Hey, look, we've made it to six weeks! Good job, everybody!
Six weeks means that O is smiling (sometimes), cooing (occasionally), and extremely cute (all of the time.) It also means that I had my six weeks postpartum checkup, which ordinarily would have focused on healing Down There and birth control plans, but was a bit more interesting for me. The endometriosis that got us into this whole IVF mess is a problem that won't go away, so there are a few things we're going to continue to monitor going forward.
First of all, some good news. I passed another milestone this week: I'm off Lovenox! No more enoxaparin sodium for this girl, at least until/unless I get pregnant again. For those of you keeping score at home, this was nearly a full year of daily injections, with a few short breaks here and there. Someday I'll post the total number of needles that it took to get O from theory to reality, but for now I'm content just watching the bruises fade.
Also, the preliminary results suggest that the endometriomas have not recurred (or are pretty small if they did.) The one on the left was 4 cm right before my IVF cycle and we'll see what continued breastfeeding does to keep things quiet. I've seen it described as "natural Lupron," which would be nice since I want to avoid taking that stuff again if at all possible.
Since I had a complicated pregnancy, I also wanted to go over whether I'd have to be concerned about attempting any other pregnancies in the future. Yes, I will likely have to be on Lovenox again, but my risk of placenta previa is only slightly higher than normal and the fact that it resolved this time is a good thing. I also had some weird liver stuff that popped up on my bloodwork at the very end, but that just means they'll be on the lookout for pre-eclampsia as they would for anyone. Overall, I guess I'm not a terribly complicated patient when it comes to another pregnancy, which is nice!
Now for the tricky stuff. The endometriosis which caused my tubes to scar over and my ovaries to grow endometriomas will theoretically get worse every time I have an ovulatory cycle (though how much worse, and how much it will bother me, is kind of a question mark.) Ordinarily I would probably be prescribed a combination estrogen/progesterone birth control pill, but thanks to my DVT, I'm not a good candidate for that. I'm likely headed towards a progestin-only pill or maybe a Mirena IUD - and yes, I really am considering taking the pill despite my earlier protestations about systemic hormones. Why? Well, partially because the side effects are theoretically less problematic than the combined BCP, and partially because I can wrap my head around taking a pill if I know it's only for a short period of time.
All this to say: it's a matter of time before we're back on the IVF train. Don't think I've forgotten about those three embryos on ice, and because of a combination of family and medical factors, we're probably looking at attempting another cycle in a year. Or less. Or maybe a little bit more. There are a lot of moving parts to consider, even though we're committed to giving O a sibling - or at least trying our hardest to do so. We've been so blessed to have him, and I hope and pray that our luck continues!
Showing posts with label DVT. Show all posts
Showing posts with label DVT. Show all posts
Friday, November 30, 2012
Tuesday, July 31, 2012
Family, Loss, and New Life
Spoiler alert: the baby and I are just fine. The loss I'm referring to is my grandfather, who left us last week. He had been struggling with his health for some time now and I had hoped he would still be around when the baby is born, but it didn't work out that way. Instead, I've spent the past few days with my extended family thinking a lot about the circle of life (and now you'll have that song stuck in your head, just because I mentioned it - you're welcome!)
My grandfather lived a long and full life. I know that's something people tend to say when a death occurs, and it's often not very comforting when you're grieving a loved one, but that doesn't make it any less true. I looked around at his memorial service and saw so many people - his wife, his children, his grandchildren, his great-grandchildren, his siblings and their children and grandchildren and so on - and I was incredibly grateful for the little one in my belly. I kind of backed into this whole motherhood thing and being at an event like this, which celebrates family and life, made me think more about how the choices we make when we are young have a ripple effect. I feel like I've been wearing my "next few months" glasses for a while now and the truth is that I have no idea what my life will be like long-term now that I've decided to reproduce. None of us do. I'm having a baby, sure. The next few years will be about diapers and playing with blocks and kissing boo-boos and the first day of school. But after that? Really, really far after that? I can't even begin to sketch out what shape our family will take. I can only hope that whenever I die, my loved ones will take as much comfort from each other as I have recently.
Oh, and remember that whole DVT/on an anticoagulant/told not to travel and especially not to fly thing? It made logistics for the memorial service pretty exciting. Let's just say that I spent some time recently appreciating our fair country from ground level and enjoying many regional specialties (barbecue!) and some not-so-regional specialties (McDonald's!) I forgot how much I enjoy traveling, even in less-than-ideal circumstances. In a weird way, it was a nice break from sitting at home in the same environment I've been stewing in for months, and although I would give anything for my grandfather to still be with us, I was grateful for the opportunity to hit the road. This kid better get ready to move!
