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.