Not that I'm complaining

I've tried to write this post several times, but because I keep checking updates from fellow IF blogs before I start typing, I haven't felt able to go through with it. What do I have to complain about, honestly? It takes about five minutes of clicking around to find heartbreaking, awful stories from women who have lost their babies, whose cycles did not work, who are preparing for life without the children they so desperately want. And then there's me, trucking along just fine on my FET cycle, heading home each night to my healthy son and my loving husband, and I have the gall to start moaning about how terrible things are?

Yup. Brace yourself (or stop reading), because I am totally about to complain. But here's the thing! I don't complain to anyone in real life anymore. I don't talk about this cycle with my husband, my parents, my siblings, my friends, my coworkers. As far as they are concerned, there is no cycle happening, no attempt at another pregnancy, everything is just status quo. (I should clarify: my husband knows that this cycle is happening, but that's all. I do not discuss it with him.) It's my first time really experimenting with denial, and I have to say, it's going much better than I expected. A lack of sympathetic faces in my life means that I don't turn to them when things get tough. And if I don't have the option of getting any sympathy - if it simply doesn't exist - well, I find I don't need it as much as I thought I did. And then at least I can cling to that thought - as bad as it gets, as bad as it has been, at least I haven't burdened my loved ones with my inability to cope.

And what is there to cope with, really? Here's a brief summation of what's happened in the last few weeks:
- Right after my SHG, while I was on the antibiotics they prescribed, I got a yeast infection. I tried OTC remedies unsuccessfully for two days before finally procuring some prescription-only Diflucan (don't ask - let's just say that I managed not to hassle my OB or RE.)
- As the yeast infection was coming to an end, I started bleeding heavily. It lasted for three weeks and was similar to my post-partum bleeding, with clots the size of walnuts. I went through a staggering amount of feminine supplies. Another period? Just more irregular bleeding? Who knows!
- I started Lupron injections and got a headache that never really goes away.
- I had a monitoring ultrasound and bloodwork that looked good enough to move on to the next phase of my FET. The 4-cm cyst had gotten a bit smaller, from what I could tell anyway (the OB's office was under strict instructions not to interpret my results and wait for the RE to weigh in, but then all the RE said was to proceed, so I don't really know what's happening with that.)
- I started taking oral Estradiol and injecting myself with Lovenox, since I'm a clot risk after the DVT in 2012. The Lovenox has given me giant, painful bruises on my belly that I believe I have successfully concealed from everyone besides my husband - and even he didn't see them for the first few days, so artful was my dressing/undressing.

None of this is particularly terrible, but yeah, since we're complaining and everything, I will tell you that I've been doing my usual amount of sobbing behind dark glasses. I feel pretty decent about 90% of the time, it's just occasionally that the self-loathing takes over. I start feeling sorry for myself, and then I hate myself even more for wallowing in self-pity, and usually the cycle continues until something external breaks it. Which is often - I'm crazy busy with work, travel, and life in general. That pace is unlikely to slow down for at least another month, which ordinarily would feel daunting but these days is a very welcome distraction.

Next up: at least one more monitoring ultrasound coordinated through my OB's office, another two weeks on medication, and the transfer itself at my RE's office. I am trying to figure out how to casually bring up the topic of the transfer when my nurse calls me in a few days with next steps... for instance, I don't want to put my legs in the stirrups. Could they do the transfer with my feet flat on the table? And what about my RE himself, is it worth even bringing up whether it's possible to have someone else do it? I get the feeling that his embryo transfer technique is probably the best in the practice, and of course I don't want to have to go through this ever again so I want to do everything I can to achieve a pregnancy on the first try, but I am horrified at having to physically put myself in the same position that I was in for my egg retrieval. I don't know. Sometimes I feel angry and empowered, but sometimes I just feel so defeated - sure, go ahead, do whatever you want to my body, it's not like it's worth anything anyway.

And then... then, in December, I'll find out whether this worked. Either way I will have a whole new set of decisions and obsessions. I'll come back here and complain some more, so get psyched!

Photographic Proof... Maybe

Dearest readers, I am thrilled to be able to present you with this exclusive new image of our unborn child:

Wait, what's that? You don't see a baby in this picture? It looks like a bunch of random... stuff? Well! Let me help you out a bit:

So, you see, this could be anything! But I'm told it's probably a picture of our unborn child's face. Part of his face. We think. I feel confident that we're looking at one nostril, at least. And it is an ADORABLE nostril.

In other news, everything looked fine on the rest of the scan. Hooray! Onwards!

Make It Pink! Make It Blue!