My grandfather lived a long and full life. I know that's something people tend to say when a death occurs, and it's often not very comforting when you're grieving a loved one, but that doesn't make it any less true. I looked around at his memorial service and saw so many people - his wife, his children, his grandchildren, his great-grandchildren, his siblings and their children and grandchildren and so on - and I was incredibly grateful for the little one in my belly. I kind of backed into this whole motherhood thing and being at an event like this, which celebrates family and life, made me think more about how the choices we make when we are young have a ripple effect. I feel like I've been wearing my "next few months" glasses for a while now and the truth is that I have no idea what my life will be like long-term now that I've decided to reproduce. None of us do. I'm having a baby, sure. The next few years will be about diapers and playing with blocks and kissing boo-boos and the first day of school. But after that? Really, really far after that? I can't even begin to sketch out what shape our family will take. I can only hope that whenever I die, my loved ones will take as much comfort from each other as I have recently.
Oh, and remember that whole DVT/on an anticoagulant/told not to travel and especially not to fly thing? It made logistics for the memorial service pretty exciting. Let's just say that I spent some time recently appreciating our fair country from ground level and enjoying many regional specialties (barbecue!) and some not-so-regional specialties (McDonald's!) I forgot how much I enjoy traveling, even in less-than-ideal circumstances. In a weird way, it was a nice break from sitting at home in the same environment I've been stewing in for months, and although I would give anything for my grandfather to still be with us, I was grateful for the opportunity to hit the road. This kid better get ready to move!
Monday, July 23, 2012
And Then There Was One (Complication)
Up until now, my Maternal-Fetal Medicine appointments have fit into one of two categories:
1.) Establishing that my existing complications are still going on
2.) Finding that a complication might be resolving, but discovering a new one
I am thrilled to announce that last week, I discovered that there was a third category:
3.) Learning that my complications have continued to resolve, not finding any others, and getting bumped down closer and closer to "normal pregnant woman" status!
Seriously, the visit couldn't have gone better. My placenta previa, which we already knew had technically resolved by a small amount thanks to a scan at 21 weeks after my last bleed, has moved farther and farther away from my cervix. It was barely 1 cm away at 21 weeks and at 26 weeks it was between 1.5-2 cm depending on how they measured it. The doctors said that they expect it will keep moving (though they were careful to make sure that I understood it's not the placenta that moves, it's the uterus that grows, and as the uterus grows the placenta stays put so it keeps "moving" farther away. Got it, guys. Trust me, I've looked up how placentas work by now!) Oh, and my cervix is holding strong at 3.7 cm.
The other good news is that there continues to be no new bleeding, either that I've noticed or internally. So the sub-chorionic hemorrhages from my first trimester appear to be well and truly gone (oh please, please, please let that be the case!) Perhaps the 21-week bleed was the last hurrah? Man, if I had known that, I would have thrown a party to celebrate rather than lying on the couch all weekend in terror!
So for those of you keeping track at home, we've now gone from three potentially disastrous complications to one. That one is, of course, the Lovenox I'm still taking after my deep vein thrombosis very early in the pregnancy - and it won't go away because I will be at risk for additional clots and need to stay on blood thinners right through 6 weeks after delivery. But with this in mind, my MFM doctor recommended that we change my labor and delivery plan slightly from "induce no later than 38 weeks" to "induce no later than 40 weeks." I now feel like less of a fraud when people ask my my due date and I respond "October 18th!" Inwardly, for the past few months I've been cringing inside as I said it, knowing that the babe was medically indicated to come out no later than Oct. 4th, and quite possibly earlier than that. Now he has a shot at truly, genuinely, just-as-nature-intended making it to term. I hope he does, even if it means I need to wait a bit longer to meet him!
Of course, all of this "you're a normal pregnant woman and can possibly anticipate a normal delivery" has me a bit freaked out. Which brings me to my next topic... CHILDBIRTH CLASS. I'll save that for another post, but highlights include forgetting to bring our pillows, learning to give a massage under dim lights in a room full of strangers, and me getting all high and mighty about patient consent. Fun!
1.) Establishing that my existing complications are still going on
2.) Finding that a complication might be resolving, but discovering a new one
I am thrilled to announce that last week, I discovered that there was a third category:
3.) Learning that my complications have continued to resolve, not finding any others, and getting bumped down closer and closer to "normal pregnant woman" status!
