET is to transfer one embryo. Both my MFM and my RE were adamant about this. We still don’t know what went wrong in the twin pregnancy, but there is at least the possibility of cervical insufficiency and/or that my body didn’t handle the “uterine distension” from carrying twins well. Apparently there are a number of possible treatments for cervix issues with singletons (progesterone, cerclage or a pessary to keep the cervix closed) that – for unknown reasons – don’t seem to work in twin pregnancies. So even if my cervix got short again, there’d be more possibilities that would hopefully let me carry a baby to term, or at least much longer than 20 weeks. And there would be much closer monitoring, too. And as we have previously transferred two and I got pregnant with twins, single embryo transfer seems a reasonable approach. I can only imagine how much harder this must be for those of you who have had failed transfers.

* There is no door separating the part of the house where we stay, which drastically reduces occasions for intimacy. Sigh. The in-laws do not seem to grasp the concept of privacy.

it’s complicated

Glow in the Woods had a post about trust in our bodies after babyloss. Like so many others, I’ve had ups and downs. Infertility is a major down – it’s hard to accept not being able to get pregnant “naturally”, even though given my history it wasn’t all that surprising.

But for some reason I thought I’d be good at pregnancy. I even thought, after completing our family, I could be a surrogate for friends in case they turned out to need this. That’s how convinced I was my body could do this.

We transferred two embryos, and both implanted. I’m so thankful for this. It gave me some confidence in my body back. Then there were the bleeding episodes – scary, but fortunately the babies were always fine. We made it into the second trimester, the supposedly safe zone.

I had this weird pelvic pressure, for weeks. The first doctor thought it wasn’t a concern. And then it was almost too late. I’m trying not to dwell on the what-ifs, but sometimes it is hard to resist… what if I had insisted on being checked earlier? Would there have been any way to keep the babies inside, C’s amniotic sac intact for longer?

The extra post-partum bleeding didn’t help, though I don’t think it hurt my relationship with my body much, either. The thing is, I think my body fairly reliably tells me when something is wrong. The pain I had before my endometriosis was discovered, the pelvic pressure that may have had to do with the shortening cervix… It knows, my body. It may not be able to perform all those tasks I’d want it to, but it tells me when things are off. And I am amazed that it can produce eggs that make such beautiful babies together with H’s sperm. And carry them for quite a while. I hope I’ll learn to listen to it even more, and I hope that my doctors will listen, and that they will actually be able to do something in case things start to slide.

But of course we first need to get there. I was so proud when it started making cervical mucus again (yes, proud may seem an odd feeling, but it is what it is), and glad when my period returned. On Monday I had a saline sonogram to check my uterine cavity for anything from scars to polyps that might be detrimental to implantation. They found a tiny thing, in fact, they’re not sure it’s anything at all – we’re still waiting for my main RE’s verdict. And while I didn’t have the painful cramps I had after my last saline sonogram, I started bleeding yesterday. More today, like a period. Of course I don’t even know if this has anything to do with the procedure, or if my body is simply still trying to get back on track. It’s just not exactly helping my confidence. And yet, after reading Suzanne’s post, I feel like I should be grateful that everything is most-likely-okay. And I am. I’d just have it rather all be great, for all of us.

PS: WordPress says this was my 100th post. The title seems fitting.

compound

Sometimes I’d like to blog about the normal things. How I decided that I was too lazy for turkey this year*, but planned to make two pies from this book, Salted Caramel Apple and Malted Chocolate Pecan Pie. Mostly for no other good reason that that I enjoy baking. Except then my husband declared he doesn’t like pecans, nor salted caramel. Deb to the rescue, and I had a “regular” apple pie recipe. (He did eat a piece of the pecan pie later – turns out things are different if there’s chocolate involved.)

But this year, that is just the preface. We took the pecan pie to a Thanksgiving dinner organized by some friends of ours. Mostly geeks that play a card game together, and so somehow I didn’t expect any pregnancy announcements, but of course there was one. “Announcement” may be the wrong term, she looked about 7 months pregnant, if not further along. Not sure how H didn’t know about it. We’re happy for them, of course, but also just so sad.