My favorite movie growing up was Sleeping Beauty. Okay, fine - one of my favorite films even as an adult is Sleeping Beauty. It's so fifties-tastic in style and has a happy ending and I really identified with Merriweather, one of the three good fairies. In fact, I identified with her so much that I always rooted for Princess Aurora's dress to be blue rather than pink. Remember that? Merriweather keeps magically changing the gown to blue, then Flora zaps it with her wand and it goes back to pink, and so on and so forth, until this is the result?

(Full disclosure: as a child of the '80s, I actually thought 

this splattered look was the best one of all.)

This is not to say that I dislike pink. I am always faintly embarrassed to look at my closet and realize how many of my clothes are varying shades of pink. But blue is the color of the sky and the sea and it's always been my favorite. And now, it is the color that will inevitably be most associated with... our son. Yes, you read that right:

We're having a boy!

A boy who has ten fingers, ten toes, a normally shaped palate and feet, and who was so active during the ultrasound that we had no problem taking a peek between his tiny legs. I was actually the one to identify his, um, personal region - the ultrasound tech and I both started laughing since it was so obvious. So there you have it. The tiny creature who keeps kicking me (he was especially active during this week's Game of Thrones episode and appears to support Stannis more than the Lannisters, whatever that might indicate) will someday, we hope and pray, be a man. How weird, and how wonderful.

Placenta Previa

Okay. Another appointment this morning yielded a ton of information. In the good column we have:

•  The baby is alive! 
•  And huge! Measuring 8 days farther along than average. 
•  S/he still has a terrifying face. 
•  One of the sub-chorionic hemorrhages is gone, and the other appears to be resolving. 

And, as always, the bad:

• The placenta is covering the cervical opening entirely (known as placenta previa), which will require close monitoring for second- and third-trimester bleeding, and probable early delivery.
• There's a small chance the placenta previa could resolve, but it's very unlikely in my case. 
• Even if I make it to term - or close to it - I'm definitely looking at a C-section delivery.

So, to sum it up, my message to the universe this morning is: what the f*cking f*ck. One step forward, two steps back. Oh, and in case you were wondering, it's a complete previa, meaning that the placenta is entirely covering the cervix and very unlikely to resolve as the uterus grows. (Often, women will be diagnosed with a partial placenta previa and as things get bigger, the placenta is naturally pulled upwards and away from the cervical opening so the problem is resolved. This is emphatically not what is happening in my uterus; near as we can tell - and yes, Mr. Wandy helped make this diagnosis so there were a total of two ultrasound angles and two MDs involved - my cervix is pretty much smack-dab in the middle of my placenta. Worst place it could be.) Now I'm wondering if the sub-chorionic hemorrhages and the placenta previa were all ultimately related to the problem the RE had with the angle of my uterus and finding the right catheter during the transfer, and the embryo implanting lower than it should have. And I'm also wondering if, by some miracle we do have a healthy baby at the end of all this, I'll have difficulty getting a sibling to implant in the future now that I'm almost certainly going to have a big ol' scar right across my uterus. Oh, and did I mention that placenta previa is associated with placenta accreta, where it grows too deeply into your uterus and they can't take it out and then you have to have a hysterectomy?!?


Anyway. Breathe. I probably should have waited to post this until I was a little calmer; the Maternal-Fetal Medicine doctor could tell that Harry and I were starting to lose it a little bit and he said at the end of our visit, "You're doing really well, you still get an A today." I appreciate his optimism, I really do. But there are days I just feel like taking to my bed (how convenient, since bedrest could easily be involved at some point in the not-so-distant future) and this is one of them. Still, let's focus on something positive: I will probably never hear somebody say "Well, Charlotte, it looks like you have a fourth-degree perineal tear from pushing this giant baby through your vagina!" And for that, and our healthy growing fetus, I am very grateful indeed.

Scan: One Healthy Baby, now with Extra Hemorrhages!

Another week, another high-resolution ultrasound. First, the good news: despite hanging on to those adorable (?) alien facial features, our baby looks great. S/he is 55mm long from crown to rump and has a lovely fluttering heartbeat. This was the clearest scan yet, and we were able to see all sorts of details like fingers and toes and a reassuringly normal nuchal space. Our odds for both Down's Syndrome and Trisomy 18 are nice and low, which is a big relief.

However. It seems that whenever I write about this pregnancy I have to add an addendum of not-so-good news, and today is no exception. We saw the sub-chorionic hemorrhage from March 20th and it's getting smaller - great! And then the sonographer moved the wand over to a different part of my belly and... wait, what's that? Could it be? Why, it's ANOTHER HEMORRHAGE! Ding ding ding! Folks, tell the lady what she's won!

