Well the Fun Never Ends!

I recently met a very kind, patient woman who has six year old fraternal triplets. Two boys and one girl. One of the boys recently became obsessed with conjoined twins. He was quite panicky about the idea that he and his brother could have been conjoined. This despite the fact that his mother explained on several occasions that this was an utter impossibility--seeing as the boys came from two different eggs. Later she overheard him talking to his brother about the whole conjoined business. He ended the conversation with, "Wow, we really dodged a bullet!"

In the spirit of young Tad, "We really dodged a bullet."

Back in January, during a consult visit with Dr. Whoseitwhastit (aka "Dr. Wonderful") there was some mention that I was postive for antibodies against Rh-positive blood. Most people have the Rh (Rhesus) factor, a protein on the surface of the red blood cells. I don't. This would be fine and dandy if I wanted to procreate with an Rh-negative bloke, but as it happens, the Husband is positive. He is Mr. Everything's-Normal-Over-Here-Thank-You-Very-Much. Again, I am not. Everytime I come in contact with Rh-positive blood, by say, a miscarriage, I also must come in contact with a big jabbing needle of RhoGam. The great neutralizer. If I do not, my immune system will start to produce antibodies against the Rh-positive blood and I will become "Rh-sensitized." If I become "Rh-sensitized" the next time I am pregnant with an Rh-positive baby (I have a 70% of carrying an Rh-positive baby), those antibodies may (read: likely) attack my baby's blood. If this should happen, my child will develop Rh disease (hemolytic disease). My antibodies would cross the placenta and attack the Rh factor in my baby's Rh-positive blood as if it's a foreign substance, destroying his/her red blood cells and causing anemia. The disease can cause problems ranging from severe newborn jaundice to brain damage or, in extreme cases, even miscarriage or stillbirth. Treatments include inducing the baby early and blood transfusions in utero. It's a scary business.

During my last consult, I asked about the antibodies and Dr. Whoseitwhatsit said that he couldn't find anything in my chart that would indicate that I'm positive for the antibodies. But I was SURE he had said something about it at that initial consult. When I got back to my office in the city, I reviewed my chart from my OB/GYN. I forwarded it to Dr. Whoseitwhatsit for his review. He left me a voice mail and indicated that I was in fact positive, but it was "too weak to titrate," meaning that the amount is very small. It could be a false positive or a lab error. Or I could be positive. He also indicated that I don't need the RhoGam now because the last pregnancy ended so early that there were no red blood cells to cross contaminate - something we'd already discussed in his office.

I also called my OB/GYN (last seen in September 2006). He happens to be out of town. However, the other doctor in the office, Dr. Cranky Pants, called and we discussed it. He said that the test was more than likely picking up the antibodies from the RhoGam shot I had had in July. Apparently it lasts for 12 weeks. He suggested that I go in and get a blood test that evening. Which I did.

Dr. New (recently joined the practice) called me back - the result was negative. I am (we are) so relieved.

The use of RhoGam has only existed since 1968. In 1967 or so, my aunt, who is Rh-negative, gave birth to her son, stillborn. Just a few days prior to her due date he died. She had to wait to go into labor and give birth to him knowing this. My mother tells me that her sister, my aunt, has never been the same. My mother was terrified when she was pregnant with me, several years later. Luckily, both my sister and I are Rh-negative, just like her. My mother and I argue over his name, she thinks it was Scott, I think it was Brent. My mother should know - but we don't ask my aunt. She never got to hold him, there was no funeral. The cause of death? Likely hemolytic disease. But we'll never know for sure.

We really dodged a bullet.

Also . . .