Seriously, the visit couldn't have gone better. My placenta previa, which we already knew had technically resolved by a small amount thanks to a scan at 21 weeks after my last bleed, has moved farther and farther away from my cervix. It was barely 1 cm away at 21 weeks and at 26 weeks it was between 1.5-2 cm depending on how they measured it. The doctors said that they expect it will keep moving (though they were careful to make sure that I understood it's not the placenta that moves, it's the uterus that grows, and as the uterus grows the placenta stays put so it keeps "moving" farther away. Got it, guys. Trust me, I've looked up how placentas work by now!) Oh, and my cervix is holding strong at 3.7 cm.
The other good news is that there continues to be no new bleeding, either that I've noticed or internally. So the sub-chorionic hemorrhages from my first trimester appear to be well and truly gone (oh please, please, please let that be the case!) Perhaps the 21-week bleed was the last hurrah? Man, if I had known that, I would have thrown a party to celebrate rather than lying on the couch all weekend in terror!
So for those of you keeping track at home, we've now gone from three potentially disastrous complications to one. That one is, of course, the Lovenox I'm still taking after my deep vein thrombosis very early in the pregnancy - and it won't go away because I will be at risk for additional clots and need to stay on blood thinners right through 6 weeks after delivery. But with this in mind, my MFM doctor recommended that we change my labor and delivery plan slightly from "induce no later than 38 weeks" to "induce no later than 40 weeks." I now feel like less of a fraud when people ask my my due date and I respond "October 18th!" Inwardly, for the past few months I've been cringing inside as I said it, knowing that the babe was medically indicated to come out no later than Oct. 4th, and quite possibly earlier than that. Now he has a shot at truly, genuinely, just-as-nature-intended making it to term. I hope he does, even if it means I need to wait a bit longer to meet him!
Of course, all of this "you're a normal pregnant woman and can possibly anticipate a normal delivery" has me a bit freaked out. Which brings me to my next topic... CHILDBIRTH CLASS. I'll save that for another post, but highlights include forgetting to bring our pillows, learning to give a massage under dim lights in a room full of strangers, and me getting all high and mighty about patient consent. Fun!
Wednesday, February 29, 2012
DVT Update and I Hate Being Sick
This morning I had my first appointment with a Maternal-Fetal Medicine doctor who specializes in blood clots. I actually set up this meeting precisely one week after my transfer - three days before my first beta hCG test would ordinarily have been done - and I kind of wonder if that's some sort of record. Congratulations, you have literally only been pregnant for a week, and it's off to the high-risk doctor!
There was good news and bad news from the appointment. The good news is that he was really optimistic about my pregnancy in general, despite being surprised that I hadn't yet gotten an ultrasound to confirm. (Ummm... it's on Friday?) He said that my beta hCG values had doubled right on track for a singleton pregnancy and my fatigue and nausea were signs that everything was proceeding normally. He also said that my thrombophilia bloodwork had come back showing NO genetic mutations and that all my levels were within normal ranges, so it appears that I don't have any inherent predisposition towards clots. Great!
The bad news, and I think he didn't really consider it bad news but I sure did, is that if he had to guess right now then he would expect that I will have to stay on the Lovenox right through the pregnancy and six weeks after the birth. He mentioned that at 35 weeks or so, I'll probably switch to Heparin so they have more options (epidural, C-section) during labor and delivery. If I need emergency surgery at some other point during the pregnancy, that could get interesting because it takes ~24 hours to get Lovenox out of your system, though of course it's low odds that something like that would happen and they would weigh the benefits and risks at that point. Additionally, they don't like to see ladies with clotting problems go past dates, so he said that there's a chance I would be induced between 38-39 weeks... I have two responses to that: 1.) I wake up every day thinking that I've miscarried, so let's just hold off on all the labor and delivery plans for the moment, mmkay? and 2.) I'm not inducing. I mean, never say never, but induction to me is a last-ditch, everybody-is-about-to-die, this-is-an-indication-of-huge-problems kind of option. My experience with the world of obstetric and gynecological medicine to date has pretty neatly illustrated the problem that one intervention leads to another problem which leads to another intervention and so on. The link between induction of labor and increased complications (including a higher C-section rate) is pretty well established, but this is a battle that I'm just going to wait to fight on another day.
