Waiting for a heartbeat

So, it would have been nice if I had gotten pregnant this easily earlier on. In the first 18 months I got pregnant twice out of 11 cycles of trying. In the last year, I've gotten pregnant three times out of 5 cycles of trying.

Now I am around 4 weeks 5 days pregnant. My previous four pregnancies all failed around the fifth week (although with one I didn't miscarry and didn't find out until the 7 week scan).

However, I do have some reason to be hopeful this time around. My hormones are rising much better than they did with my previous two pregnancies where I had hormone monitoring. My levels are below the median, although not by too much, but they are rising faster than average for this stage of pregnancy.

And as every health professional I meet takes great delight in telling me - I still have a 70% chance of it working out fine this time.

At this point, I am waiting for a scan at six weeks where I hope to see a heartbeat. While there will still be many hurdles afterwards, this would be a huge milestone.

Fragile

So I left you all hanging there for a while.

The outcome from my last pregnancy is that they never found whether it was in my uterus or in my tubes but the hcg levels did eventually decline to nothing within a week or two. So the pregnancy did have some indications of being ectopic but we will never know for sure.

And life goes on, the sun rises and sets. I get up each day and try to do the things I am supposed to and that I need to do and sometime even that I want to do. And some days life has some joy and others it has mostly sadness. And we keep trying to have a baby.

It seems it is possible there is a genetic condition in my family called Fragile X. This condition can cause intellectual disability including autism, learning disabilities and developmental delays. About 20% of female carriers of the condition have premature ovarian failure. So if I have it it could mean that my miscarriages have been caused by poor egg quality. I got tested for Fragile X a couple of days ago and last week I had another test (an Anti-Mullerian Hormone or AMH test) which measures ovarian reserve. I should get the results back in the next two or three weeks.

If I am a carrier I'm not sure where we'll go from here. A Fragile X carrier will pass on the condition to 50% of her children. Embryos can be screened for Fragile X so that it is not passed on - but this means you need to have an ivf cycle where you collect a lot of eggs in order for you to have a decent chance of having a successful pregnancy with a baby that is unaffected by the condition. Its unlikely to be able to collect that many eggs if your ovarian reserve is getting low.

I figure there is no point getting too worried about it until I get the test results back. However, I have started to read more about the ivf process.

I am also having a procedure called an HSG which involves pumping dye into the uterus so that the fallopian tubes can be seen on an x-ray. Its possible, although unlikely, that I have some problem in one or both tubes that could be causing ectopic pregnancies. I only know for sure that one of the pregnancies was in the uterus. In theory, some or all of the other three could have been ectopic.

If you are thinking that looking for the cause of recurrent miscarriage is like looking for a needle in a haystack then you would probably be right.

I can't help but search anyway.

Pregnancy of unknown location

This is my latest diagnosis. It means that my hcg is being funky (by neither rising - as it would if it were viable- or falling - as it would if it were an ordinary miscarriage - as it should) and they cannot see signs of pregnancy in either the uterus or the fallopian tubes when they look in a scan. So basically it means I might be having a (very small) ectopic pregnancy or else just a really weird ordinary miscarriage.

Some people like to 'do' countries by travelling around them, apparently my quest in life is to collect obscure early pregnancy complications.

Rats - NB post not suitable for readers with rodent phobias

I don't usually feel sorry for rats but I did for the one I found last night cowering next to my hall cupboard, no doubt a prime example of 'something the cat dragged in'. It was only half grown and it was brown and fluffy with a curled up tail like an earth worm. It appeared to be trembling.

I used my standard operating procedure, which was to throw an old towel over it so I could pick it up and take it outside to the very edge of our property where the cat was unlikely to find it again. As I went to scoop it up it made the most pathetic, whimpering/squealing noise. I felt so bad for it. (BTW, don't you love my non-traditional relationship where the girl gets to deal with the vermin.)

Anyway, the rat was officially liberated and we went to bed.

This morning we found the corpse of rat #2 sprawled in the hallway in front of the kitchen door. This one was decidedly less cute and rigor mortis was starting to set in but I still felt kind of sorry for it. I know he's just doing what comes naturally but sometimes my kitty can be a nasty little predator. He hasn't been in yet this morning so he must be out in the rain, attempting to pull in a little more of the rat bounty.