I have been obsessing lately on the whole heparin/lovenox thing. I previously made appointments with two different REs - both only take one insurance, an insurance my employer happens to provide. My current RE is located quite far from my home, but is close to my old job. Since I'm somewhat convinced that I may need IVF, I thought I should begin the search for a new doctor due to the distance. Both of these physicians are considered fairly cutting edge (one uses cells from the mother's endometrial lining to grow the embryos--and has upped their success rate quite a bit and the other specializes in IVF for recurrent pregnancy loss). They are both frequently listed on "best" lists (best IVF clinic, best fertility doctor, etc.). I contacted the nurse of one doc and asked about heparin/lovenox. She stated that yes, he does prescribe heparin/lovenox for some of his patients. I am thrilled. She was quick to note that it does depend upon the individual circumstances, etc. That's fine - at least I know it's a potential option. The appointments are in October and November. Yes, November. I also got a call back from the other doc's nurse. He doesn't prescribe lovenox/heparin--but that's because he refers his patients to a hematologist who then may or may not prescribe it. I feel more comfortable with that than a blanket, "no."

In the meantime, I'm still on to Clomid with Dr. Whositwhatsit.

Seventy Percent

I received a "C" in civil procedure my first semester in law school. I was devastated. A "C". A rotten stinkin' "C". I cried. I wailed. I met with the professor. I couldn't believe it was happening. I seriously thought about dropping out of law school.

After four miscarriages, statistically, there is still a seventy percent chance of conceiving a healthy pregnancy even without any medical intervention. Whether or not I will fall on the good side of this statistic only time will tell. For now, I'm taking that "C" grade and running.

The Husband and I met with Dr. Wonderful this week. His first comment was something along the lines of:

"Well, I'm sure you want to know what happened. What you had is generally referred to as a chemical pregnancy. A chemical pregnancy is . . ."

The husband almost throttled him, "The woman KNOWS what a chemical pregnancy is - you've never seen a quick draw Dr. Google like this one over here in your life."

Except for the MTHFR, all tests have been negative. And my particular gene mutation (MTHFR A1298C) is more rare (read super special!) and therefore less is known about it and its possible effects on miscarriage. He was treating it the same as he does with his MTHFR C677T patients - extra folic acid. Heparin? Baby aspirin? I've been taking baby aspirin on my own since January. He doesn't use heparin or baby aspirin in his practice. His thoughts about MTHFR is that the problem is the absorption of the folic acid and that an anticoagulant does not address the problem. Of course I've read plenty of blogs out there where heparin is added to the mix and bingo! real live baby.

Running? I asked if running could have posed any risk. I asked this primarily because it is something that I can control, not because I want to blame myself (although that is perhaps inevitable). I ran a much greater distance than normal very early on in the pregnancy. He indicated that it COULD have caused problems but we'll never know. Dr. Wonderful said that he's loathe to recommend someone not exercise considering how many patients he's trying to get TO exercise but I can try walking next time and see what happens.

The plan? He recommends Clomid. Four cycles. Unfortunately I've read A Few Good Eggs which outlines the horror that is Clomid. Moody? Check. Fat? Check. Completely around the bend psycho? Check. Needless to say, I'm not exactly looking forward to it. His theory is that 1) if I have an ovulation problem that has gone undetected this can help and 2) the more eggs out there the more chances I have of a successful pregnancy.

If that proves unsuccessful we can move on to injectibles with IUI or without (he used the term, "relations" - as in we can have "relations" on injectibles versus an IUI - he really did).

If no dice there? We can move onto IVF with PGD. He explained the inherent problems with PGD in my case and that it's not exactly a perfect system. He also discussed a patient who just went through her second IVF with PGD - both times ALL of the embryos had problems. In that case, he said, the jig is up - it's time to move on.

His thoughts are that the recurrent miscarriages are likely due to "genetic problems" despite the fact that no chromosomal abnormalities were found in the husband, myself or the one embryo that was tested back in September. Further, he seems to believe that it's like the lottery, the more tickets you buy, i.e., pregnancies you conceive, the better chances you have of winning.

Wonderful.

