December 31, 2013

18 Years (And Still Incubating, I Hope)

So the Christmas Eve ultrasound went well - Kiddo's heart rate was up to 150, and s/he was measuring 7w4d (one day ahead). The sac continued to look better, and the neural tube (where the spinal cord will grow) was visible as a thin black line in the middle of Kiddo's body.

Now I am counting down the hours to the next ultrasound, which is on Friday afternoon. It's about 64 hours away at this point. There's no reason to think anything is wrong, but I am nervous. There has been persistent brown blood almost every time I wipe, and occasionally a bit of pink, but no bright red since one week before Christmas. Most days, I've had mild nausea that usually starts around noon and lasts for most of the rest of the day.

So what's making me nervous? Well, I haven't been feeling as much round ligament pain or joint loosening the last couple of days. And I just don't feel as pregnant. I lost that "pregnant" feeling during the beginning of week 9 with pregnancy #4, and then we found out the following week that that Kiddo's heart had stopped beating during the 8th week. But then again, I also lost that "pregnant" feeling with Miss A during her 8th week, and she was still in there, heart beating strongly. My uterus is probably still too tilted to hear anything with the home Doppler that I have, so I've decided (so far - I could certainly cave at any point) not to torture myself by trying to use it.

In the meantime, plenty of other things have been keeping me occupied.

First of all was the magic of Christmas. It was wonderful with Miss A last year, but even better this year! She was able to tear the paper off her gifts much more easily, and she has several that she loved. We got her a set of traditional wooden blocks, and one of her favorite things to do is stack them high and then watch them fall over. It is the first time she has full-on belly laughed. Up until now, there have been lots and lots of giggles, but for some reason, the site of blocks falling over (even if it's just 2 or 3) brings out the biggest laugh that she has ever had. It is so much fun to experience that with her!

She also loves her little rider, complete with drum, horn, and keyboard. She rides it around the house, and we also try to go for a walk with her around the neighborhood whenever we can. It's great exercise for all of us. (And, selfishly, we always hope all that exercise leads to a long, deep nap afterward. :-) )

In addition to the holiday, the end of the year also brings our wedding anniversary. R has been putting up with me for 18 years now. We celebrated by going out to breakfast, then coming home and trying to clean up as much as possible. (These days, we've gotta take those rare opportunities when we get them!) After that, we went to a movie, which we haven't done since Miss A was born, and then out to dinner. Overall, it was a lovely day and a great chance to spend some time re-connecting one-on-one, even if it was while we were picking up the house.

The other thing that has been keeping me distracted and busy is work. We're getting ready to enter our busiest time of year tomorrow, so the last few weeks of December and first few weeks of January are always crazy busy, with an early start to the day once the year begins. (I'll be working on and off tomorrow, and starting work at 5 a.m. beginning on Thursday for the next couple of weeks.)

There have been a lot of interesting changes at work this year with a new team being formed, and figuring out how that new team will work with the existing teams, including the one that I am on. A couple of days before Christmas, one of my co-workers approached me with an offer to join the new team that has formed.

There are pros and cons to this. The particular offer she made to me is probably the only time I will get an offer like this in my career, so it warrants serious consideration. On the other hand, I feel like any time you make a transition to a new position, even if it's with a company you're already with and with colleagues you already work with, it requires stepping up your time/energy/effort commitment.

I have not talked with my co-worker about the Kiddo situation yet. We are meeting to discuss the offer some more on Friday before the ultrasound. I will probably wait to see how that goes before saying anything about it. It's still early, and I'd rather wait until the second trimester (early February) to share that news. But if I do wind up transitioning to the new team, I don't think I'll be able to wait that long. All of the colleagues I'd be working closely with are in another state, and I will need to explain that I can't travel to meet them.

We'll see what happens, both with Kiddo and with the job situation, in the new year. 2013 has been an incredible year. Here's hoping that 2014 is equally incredible, not only for us, but for all of you, especially those of you who are awaiting your miracles this coming year!

December 21, 2013

Still Incubating (7w0d)

Every time I start to think things are settling down, I wind up seeing a pinkish color that is closer to red than I am comfortable with. After a while, things turn back to brown, and the cycle seems to start over. So hopefully things won't change in a drastically negative way after I post this update...

We had ultrasound #3 yesterday morning. Thankfully, I have not passed any other large clots since Monday night, and the last truly, definitively, without-question-it's-bright-red-blood incident was Wednesday morning. So I knew the gestational sac was still in there, and I was hopeful there was still a heartbeat.