It was a nice afternoon overall, and for a while it was good to do normal things with other people. After a few hours though the sadness resurfaced and I mainly wanted to go home. I suppose this is where I’m at right now – company for a little while may be nice, but then I need a break. Grief is hard work, and it has so many different faces and aspects I’m only beginning to discover.

We’re still so fresh out of this loss. We miss these little girls, their sweet little faces, the personalities we never got to know. While we hope that we’ll be blessed with raising their siblings one day, we will always miss A & C.

Yet any thought of their siblings comes with the fear that something might go wrong again. That my body might fail them, too. I haven’t gotten around to writing about the appointment with the specialist, but basically there is a chance that my cervix will struggle even in a singleton pregnancy.

And of course I’d first need to get there. I am actually quite hopeful on this issue, yet it’s hard to ignore the nagging fear. What if this was our lucky round? I do hope there will be more, and longer lasting ones. For an encouraging start, my period has returned (an event that isn’t commonly celebrated in the IF world). I’m glad my body seems to be getting back on track.

* keep in mind that we didn’t grow up here, so it’s not as much of a big deal as it may seem

ruptured

I was getting used to my mostly-couch routine, and the babies seemed to be hanging in there. Then yesterday I suddenly felt as if something was weird, and then there was a big gush of fluid. More fluid when I got to the bathroom, and even more.
We went to L&D, who confirmed that my membranes had indeed ruptured, and saw that baby A had very little fluid. We had hoped that they’d be able to save at least one baby, but apparently that’s really difficult – the main risk now is infection, both for the babies and for me. At 20 weeks, they’re much too young to survive. The options we were presented are “expectant management”, also known as wait-and-see, and termination. Gulp. We certainly weren’t able to chose the latter, not after all these steps it took to get here.
They offered to keep me in for the night for observation, but H said he’d much rather have me home with him, unless there was a risk. Hospital germs tend to be worse than homegrown ones, so they don’t want me to stay for long anyway. My cervix was still at 1.5cm, and no contractions, so it didn’t seem as if labor was imminent. After being explained the risks three times over, we went home and cried. I have never seen my husband cry like this. That alone was heartbreaking.
The good news is that I haven’t had any more leaking or gushing of fluid since coming home. Resealing of membranes is rare, but possible. My cervix went into mucus overproduction mode, which I hope also is a good sign – maybe it is trying to regenerate the mucus plug?
Basically we now need a miracle: no infection, no contractions, resealed membranes and refilling fluid. We have an ultrasound tomorrow to see how things are going. If you have good thoughts to spare for us, or stories from other PPROM survivors, please share.

can we just skip October?

And maybe November too, while we’re at it. I’d so much rather wake up just shy of 24 or 28 weeks, respectively, instead of the 19 I will be tomorrow. Not that 19 weeks per se would be a bad thing, but as my cervix measured 1.5cm today, half of what it was on Wednesday, I’m getting rather worried that we might not even make it to viability. I found the measurement particularly mean as I was feeling better – on Thursday through Saturday I took it really easy, and I think that helped. On Saturday I passed quite a bit of brown, almost solid mucus, which I found terribly scary, but my doctors thought likely came from the internal exam. On Sunday we had friends visiting, and I wanted to do some cleaning. Yeah, stupid me. I really hope the shortening was from that (or some other transient cause) and that it’s not too late to reverse it. (Otherwise, it was lovely to have them over, and really they cannot be blamed for my stupidity.)

The rest of the scan went well. It looks like we have two little girls in there! I’m kind of suspicious with one of the pictures, whether there’s really nothing between the legs… but either way, we’re so happy that they are doing well and still unaffected by the situation around them. And now so scared of losing them. It is a heartbreaking feeling that my body might fail my precious babies.

Unfortunately, according to my doctors, there’s not really much they can do at this point in a twin pregnancy. Apparently there’s no scientific evidence that a cerclage or bed rest would help, and that they may actually be harmful. I know that there’s many stories out there of women who made it, often with these – but I’m also a scientist. There is some data that progesterone may help, not enough for significance in twin pregnancies, but it seems fairly clear for singletons, so I think we’ll try that. Because it seems awful to do nothing. And then we have to try and get to 23 weeks and change, re-measure, and consider steroid shots if my cervix is still short. We have a long month ahead of us.