My biggest fear was to walk in and hear, "Donor eggs." I can't tell you how many blogs I scoured subsequent to this latest miscarriage and read of donor eggs. Adoption. Living childless. It scared the absolute daylights out of me. Then a few days later I found several blogs of women who had had multiple miscarriages and are now about to give birth. No explanation. No found causes for all those losses. Many with little or no medical intervention. They just had to endure sometimes five, sometimes more than ten, miscarriages. Dr. Wonderful indicated that a lot of this has to do with patience--some people become "impatient" and need to move on to medical intervention even though with time it could and the chances are likely, that it will happen naturally. I'm not sure I would characterize not wanting to go through any more miscarriages as "impatience" but hey, what do I know?

Clomid, here I come.


P.S. Thank you all so much for all your comments. We haven't told many people about this latest miscarriage and the kind thoughts from all of you was incredibly helpful and made us feel a little less alone.

Idiopathic Recurrent Pregnancy Loss

idiopathic:
-adjective.
of relating to, or designating a disease having no known cause

recurrent:
-adjective.
that recurs, occurring or appearing again, esp. repeatedly or periodically

pregnancy:
-noun.
1.
a. The condition of being pregnant
b. An instance of being pregnant
c. The period during which one is pregnant
2. The quality or condition of being rich in significance, import or implication
3. creativity, inventiveness

loss:
-noun.
1. Detriment, disadvantage, or deprivation from failure to keep, have or get
2. Something that is lost.
3. An amount or number lost
4. The state of being deprived of or being without something that one has had
5. Death
6. The accidental or inadvertent losing of something dropped, misplaced, stolen, etc.
7. A losing by defeat; failure to win
8. Failure to make good use of something, as time
9. Failure to preserve or maintain
10. Destruction or ruin
11. A thing or number of related things that are lost or destroyed to some extent

FVCK

Beta hCG: 13
Progesterone: 4.8

Stress and Miscarriage

Yesterday I was EXTREMELY anxious, upset and stressed-out. The husband and I were fighting, I lost my cell phone (again-later found) and the hCG level made me anxious and stressed. So much so, that I began feeling crampy. Although I have yelled at my mother for even suggesting that stress might be a factor contributing to my recurrent miscarriages, I am beginning to wonder. I did some quick research on-line and saw several recent studies that found a connection between stress/anxiety and recurrent miscarriages: How Stress Causes Miscarriage, Stress and Early Miscarriage, Stress 'linked to miscarriages' and Mother's Stress Could Contribute to Early Miscarriage . The amount of stress/anxiety, however, was not noted. Is one episode enough? Does it have to be several? One study mentioned that three weeks is the critical time. My doctor believes I was about 3 1/2 weeks on Tuesday.

What do you think? Do you see a connection? Has your doctor mentioned a connection?

Results

I've been waiting all day for the results. Just about the time when I was going to throw my fist through a nearby window, the nurse called:

Beta hCG: 47
Progesterone: 22.4

Out of curiosity, I looked back at the test results from my last pregnancy. It's bizarre that it was just about exactly one year ago - although I believe I was a tad farther along then (although it could be mere days--I'll have to investigate):

August 16, 2006:
Beta hCG: 385
Progesterone: 14.1 (I'd just eaten--apparently that makes a difference)

August 21st:
Beta hCG: 2,261.7
Progesterone: 28.1

As a point of reference (for most of you this is old news, I suspect):

hCG levels in weeks from LMP (gestational age)* :

3 weeks LMP: 5 - 50 mIU/ml
4 weeks LMP: 5 - 426 mIU/ml
5 weeks LMP: 18 - 7,340 mIU/ml
6 weeks LMP: 1,080 - 56,500 mIU/ml
7 - 8 weeks LMP: 7, 650 - 229,000 mIU/ml
9 - 12 weeks LMP: 25,700 - 288,000 mIU/ml
13 - 16 weeks LMP: 13,300 - 254,000 mIU/ml
17 - 24 weeks LMP: 4,060 - 165,400 mIU/ml
25 - 40 weeks LMP: 3,640 - 117,000 mIU/ml

* These numbers are just a GUIDELINE-- every woman’s level of hCGfont> can rise differently. It is not necessarily the level that matters but rather the change in the level.