Yup, there's another sub-chorionic hemorrhage, on the small side size-wise, but this time it is behind the placenta. It was probably the source of the spotting I had last Friday, which makes some sense, and there's no indication that it consists of anything besides old and clotted blood, so it probably stopped pretty soon after it began. It could be related to the original hemorrhage, but it might not be, and nobody seems to be terribly curious about why this keeps happening. They just keep saying that it will probably work out fine, but blood is an irritant so as long as it's in there it puts me at higher risk for miscarriage, etc. It's particularly deflating because every day I'm passing a significant amount of what are probably the grossest brown clots that I've ever seen emerge from my personal region, so I was all set to go in today and have them say "Wow, looks like you're really getting rid of this thing!" and I would blush modestly and say, "Well, you know, my uterus just knows what it wants" and everything would be happy and we could start telling people and tra la la.

Now, dear Internet, you remain on a very short list of people and places where I will (anonymously) discuss my pregnancy. The big extended-family holiday gathering we're having this weekend? Deflect all questions. The four "glasses" of wine I'll be expected to enjoy as part of our Seder? I'll have to switch my goblet with Harry's halfway through the meal. The friends who are going to come with me to see Titanic 3D in the theater? Distracted by my baggy coat, we hope! Oh well. I always thought it would be kind of badass to just announce a pregnancy at like 5 months along and impress everyone with our secret-keeping abilities, and now we may get the chance to do just that.

Ultrasound: May the Odds Be Ever in Our Favor

Today's appointment had lots of news - some great, some good, and some not-so-good.

What's great: there's a little baby growing inside me! It has arms and legs and a still-big-but-less-freakishly-large head. It looks like he or she was sleeping at first but woke up briefly during the scan to kick and punch the amniotic fluid a little bit. However, he or she still has a weird alien face that only a mother could love. (Errr....) The ultrasound tech paused on an angle that showed its facial features pretty clearly and, wow, I really hope those aren't family traits we're seeing! Perhaps someday I'll post an actual ultrasound picture, but in the meantime, you can use this as a guide:

Hello, my baby!

What's merely good: there's still a sub-chorionic hemorrhage inside my uterus. It is not on the side with the placenta, which we knew from last week, and it has not grown in size. It's actually slightly smaller than the last time it was measured, and most hemorrhages take between several days and several weeks to resolve, so this is more or less expected. There's no indication of new bleeding, and the gestational sac remains uncompromised. All good things. Except:

What's not-so-good: The doctor was going over all the positive findings listed above, and Harry and I were feeling pretty confident about things, and then she said - and I quote - "bleeding is an irritant, so we're not out of the woods yet." And that deflating sound you hear is the optimism just draining right out of the room. 

She's right, of course. My obsessive searching about miscarriage rates by week in the first trimester had me obsessed with percentages and it was very gratifying to watch them drop as we passed each milestone: seeing the sac, hearing the heartbeat, etc. And then when this happened, our possibility of having a miscarriage shot right back up again, though it's probably well below the first 50% statistic I saw that scared the living daylights out of me. The analytical side of me wants to do more research on this and see  what my percent risk is now that the hemorrhage is a bit smaller, I haven't had any new bleeding for a week, etc. But even if the medical literature suggests that it's 15% rather than 10%, is that going to really make a difference? Nope. Not one bit. It's not going to change the way we're managing it, and it's not going to change whether this particular baby in this particular pregnancy makes it to term. And it's also important to remember that we still have a much better chance of the baby surviving this crisis than losing it to a miscarriage. A 15% miscarriage risk is also an 85% "risk" of a healthy pregnancy. That's a way better chance than Katniss had going into the Hunger Games, y'all! So, yes, the odds really are in our favor. May it ever be so!

Good Morning! I Have Tiny Arms!

We had another ultrasound this morning and everything looks wonderful. The embryo, who I am told will graduate to "fetus" on Thursday when we hit 10 weeks, is 28mm long and was waving around tiny, hilarious T. Rex arms. I do have a picture, but because it's so grainy (and frankly it looks like every other 9 week ultrasound that you might care to google) I have attached this helpful graphic highlighting our unborn child's dominant physical characteristics:

We did hear a heartbeat but stupidly forgot to ask exactly what it was... oh well. My RE said that everything looked perfect for this stage of development. We are so, so grateful for this news. From here on out, I won't be seeing him but will go to my regular Ob-Gyn for obstetric care as well as visiting the high-risk Maternal-Fetal Medicine specialist occasionally to follow up on this whole DVT issue.

