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.

it-that-shall-not-be-named

Every time I think my bleeding/spotting has finally stopped it starts again. This time was no exception – on Monday I was wearing a red slip, and when something felt weird and I went to the bathroom, the panty liner had almost become invisible. Isn’t that just what you were hoping for at 12w5d? Me too.
There was some more blood later, and then it largely stopped. Luckily “just” blood, no clots or so. I called the clinic but as it was already in the afternoon and I had my NT scan the next morning we decided to wait until then.

The most important part of the scan, the result, was great — both babies are still there and look great, both trisomy risks are very low. Phew. The scan itself was not that much fun, which was a shame because I think it could have been a great experience, but the ultrasound tech we had was weird. H probably disliked her at first glance, a feeling that was only confirmed. She decided my bladder was too full and I should fill and discard one cup (has that ever happened to any of you?) It was probably meant to make me more comfortable, but somehow the way she went about it was odd. During the scan we tried to ask questions to give her pointers of stuff to talk about, but the communication didn’t work out. Not that she was quiet all the time, just only talking about stuff she wanted to. Including complaints about the lack of cooperation of my babies (see, my protective parent skills are already getting exercised) and how difficult these measurements were to make with twins. To make them move, she pushed the wand like a juggernaut on my belly. Not really hard, but still, dear woman, didn’t I TELL YOU that I had some bleeding yesterday? Could you perhaps be a bit more gentle?!

In contrast, the geneticist we later met to go over our results was lovely. She congratulated us again and recommended we book the anatomy ultrasound for 18-19 weeks, as we’d get lots of ultrasounds later, because twins. H wanted me to specifically ask for another tech but I chickened out, I’m no good at this. Hoping we’ll just be lucky and get someone else…

To get back to the beginning and the title, maybe if I just don’t mention a certain issue anymore, it won’t come up again…