Progesterone during pregnancy:

First Trimester 9-47 ngfont>/ml
Second Trimester 17-147 ngfont>/ml
Third Trimester 55-200 ngfont>/ml

So, tomorrow another visit to the local vampire.

*Update*

I just checked the cycle days of the last time I was pregnant. The first blood draw, on August 16, 2006, was on cycle day 27. The first blood draw for this pregnancy, August 13, 2007? CYCLE DAY 28. Now I'm a bit worried.

*Further Update*

Thanks to Carey and Christina I reviewed my possible ovulation dates. My doctor believes that this time I ovulated on either July 30th or July 31st. Last year, I believe I ovulated on August 2nd or August 3rd. August 14, 2007 is then 14 or 15 days post ovulation. August 16, 2006, was likely 13 or 14 days post ovulation.

MUST LEARN PATIENCE . . . MUST WAIT FOR TOMORROW'S RESULTS.

Meanwhile, I've been reading one or two pages of the seventh and final installment about that courageous wizard kid -- perhaps the ending will distract me. That and BurritoVille. Not likely, however. But a good try nonetheless.

First Doc Appointment

So, the doctor's appointment with Dr. Wonderful was fairly routine. I made the appointment initially because of the whole not-getting-pregnant thing but didn't call prior to the appointment to inform of the latest "development." This was due, at least in part, to my fear that things will change at any moment. Hence the six pregnancy tests.

When I went in, I said to the receptionist, "So, um, I made an appointment initially because um . . . "

"You made a consultation appointment."

"Right, a, um, consultation, um, there's been a change."

"What change?" the receptionist barked.

"Um, well, um, well."

There I was, standing in the middle of a waiting room, filled with hopeful ladies. Everything went dark and a bullhorn was thrust in front of my face.

"Speak into this!" she said. "We want everyone to be able to hear you!"

I finally stammered, "Well, I think I might be pregnant?" It echoed throughout the room. And she eyed me suspiciously.

"Did you take a pregnancy test?"

"No, actually, I laid a hot rock on my stomach and watched to see if it changed colors."

"Well, in that case, go to accounts to pay your co-pay and bring this back," Miss Too-Much-Black-Liquid-Eyeliner said curtly.

So, the normal: blood test to detect the amount of Beta hCG. Another on Thursday. First results should be back on Wednesday.

We discussed running--which I really miss and stopped doing immediately upon the first test. Last time he told me not to run. He was somewhat ambivalent this time--until I told him that I had trouble last time keeping my heart rate under 140. He suggested that I walk. I hate walking. Well, hate is a strong word, I don't hate it, but when you are used to flying down the hill, walking just seems underwhelming. Running feels good. I enjoy it. It's a great stress reliever. Perhaps I will be forced to do a nerdy race walk instead.

According to Dr. Wonderful, I am likely only THREE AND A HALF WEEKS PREGNANT. Which means detecting the hCG last Wednesday is fairly astonishing. What's next? Detecting it the moment you and your partner's buttocks hit the sheets? Or the second the catheter is threaded through the cervix? Or the the egg is fertilized in the dish? Or the moment when a single sperm is injected directly into the egg?
No more waiting for the cells to divide? It's insanity people. Insanity. This means that gestationally, the little bugger is only a week and a half.

Makes me realize even more how fragile this all is.

And thank you. Thank you for all your warm thoughts and well-wishes. It means a lot. Especially since no one else knows about this--except of course, the doctor, his staff and the seventy-five women in the waiting room.

Sometimes You Feel Like A Nut

I feel slightly nutty that I went on a rant recently - not realizing that I may actually have been pregnant at the time. But that is the nature of infertility: a fun new adventure every second!