Because this was my last meeting with my RE for what we hope is quite a while, it was also my big chance to talk about my experience with egg retrieval. The conversation went pretty well, all things considered (definitely better than when I brought up my concerns with him initially, and way better than the time I told my Ob-Gyn that I wouldn't take the birth control pill because "this is America, dammit!" Note to self: if you are using the phrase "this is America" to bolster your argument, you have already lost.) Anyway. I said that while we were so thankful for such a positive outcome, the hardest part of this pregnancy has been trying to reconcile my joy at becoming a parent with my horrible memories of how our child was conceived. I was a bit surprised that he immediately agreed with me that more pain relief should be offered, and he even gave some examples of other gyn procedures totally unrelated to IVF that are only performed under anesthesia even though they're considered less invasive than egg retrieval. But... it's not within his power to change their policy, and without going into too much detail, he summarized some of the reasons why the senior doctors in the clinic set it up this way. I reiterated that I didn't feel at all as though he personally had given me substandard care - in fact I think he has done a great job and I intend to go back to him in the future if and when we try for a sibling with our three frozen embryos - but I offered to write a letter to the head of their practice describing my experience in case this issue ever comes up in the future. He said that might be a good idea, and now I'm trying to decide how much of a squeaky wheel I want to be. On the one hand, everybody got what they wanted out of this cycle, clearly the majority of their patients find the service they provide to be acceptable since they're not exactly going out of business, and I'm not often inclined to rock the boat. On the other hand, I do think their policy to go with minimal anesthesia for egg retrievals puts women through unnecessary pain and suffering during what is already an incredibly difficult process. So, I'll be thinking about this one.

For today, I want to focus on our good news. In fact, this is my new policy overall - I found this (unattributed?) quote online and I pinned it up by my desk so I'm looking at it every day. Good things are happening, and I hope and pray that they continue.

Heartbeat

The blastocyst that was transferred to my uterus a month ago is now 10mm long. He or she has a heartbeat of 152 beats per minute that was strong enough to be heard by the Doppler ultrasound. I was given a grainy picture depicting an alien floating in a black bubble that looks, I am told, exactly as it should at this stage. It's pretty crazy.

I know that other people have described bursting into tears or otherwise feeling overcome when they heard their baby's heartbeat for the first time, but for me, the big moment was when the first image came on the screen and it looked like the other eleventy billion 7-week ultrasounds I googled in preparation for this visit. I gasped and put my hands over my mouth and my RE said "are you okay?" and I sort of squeaked back "yes" and he continued his measurements. He was totally unfazed and only took about 90 seconds to look around and say "yup, as expected, everything looks normal." The longest part of the appointment was after the scan when I complained about morning sickness and everything he suggested, I had already tried - finally the nurse broke in to say that she has two children, remembers how awful the first trimester was, and to just hang in there. They did say that I can have a prescription for Zofran if it gets really bad, and I'll keep that in mind... I don't want to resort to any kind of drug, even a really safe one, if there's any way to avoid it. Until then, blech.

I won't have another scan for (knock on wood) about 3 weeks. So much suspense! At least it's Friday so I have the next two days to lie on the couch and stare at the ultrasound picture. Wow, a heartbeat, wow wow wow!

I Turned Down an Ultrasound. Am I Crazy?

I mean, we know I'm crazy, but was turning down a perfectly good ultrasound opportunity a crazy thing to do? My RE's office wanted me to come in today even though the man himself is on vacation all week. They said one of the techs would do it and I'd still have to have my RE perform another one next week when he's back in town. I think a lot of it was that the scheduler reached me when I happened to be feeling pretty crummy, so my patience wasn't terribly high, but I was also really frustrated with having to come into their office at the crack of dawn every 48 hours for two weeks to track my beta doubling time. That, coupled with the knowledge that an ultrasound at 5 weeks could tell me about potential problems but wouldn't give me any ability to solve them, made me less interested in coming for a special tech-only visit. I politely declined their request (okay, my tone of voice was a wee bit sharper than it probably should have been) and said that I would prefer to wait until next week, when my RE will be there and we'll be able to see more of the embryo development anyway. And then I hung up and wondered what kind of IVF patient I am, and what kind of mother-to-be, that I didn't want to go for as many ultrasounds as possible. (Even though I know all I would have seen is a blob, and maybe not the right kind of blob, and you know what? Maybe I don't want to know yet if that's the case.)

In related news, I had seen the headlines about Virginia's proposed law to require a transvaginal ultrasound before performing an abortion, but somehow I didn't put two and two together until today that they were debating our old friend Mr. Wandy. When I realized that all of the hullabaloo was about the same procedure I've been regularly undergoing with little fanfare for a couple of months now, I felt the following emotions:

1.) Indignation that a legislature would mandate any kind of vaginal penetration of a woman against her wishes;
2.) Confusion at how a doctor would accurately gauge how far along a pregnancy had progressed in the early stages without doing a transvaginal ultrasound;
3.) A bizarre affection for Mr. Wandy. It's okay, buddy! Not everybody is mad at you! I swear, when I do go for my ultrasound next week, I will be really pleased with all of the information that you give me.