No not yet, maybe not ever

So in the last 48 hours I've been asked if I am thinking about using donor eggs and whether I am considering adoption. Clearly I've hit some kind of threshold where people are starting to think that I am pursuing a lost cause and that maybe I should give up.

This raises lots of issues for me.

First, adoption and donor eggs are generally expensive and difficult, neither are a sure bet and both have a whole lot of complex emotional issues attached to them that come with parenting/giving birth to a child with a genetic makeup different from his or her parent(s). Moreover, even if we did decide to pursue this as a couple we are not necessarily a good candidates for adoptive parents given our relatively advanced ages and the fact I am being medicated for depression. And it could be that donor eggs wouldn't work any better than my own eggs, if the cause for the miscarriages is some kind of underlying condition that stops the pregnancies from progressing.

Second, there is still a good chance that I will have a pregnancy that ends in a live birth of a healthy child. There are interventions that I haven't tried yet (basically because they are unproven and the doctors wouldn't give them to me until I had four losses or because they are really expensive). Plus most women with recurrent miscarriage eventually have a successful pregnancy if they keep trying. Its really about how many times you can bring yourself to go through it.

While my feelings on this stuff can fluctuate like mercury, right now I feel certain that we will be successful if we keep trying.

Rollercoaster blah blah

So today the blood test showed my hcg is dropping, which means the pregnancy is almost certainly non-viable. I kind of feel like some higher power is cruelly toying with me.

So shall we just go back and replay Friday's post.

And for those of you who feel like something really carthartic there is also this song.

OMG, this stuff can mess with your head

So it seems, despite all indications to the contrary, that this pregnancy may be viable. My hcg levels have risen from 20 to 55, which is a 49 hour doubling time, with the average doubling time for normal pregnancy being 48 hours. Still bleeding though.

Sorry, again, for traumatising everyone with my post the other day. After everything that has happened. and with everything looking so bad it was self-protective for me to assume the worst.

It will still be weeks before the danger zone for miscarriage is past and things could go kaput at any time. From here on out I will have three-daily hcg tests and a scan at around 6 weeks - it will be a waiting game to see what happens. Wish me luck.

Anthems

I really didn't mean to traumatise anyone with yesterday's post. Today I am feeling ok, although a little introspective and fragile. I am not sure really how to process all of this or what it means. It could mean:

a)I am really unlucky and have had a string of mcs from sporadic one-off events
b)I have some kind of undiagnosed underlying condition that is likely to reocur
c)Some strange mixture of a and b

I don't really know what to believe. Statistics still say I am likely to have a child one day. Although they also say that my chances have dropped a somewhat with no.4. Statistics have stopped holding much power with me now. Its now turning into a matter of faith.

Anyway, I thought I'd share with you my two anthems for this part of my journey.

Maybe tomorrow

and

Something good

I can't even say how I feel right now

Its come to the point that when we get a positive pregnancy test instead of being excited we cry. This morning L and I hugged and I cried when I thought about how difficult the last pregnancy was. But I don't think I need to worry about this pregnancy playing out in the same way as that one, I think this one's going to be over pretty quickly.

This time around I got caught out in that classic way, when I started bleeding on Saturday I thought it was my period. It was a pretty convincing imitation - but it dragged on longer than my period does and after tapering off the bleeding started intensifying again. So this morning I took a home test and it was positive and then I went and got a blood test and the hcg level is only 20 (it really should be around 100). And then I read up (again) about bleeding during early pregnancy and found a lot of people saying that the kind of bleeding I was having was indicating a miscarriage.

So I've found out about the pregnancy and the miscarriage on the same day. And my head is kind of spinning. What are the odds of four miscarriages in a row any way? The next medical professional who tells me that I have an excellent chance of my next pregnancy being successful is gonna get slapped in the face!

And I'm more and more becoming 'that' woman - the horribly unlucky one, the one that other people pity, the one that people can't deal with because all they can thing is "god, I hope that never happens to me", the one that miscarries over and over again and no one can tell her why. I am becoming the 'barren woman'.