I won't know much until tomorrow's appointment, but at this point I have taken six different pregnancy tests - all with lines - some dark, some faint, some in the middle range. I have ceased running - which I am hating. The husband is out of town and I have spent much of it sobbing or in the throes of jubilation. I have looked at the calendar and thought about at what point I may need a D & C. Alternatively, I have envisioned the husband, the baby and I picnicking in Central Park next summer. I have gone into Baby Gap, "just to look around." I ate an enormous, nine dollar slice of chocolate cake at the Museum of Modern Art on Sunday because "I'm pregnant and I deserve it." I have been downing calcium enriched orange juice and ceased drinking the beloved diet soda. I have tried not to look at all those damn pregnancy books but I find myself flipping through them nonetheless. I have learned that if I really am pregnant, the current size of these wondrous dividing cells is half the size of the "o" on this web page. I have felt nauseous more than once--but wonder if it is psychosomatic. I have not had the, um, bathroom issues that I had in the previous pregnancies. Perhaps that is good--but perhaps it is not. I have had no more spotting. And I have begun to feel tired. But not terribly so. Not yet, anyway.

It is a waiting game. And I know the drill by now. Beta. Doubling? Sonogram. Heart flicker? Still there? Growth?

We'll see.

No cause for celebrations at this point - but hoping, hoping, hoping.

Hope

I've been attempting to ride my bike to work. So, far, however, I have only accomplished this lofty goal (it's not really all that lofty) twice. Once during my second week when I was feeling particularly energetic and once this week--due to a little rain. New York's subway system basically ceased operating, like dominoes, one by one.

I didn't particularly enjoy the ride there--the traffic was chaotic and I was stressed about the time. I was also worried that everyone else would have shown up to work in a more timely fashion and I'd be the only ass that couldn't figure out a better way to get to work. The last time this sort of thing happened, I also ended up riding my bike. Under dressed and in freezing cold weather. In December. In New York. And pregnant.

After I miscarried, I was somewhat convinced it was due, at least in part, to the hellish bicycle ride I took that December. Of course that is a ridiculous notion. Bicycle rides don't generally cause miscarriages.

So, on Wednesday, during my rather enjoyable ride home, I decided that once I got home, I'd take a pregnancy test. For the hell of it. My period was not due for several, and really, I mean several days. Like, next Monday. I might as well have been peeing on a stack of money. Besides, I wasn't feeling particularly pregnant. My breasts were hurting--but I'd learned that most symptoms I've felt in the last few months have either been the product of wishful thinking or premenstrual syndrome or a little of both. The last time, I just KNEW I was pregnant. I just knew. So, I took the test. And it was instantly negative. I chastised myself for doing something so idiotic--part of me, I know, had made that appointment with the Reproductive Endocrinologist because, I really believed that it could somehow bring us good luck - that I'd show up and be pregnant and NOT EVEN KNOW IT! And wouldn't that be hilarious? A real HOOT. The doctor would laugh, the nurses would laugh. We'd all grab hands and sing and dance in a circle around the stirrups. And all would be well.

But, it was negative.

I actually forgot about it fairly quickly thereafter and went about my business. I was somewhat exhausted and sweaty and disgusting. But I sat at the computer doing very, very important things. Like looking at furniture stores. And perusing silly blogs about clothes. And answering a few e-mails. I went to the bathroom to shower, and was about to throw the damn thing away when I noticed a faint second line. Yes. Very, very faint. I was meeting my husband and a friend of his out and didn't really know how to react. I really wasn't expecting it, at all. I took another the next morning. Faint line. One that evening. Line. Then this afternoon, I saw what I normally see the day before my period--a slight discoloration, brownish. I called the husband and told him it may be another chemical. I tested again. Faint line. Seems fainter. There isn't anything I can do--and I know that. And I just have to wait.

But hope springs eternal.

And bike riding? I'm trying to hang up the superstitions. Not a simple task.

It's Not a Freak Show, Folks, It's Just My Life

Step right up, folks. Step right up. It's cycle number twenty-four! That's right. Come inside the freak show and watch as Ali and the Husband attempt to get pregnant and STAY pregnant for the twenty-fourth time!

As an added bonus, if I can't guess your weight within five pounds, you'll win great prizes—like a used ovulation predictor stick! Or one of a dozen empty bottles of prenatal vitamins! Or perhaps fifty or so prenatal, postnatal, child-rearing, how to conceive, what-to-do-once-you-are-knocked-up-books, pamphlets or articles I have piled up next to my bed!