There was, and it's speeding up appropriately - 135 bpm. Growth is exactly on track, measuring 6w6d, which is what yesterday was.

It's amazing how much an embryo changes in such a short period of time. There was less than 94 hours between ultrasound #1 and ultrasound #3. At #1, the baby was measuring 0.66 cm and looked like an ever-so-slightly curved line attached to a circle (the yolk sac). By yesterday, it was 0.87 cm, it was obvious which end was the head and which end was the rump, and the ultrasound tech said she could see the brain beginning to form. Incredible.

That is one of the silver linings of all the infertility/pregnancy drama we have to endure - we get a view of our Kiddo's in utero development that few people ever get to experience. It is so amazing to witness it.

The gestational sac looked a bit better, too. Still not as perfectly shaped as I'd like to be comfortable, but not nearly as squished by the hematoma as it looked on Tuesday. The tech who did our ultrasound yesterday was the one who had done most of our ultrasounds with Miss A. She hadn't done the first two this week, but she said she looked at my images from Tuesday before calling us into her room, and she was very happy about the way the sac looked compared to Tuesday. She couldn't see much fluid in the sac on Tuesday, and that had concerned her.

To me, the hematoma still looked about the same size as it did on Tuesday, but R said he thought it looked smaller, and when the tech measured it, she said it had shrunk considerably, from 16 ml to 5 ml. (She measured the width and height, but gave me the volume measurement. I'm not sure why. The tech on Tuesday did the same thing.

Based on how that scan went, we decided to go ahead and do the next round of IVIG. It's scheduled for Monday at 4 p.m., and the next ultrasound is scheduled for the next morning, on Christmas Eve.

For now, we are just continuing to take things one day at a time, and I am trying to stay off my feet as much as possible. Today, I've been feeling some low-grade nausea all day, along with a slight sensitivity to smells. My progesterone and estrogen meds have not been increased, so I am hoping that is a sign that my body is starting to kick in with its own contribution of hormones. Whatever the reason, nausea always makes me so happy. (Especially low-grade, but I'd even be thrilled with the lay-in-front-of-the-toilet-all-day variety.)

R laughs when I get so excited about it, but what can I say? I love every moment that I feel pregnant. And since we can't exactly afford our own personal in-home ultrasound machine so that I can see visible proof of the pregnancy at all times, I'll gladly take nausea as some form of reassurance.

December 17, 2013

Not Feeling Confident About This

Ultrasound #2 wound up being this afternoon. As of now, I am still incubating, but we are not feeling great about the chances.

I wound up having a lot more bleeding last night. I knew at least some of the hematoma had evacuated, I just wasn't sure if it had taken the baby with it. Unfortunately, the RI says that I need another round of IVIG, so I wanted to make sure there was a reason to do it before we fork out another $4,000.

The heart rate had increased by 3, and there was a day's growth. So, yea for those things.

Unfortunately, not all of the clot had liquefied, and the part that is still in there is pressing on the gestational sac. From what I've read online, in general, SCH tends to increase risk of miscarriage to about 10 percent. But the peri gave us only 50/50 odds since the clot is taking up more than half of the uterine cavity. She thinks if this does not go our way, it will probably end within the next week.

The bleeding stopped by this afternoon, and I was hoping that would be the end of it, but bright red has shown up again, and I'm starting to feel pain again.

I know there is a chance this could still work out, and we're not discounting that. But on the other hand, because it is a large clot, that makes me a bit nervous about what our increased risks would be if this pregnancy does continue. Large SCHs tend to be associated with higher risk of placental abruption, PPROM, and pre-term labor.

The peri wanted us to still keep our Friday morning ultrasound appointment, although she said if something else significant happens between now and then, they will bring me in sooner. Without me even saying anything about it, she also said she wants to monitor me 2 or 3 times a week until this resolves, instead of the planned weekly appointment. I appreciate her concern, but honestly, at this point I know there's not really much that can be done other than wait and see. So unless I wind up in a situation again like last night, where I'm not sure I'm still pregnant, I may try to stick with weekly appointments.

R and I also decided to hold off on the IVIG for now. If this pregnancy ends, I don't think it will be because of lack of a second round of IVIG - it will be because of the hematoma. The RI's nurse said they believe IVIG can help heal SCH. I did some searching online, and the doctor's (Beer) thought was that elevated NK cells can contribute to hematomas. But the thing is, my NK levels and my T-reg levels were fine as of the most recent testing last week. The only thing that was elevated (34.7, when they want it to be below 30) was cytokines. And, I did a round of IVIG right before the transfer, and yet the SCH still developed, so I don't think IVIG is necessarily the solution to this particular hematoma.