So far I have learned patience, I have learned endurance, I have learned a kind of surrender. But, apparently I still have more to learn in this miscarriage milarky.

I've turned into a women's magazine

You know how those women's magazines always announce pregnancies of celebrities by publishing a photo where a female celebrity has a tiny suggestion of a pot belly or perhaps an item of clothing that is slightly baggy or wrinkled around the midriff and they photoshop in a large arrow and add a caption that says BABY BUMP? Then at least 70% of the time it turns out that the celebrity was just slouching in a minorly unflattering way and is not actually with child.

I am now chanelling the women's magazines. If ever I meet a woman of child bearing age (or even one that is arguably borderline) who appears to have a belly of some kind I am transfixed by it and start wondering - is there a baby in there? It's getting so bad that I am having to bite my tounge to stop myself from asking some of them if they're pregnant.

Endurance

So I got depressed after the surgery I had in March. I felt teary every day. Ordinary levels of stress made me feel overwhelmed and unable to cope. It got to the point where I felt like I was walking around with a large and heavy stone on each shoulder. I used to feel like this a lot on and off (basically throughout most of my teens and 20s) until I started taking antidepressants. SSRIs changed my life so much for the better. Once I found the right ones and they kicked in it was like I had been sitting in a room while dusk had fallen and hadn't noticed how dark it had gotten until someone turned on the light. Some people say that antidepressants flatten out their feelings but it wasn't like that for me. My feelings were already flatlining and because of the drugs I suddenly felt a much broader spectrum of emotion than I had for years. Previously my main emotions had been anxiety and despair.

Since I started on the SSRIs back in 2003 I have only been depressed twice. (Thats not to say that I haven't been unhappy, but unhappy is different from depressed and I would say a normal and healthy part of anyone's emotional life.) The first time was in late 2006/early 2007 when I stopped taking the drugs in preparation for trying to conceive. I took about 6 weeks to taper off the drugs and it was all looking good but then shit happened - in an 8 week period I had a big dramatic fight with some close family members on Christmas day, a had a painful run-in with a work colleague that shattered a lot illusions I'd had about my job, my job was seemingly disestablished and I was told by email, L's stepmother died. My mood crashed. I couldn't even cope with simple things like ringing the electricity company to query a bill. I wanted so badly to have a drug free pregnancy but when my GP suggested I go back on the medication, at least temporarily, I was relieved. I decided that the risk to my mental health of being off the meds (which was high) outweighed the risk to a future child of being on them (which was low).

The second time I got depressed was last month. In some ways this time was scarier because this time it happened while I was on the meds. I don't know why the surgery was the trigger for depression when there have been so many other more stressful life events happening over the last year. Maybe it was just culmulative.

As luck would have it this bout of depression got pinged pretty early on and it pretty much gone now. The great saviour this time was traditional chinese medicine. I know lots of people don't hold much stock in TCM , L being one of them. And while TCM has been proven effective for a limited number of medical conditions depression is not one of them. On the day that I felt weighed down by heavy stones I happened to have one of my regular acupuncture appointments. When I told my acupuncturist about the depression she treated me for it through both needles and herbs and I felt better straight away and pretty much a lot better within about 3 days. Now you can say thats a placebo effect but I have to say that its the best damned placebo effect I've ever come across.

Still, here I am now not depressed but I would have to say that I'm not so happy either. I remember being happy and excited about my life and the future and the last times I can remember feeling this way is right before I got married in 2007 and then again in mid 2008 when I got pregnant for the second time before I miscarried. I know that life goes in phases and I have to say that 2003 to 2007 were pretty happy times for me. Lots of stuff went right, I found a job I loved, I got promoted, I got together with L, I bought a property, I got a car and learned to drive. All long held goals that suddenly all came together. Now I am in a phase where it feels like my long term goals are being thwarted and where there has been a lot of loss and sadness. I guess when I take the long term view I see that I will at some point move from this phase and into a happier one but in the meantime I am learning endurance.