How long have we been trying, you ask? Two whole fun-filled years! What? Oh, right, you know someone who went through infertility, too? Your cousin's cousin who couldn't get pregnant for six whole months while trying for number three? That is awful. Really. Oh, then they took a vacation and bam! Pregnant? Yes, I've heard of that phenomenon before. Oh, right, another friend of a friend started adoption proceedings and then got pregnant? Right. Yes. Not sure why I hadn't thought of doing that previously.

Needless to say, feeling somewhat disillusioned. And fed up. And tired.

When I was in my early twenties I went backpacking solo through Ireland. There were moments of great bliss. I could get up whenever I wanted (pending the rules of the particular hostel, bed and breakfast, etc.), get tea where I wanted, visit museums and plays of my choosing, stay in a town I liked longer than initially planned, wander the streets taking photographs with my trusty Pentax K1000 at my leisure. No one becoming impatient. No one yelling that we would be missing the train.

However, there were also plenty of moments of utter and absolute nausea of spending another moment with myself. By the end of the trip I was completely, utterly, and absolutely sick of myself and my own company. Sure, there were many occasions where I met people, mingled, struck up great conversations. But there were just as many times when it was just me and me and well, me. Which generally is fine. I don't have to be around others at all times. I enjoy a little me time. But when it stretches on for weeks at at time, it becomes a bit old.

This is happening to me now. In that I am just sick of myself. And sick of this. Sick of what is going on or not going on. The continuous uncertainty. The worry. The vortex that is infertility. With that in mind, I made an appointment with my Reproductive Endocrinologist, a.k.a., "Magic Man", in the hopes that we can move on to the next step. Back in January, the next step (after trying on our own with the daily administration of Super Folic Acid!) was the fertility drug, Clomid and then, possibly In Vitro Fertilization (IVF) - do I understand why a recurrent miscarrier without any evidence of chromosomal deficiencies, issues, etc., needs IVF? Notwithstanding the recent dry spell? No, I do not. At this point, with the not getting pregnant at all, not sure where we might be headed.

So, that's me in a nutshell. Crabby. Sick of myself. Tired.

I did hang out with a friend last night at a great little restaurant (that she and her husband recently opened here in NYC). I banned her somewhat since my first miscarriage. Insensitive comments and all that. In all these many months since the first miscarriage, I have not uttered a single word to her about any of my fertility issues. Never discussed going to an RE, the many lovely tests, or the subsequent miscarriage(s). However, last night, she brought it up. She wanted to know if we were still trying. Perhaps because I'm not as raw as I once was, I just told her like it is (except that I said we were actually NOT trying). I explained that we are not trying, that I've had a chemical pregnancy and a miscarriage since the first one, that from what they've found, they think I have a type of blood clotting disorder and that although fairly benign for me, it is not benign for my offspring. I didn't really care what she said about it. I'm not going to feel like the pain of miscarriage/infertility is any less just because SHE doesn't think so. I was blindsided, however, by her reaction. She was very sweet. And she got a little weepy. I do not need her reaction to validate how painful this is, has been and will continue to be. It's just the path my life has taken. A completely, utterly, unexpected path.

But here we are.

And I say, onward, ho.

I'm Canada!

I couldn't resist this silly quiz. I mean, it is 11:00 at night.

Turns out, I am Canada. It is somewhat fitting. We honeymooned there. We used to cross the border into Vancouver just for the funky, crazy chocolate bars. And we're always talking about how much we love the Canadians. Oh, right, and I love human rights and wacky things like health care for all.

"You're Canada!
People make fun of you a lot, but they're stupid because you've got a much better life than they do. In fact, they're probably just jealous. You believe in crazy things like human rights and health care and not dying in the streets, and you end up securing these rights for yourself and others. If it weren't for your weird affection for ice hockey, you'd be the perfect person."

What country are you from, eh?

Courtesy of the Oneliner.