December 16, 2013

So Much for 'Normal'

About that last post - everything uneventful, no bleeding, no staining. Yeah, not so much anymore.

The bright red bleeding started this morning, followed by back pain and general lower pelvic achiness. I called the perinatologist's office and got our first ultrasound moved up from Wednesday to today.

I was totally expecting bad news. So imagine my surprise when there was a heartbeat - 121 bpm at 6w2d, and the Kiddo measured at 6w3d.

I also knew as soon as I saw the ultrasound screen that there is a large subchorionic hematoma in there, too. It looked slightly larger than the gestational sac. The ultrasound tech said that the uterus is still small at this point, so it all looks close together, but the Kiddo is actually on one side of the uterus and the hematoma is on the other. So at least it's not right under it. I'm choosing to be thankful for that.

There's not really anything to do but stay as hydrated as possible and keep my feet up as much as possible, which is tough to do when the Little Miss is home. And right now she's feeling ill, so I think she's going to wind up being home all day tomorrow.

The next ultrasound is scheduled for Friday morning. I had a lot more bleeding this afternoon, so I don't know what the current state of things is, but there's no point in going in every day for ultrasounds - there's nothing anyone can really do but wait and see and pray.

I've said for a long time that I'd like three Kiddos. But if we are fortunate enough to wind up with two, it's very possible we may stop at that point. I forget how hard this is until I'm in the middle of it.

December 10, 2013

This is Bizarre

Today is 5w3d. I had blood drawn yesterday to check E2 and P4 levels. The results came in this afternoon: normal.

"Normal" is not what we normally experience. This feels very bizarre, surreal.

It's still very early. I've gotten this far before, only to have it fall apart. But so far, there has been no bleeding, and there hasn't even been any staining in the last couple of weeks.

The first ultrasound is scheduled for the afternoon of the 18th, which is a week from tomorrow. Assuming nothing starts to look wrong between now and then. That will be 6w4d, so if this is truly on track, a heartbeat should be visible at that point.

The perinatologist's office has a new receptionist. Everyone there is fantastic, they totally get all the mental stuff that IF inflicts on their patients. But I don't think the receptionist has much experience with that yet.

She asked who my ob was. I explained that I don't have one - Dr. H manages my entire pregnancy from start to finish. She insisted that I need a regular ob. I told her I would not go to one. She put me on hold, came back, and proceeded to schedule the appointment.

Then she asked when my last menstrual period was. I had to explain about the FET. I told her I would give her the LMP date, but only if she promised to not tell me what the estimated due date is. I told her that I know vaguely that it would be sometime next summer, and I don't want to know anything more specific than that at this point.

Then I brought up that I want the ultrasound tech who did my first ultrasound with Miss A to also do this first ultrasound. She explained that they don't schedule a specific ultrasound tech, only the doctor. I replied that I know that, and I still want that particular ultrasound tech to be the one to do it. She had to put me on hold again to confirm that the tech will be there that day. (She will.)

I swear I could hear the receptionist's eyes rolling skyward. I totally recognize that I give a whole new level of meaning to the words "difficult patient". And frankly, at this point, I don't care.

Emily Erin, since you don't have a blog that I can comment on to answer your question - We did the immune testing before this cycle. We had already decided that regardless of the testing, we would not do LIT again, even if it means never having another child. The situation at the border has changed significantly since we went 3 years ago. The process requires both of us to go, and we just weren't comfortable with the risk, given that Miss A is here now. Thankfully, the testing showed that we did not need LIT again.

It showed that I did need IVIG. While I was pregnant with Miss A, I had great insurance that covered it. Unfortunately, that insurance changed in June, and IVIG is no longer covered. However, we do feel that the immune treatments we did were what made the difference to result in success last time, so we paid out of pocket. It's expensive - the initial testing was about $1,300, the IVIG itself was $3,500 (I need to lose some weight - the amount is based on weight, and the cost is based on amount), the nursing fee for it was another $400, and the next round of testing, which I had drawn yesterday, was another $1,000.

I wound up doing 3 rounds of IVIG with Miss A. If they recommend that I do it again, we'll have to move some balances around on credit cards, but we'll do it. Assuming this all ends well and we try for a third child at some point, we may give it a try without IVIG and see what happens. Maybe if it works twice, my body will start to recognize that it's okay to allow kiddos to grow in there...