Overwrought

Is how my state of mind has been in the last day or two. Last night I became convinced that the abdominal and lower back pain I was having must be the beginning of a pelvic infection from the hysteroscopy (camera through the cervix thingy) I had last week. So after 60 minutes at the after hours clinic and and expenditure of $83.50, I had a packet of 30 ibuprofen and advice to come back again if I started to get a temperature or feel sick. L was very good to refrain from saying 'I told you so' and chauffeured me both ways with no complaint.

Anyway, so I found this article, where Dr Lesley Regan, who runs the top recurrent miscarriage clinic in the world (based in London) says "We have done studies that have shown that the levels of psychological distress and disturbance in couples who have repeated miscarriages and lose babies is very similar to that in psychiatric hospitals. It really is an enormous burden on people."

So the first thing this makes me think is "Yay, finally some validation for my wonky emotional state." Cos seriously, infertility and pregnancy loss hardly ever show up in official literature about stressors that impact on emotional health.

But then I start to wonder "Does this mean I should be institutionalised or is it just that the UK its easier to get into a psychiatric inpatient unit?"

Brittle

I feel like a window pane with a crack in it. There is a truth at the core of me and sometimes I feel it could make me shatter - I want a baby, I want a baby but my arms are empty.

Thanksgiving

Sometimes its good to give thanks

for waves and sunsets

and rainbows

and playing in the sand

for food prepared with love and generosity

for grace and beauty

for wit and the creative spark

for friends and community.

Thank you HP for bringing us together in celebration.

Clean as a whistle

is how the gynae consultant described my uterus after looking into it with a camera yesterday. No scars, no fibroids, no polyps, nothing out of the usual - completely normal. It seems that it's reasonably common for a scan to show that something is a bit odd but for nothing to be found once the doctors get a real inside look.

So after being told that I might have to wait six months for this procedure it turns out I only had to wait three weeks, which just confirms my previous assessment of the quality of care in the public health system - highly variable.

And I have to say, this was way easier than having the D & C basically because this time I wasn't in the midst of an intense emotional crisis. Although I have to say the anaethetist scared me a little - I ended up concluding that either he had very poor interpersonal skills (mumbling in a monotone and refraining from eye contact as he went over the risks of GA), or that he was going through some kind of personal crisis (he was late to work and everyone was waiting for him before they could start). Given that patients can't really say "OMG is the anaethetist wacked out?" and still expect to get prompt treatment I decided to just cross my fingers and hope that he was just aspergic. I seem to have survived the procedure with few ill effects so I guess he did his job alright.

Anyway, in a burst of unwarranted optimism, I'm thinking that maybe this is the end of the line for me in terms of reproductive crap. Maybe things will just be really easy from here on out. A girl can dream can't she.

Journeys

The other couple who live in our apartment complex had slightly premature twin babies in mid February. The babies were in the hospital for a while but now they have come home.

Since they came home I've had glimpses of their presence every now and then - rows of baby onesies hanging on the communal washing line, faint newborn crying. But the other day we had a odd confrontation. L and I were carrying our mountain bikes up some steps to the driveway and removing the front wheels so we could load them in our hatchback. At the same time, our neighbours were valiantly trying to load their double stroller, two baby car seats and assorted baby paraphernalia into their vehicle.

We chatted a little and I got my first good look at one of the babies - a small sleepy bundle. It turned out this was the first time they were leaving the house with the babies since they had come home. S, the mother, was looking a little grey with fatigue. When I asked her how it was all going she simply said "It pretty full on".

It was an odd moment because if my second pregnancy had worked out I too would have been lugging around a newborn right then. Or if my third pregnancy had worked out, I would have had a visible bump and been able to trade stories about the trials of pregnancy. But as things were, I was still footloose and fancy free, about to spend the afternoon whizzing around on my pretty new bike with my partner and to spare no thought for the needs of any other. And at that moment, although I would happily give a kidney or some other body part to have a baby myself, I was glad that I was not the one weighed down with responsibility and the awful slog of wrangling two new borns.

Last night I was walking past their lounge window on my way to the car, and as I have been doing habitually since the babies came home, I tried to subtly catch a glimpse of the interior. This time I saw J, the father, in the cosily lighted room, cradling a newborn gently on his lap, gazing enraptured at his child. And I felt like the orphan child in the Hans Christian Anderson fairy tale who presses her nose against the glass of the rich house on Christmas eve to glimpse the beauty of the Christimas tree and the glorious presents wrapped beneath.

Tick tock, turn the screw, raise the stakes

So the same day that I saw the beautiful ob/gyn in his private practice I also fronted up to Wellington Hospital for a publicly funded consultation. (The public ob/gyn got pissed off when I told him I'd had the two appointments in one day, I guess because he thought I was wasting precious public resources - but if they hadn't double booked me and left me waiting for an hour in mid-Feb then I would have felt confident enough about this public appointment would go ahead that I would have cancelled the private one - after all I had to wait three months for both of them).

The hospital started the ball rolling with a 3D ultrasound scan which involved the use of a large vaginal probe with the appearance of a joke sex toy. I love the way they know how to put you at ease.

Anyway it seems that me and scans have bad karma because it turns out there is something amiss in my uterus. A very small something - the ob/gyn described it as the size of the end of a ball point pen (you know the little sticky up bit) - only a few millimetres in diameter. In this area, there was no uterine lining growing. It seems the most likely scenario is that this is scarring from my d & c. I knew that scarring was a risk - however no one told me that there is research that indicates when you are having a d & c for a missed miscarriage as I did that there is a 30 % chance of scarring. At the time I was so focused on having the chromosomal testing done that I was prepared to take what I thought was a small risk. Was this the right decision? Is this another betrayal of me by my body unfolding in its unseen depths?

On the other hand this could be a 'something else', from my internet reading most likely a fibroid or polyp, and this something else could have been the cause of at least some of my miscarriages.

So the next step is to put a teeny tiny camera through my cervix to look at my uterus from the inside to see what it is and then to possibly operate. The waiting list for this procedure is six months, although people keep making vague statements about how they think I'll probably get it done sooner than that.

I feel like I'm whooshing down the slipperly slope of medical intervention at full speed. Every procdure that involves dilation of the cervix can weaken it ultimately making it to weak to hold together during pregnancy. Every entry into my uterus risks perforation, infection and further scarring. Surgery to remove adhesions, polyps and fibroids if done improperly can damage the uterus to the point that conception becomes difficult or impossible.

And then theres the issue of whether we should continue trying to conceive while we are waiting for the 'something' in my uterus to be photographically diagnosed. Public ob/gyn said it was fine as long as there was no possibility of me being pregnant at the time they stick the camera in. But there are vague online statements about pregnancies in compromised uteruses leading to miscarriage in the second trimester, prematurity and post-birth hemoragghing. Yay.

It seems that without any conscious volition on my part we are on the track to keep trying despite the ambiguous status of my uterus. I can't bring myself to stop again.

Missing the mark

I went to see a private fertility specialist the other day. A man only a year older than me, who is renown as being the young sexy ob/gyn about town. He was beautiful, and personable and sympathetic but he still doesn't really understand how it is to be the one sitting in my chair.

After I told him we'd been trying to have a baby for two years, he asked me if I had gotten sick of taking the folic acid every day.

Uh ........ no
I'm sick of having sex just to get pregnant when I'm tired and stressed and not in the mood
I'm sick of the roller coaster wait each month to see if it worked
I'm sick of all the people around me swelling up with child and bringing their babies into work
I'm sick of wondering what went wrong and could I have stopped it and will it happen again next time
I'm sick of the impact that the grief and the stress has on my life and my relationship

But frankly, no, I'm not sick of taking a teeny tiny pill every day. I'd be willing to do a great deal more, if it would help.

Then of course, there was the cool, serene acupuncturist who poleaxed me when making polite conversation and asking if I was sick of waiting to get pregnant.

Hello, I'm not infertile I'm a recurrent miscarrier, I've already been pregnant several times. Have you even read my file lately? And frankly, "sick of waiting to get pregnant" is the biggest understatement I've heard in a long time. When I'd been trying to get pregnant for six months with no result, THEN I was sick of trying to get preggers. Now, I've visited the deepest reaches of soul and come to the understanding that I have absolutely no control over what fate chooses to dish out to me and yet I've still scraped together enough courage to keep on trying and risk it all again. OK?