When I was pregnant with Miss A, eventually the monthly testing cost settled down to about $400, so hopefully we'll get to that point again soon. Between that, co-pays (I have to pay one every visit, because it's a perinatologist rather than a regular ob/gyn), co-insurance, and meds, the pregnancy with Miss A cost us about $1,000 per month out of pocket. Paying IVIG out of pocket, this one is going to average $1,500 to $2,500 per month, depending on how many rounds we wind up needing to do. That's $12,000 to $20,000 before the kiddo even arrives, assuming I go through 8 months of pregnancy like with Miss A. And that's not counting the cost of the transfer or travel for the transfer.

Tenants moved into our old house at the end of last month. Now we need the real estate market to keep improving at a healthy (not crazy, but healthy) rate for the next couple of years to have any hopes of paying all this stuff off...

December 02, 2013

2nd beta

I spent all day biting my nails, then got a call from the clinic at 5:45 p.m. saying they hadn't received the results yet from the local REs office where I had it drawn. Fortunately, I was able to get a hold of the local RE, and he was still in the office.

Beta #2: 329, a doubling time of about 41 hours. And P4 is up to 45. Yea!

Out of all 8 pregnancies, I believe these are the best beta numbers I've ever had. (With Miss A, the first beta was 2 points higher, but the second one didn't double.) It still doesn't feel real.

Assuming there are no concerning signs that appear in the meantime, the next steps are repeat E2 and P4 in a week, and then an ultrasound in a little more than 2 weeks. With Miss A's pregnancy, we wound up doing our first ultrasound on 6w0d. That would be a Saturday in this case, so we won't be doing it on that day. I'd like to hold out until 6w5d if possible this time around. We'll see what happens - that is still too far off to talk confidently about it. I likely won't even call the perinatologist's office to schedule it until about 1 week before, assuming we get that far...

In the meantime, we are having such a blast with Little Miss this holiday season. My mom put up a 4-foot tree today, and when Miss A came home, she saw it, let out a happy squeal, and ran right to it. She stared at it with such joy, so mesmerized, reaching out to gently touch the ornaments. That angelic look - pure childlike joy and delight - was such a beautiful, amazing thing to witness. We continue to be so thankful, every day, and not just because it's the season of thanksgiving.

December 01, 2013

1st Beta Results

It would be really nice to have a time where a nurse called with test results that were nothing but good news, but we don't seem to have that kind of luck. I knew immediately from her tone of voice that not everything was ideal.

HCG - 147 (With the pg that resulted in Miss A, it was 149, but we transferred 2 that time, and we think that both initially stuck. This time, we only transferred 1.)

E2 - 300-something. Normal.

Progesterone - 14-point-something. This is the issue. I didn't even ask and she didn't say, but I think it's supposed to be above 20. She asked if I was doing the suppositories 3 times a day. (I am.) She confirmed that I am taking the PIO daily instead of every other day like their typical protocol. (I am.) She made sure I'm using a 1.5" needle and not a 1" needle. (It's 1.5".) Then she sounded stumped. So she told me to bump my PIO to 1.5 ml, up from 1 ml. She's not sure the increase will show up within 2 days, so tomorrow's number might still be low.

I'm not overly freaked out about the progesterone level at this point. With Miss A's pg, my level dropped down to 5-point-something. That was back when the clinic's standard protocol was suppositories only, and no PIO, and at that point, they had me add PIO. So from that perspective, 14 isn't horrible. And when I tried to wean from the progesterone with Miss A, my numbers dropped down below 20, and that was when I was at the end of the first trimester. So I figure to be at 14 at this point isn't all that bad, comparatively speaking.

What's worrying me more is that I've continued to do daily FRERs, and the line is not getting darker. Yesterday's line was about as dark as the control line, but this morning's looked slightly lighter than yesterday's line. R was a quick thinker, and managed to be pretty convincing when he said he thought the control line looked lighter than yesterday's, too, so he thought it was just a variation in the test, and not necessarily a reflection of a declining HCG level. (Both were tested with FMU, and both were from the same box.)

On the bright side, there has been no more staining. We'll see what tomorrow's repeat tests show. Even if all the numbers look good, we're certainly not anywhere close to out of the woods. I'm only 4w1d today, and it's usually between 6-8 weeks when things have fallen apart for us in the past.