All of this is essentially fine, although I'll feel like less of a fraud when someone confirms using ultrasound that there really is a tiny human living in my belly. So why did I burst into tears in the parking lot after the appointment? Here's the problem. If I think about the baby, I am flooded with gratitude and humility. But then I think about what my husband and I had to do to get here and the rage that simmered in me throughout the past few months - with occasional, and notable, moments of boiling over - just comes back full-force. The news that I'll probably be on the Lovenox until 6 weeks after delivery (for those of you keeping score at home, that's nearly a full year of painful, bruising, daily self-injections) was really upsetting to hear. My Lovenox bruises are a visible sign that something is not right with me. It doesn't take a genius to read what I've written to date and realize that the most traumatic parts of this experience were when I was most actively being treated for my infertility - the initial surgery on my ovaries, the start of injecting myself with leuprolide acetate, my egg retrieval procedure, my DVT diagnosis, the constant blood draws to check my hCG level. Now I have a messed-up pregnancy, too. I am deeply bothered by the idea of illness and being an ill person, and a lot of this probably stems from the experience my family went through recently with my mother's cancer treatment, but I'd venture to say that it's also pretty common. A lot of the literature on chronic and terminal illness mentions this feeling among patients, and the most vivid description I can find is what Susan Sontag writes in Illness as Metaphor:
Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. Read more here.
So every night, when I inject the Lovenox, I feel like I'm being kicked right back into the kingdom of the sick just when I was starting to think I might be able to live back in the kingdom of the well for a while. I start thinking about how I'm never going to be able to show off a baby belly and I'm probably going to have to do this right through New Year's Eve for 2013 and, you know, I still really want to tell my RE how much I hated my egg retrieval procedure (I'm concerned that now that I'm pregnant, all of our interactions are going to focus on my pregnancy and I'm never going to have a chance to tell him what my experience was like and how, frankly, I was right to worry and feel that I was justified in freaking out on him ahead of time.) I had hoped to move on from all of this unpleasantness, but no, it's still going on. And realistically, it may never stop - welcome to the world of chronic illness.
Still, eye on the prize, right? I like to sign off on a positive note, so I will say again how grateful I feel to be pregnant right now. I have felt a frisson of excitement for the future here and there - during the worst moments of morning sickness I've even started distracting myself by bookmarking cute maternity clothes online, but that's a story for another time. Keep your fingers crossed for a good report on Friday!
There was good news and bad news from the appointment. The good news is that he was really optimistic about my pregnancy in general, despite being surprised that I hadn't yet gotten an ultrasound to confirm. (Ummm... it's on Friday?) He said that my beta hCG values had doubled right on track for a singleton pregnancy and my fatigue and nausea were signs that everything was proceeding normally. He also said that my thrombophilia bloodwork had come back showing NO genetic mutations and that all my levels were within normal ranges, so it appears that I don't have any inherent predisposition towards clots. Great!
The bad news, and I think he didn't really consider it bad news but I sure did, is that if he had to guess right now then he would expect that I will have to stay on the Lovenox right through the pregnancy and six weeks after the birth. He mentioned that at 35 weeks or so, I'll probably switch to Heparin so they have more options (epidural, C-section) during labor and delivery. If I need emergency surgery at some other point during the pregnancy, that could get interesting because it takes ~24 hours to get Lovenox out of your system, though of course it's low odds that something like that would happen and they would weigh the benefits and risks at that point. Additionally, they don't like to see ladies with clotting problems go past dates, so he said that there's a chance I would be induced between 38-39 weeks... I have two responses to that: 1.) I wake up every day thinking that I've miscarried, so let's just hold off on all the labor and delivery plans for the moment, mmkay? and 2.) I'm not inducing. I mean, never say never, but induction to me is a last-ditch, everybody-is-about-to-die, this-is-an-indication-of-huge-problems kind of option. My experience with the world of obstetric and gynecological medicine to date has pretty neatly illustrated the problem that one intervention leads to another problem which leads to another intervention and so on. The link between induction of labor and increased complications (including a higher C-section rate) is pretty well established, but this is a battle that I'm just going to wait to fight on another day.
All of this is essentially fine, although I'll feel like less of a fraud when someone confirms using ultrasound that there really is a tiny human living in my belly. So why did I burst into tears in the parking lot after the appointment? Here's the problem. If I think about the baby, I am flooded with gratitude and humility. But then I think about what my husband and I had to do to get here and the rage that simmered in me throughout the past few months - with occasional, and notable, moments of boiling over - just comes back full-force. The news that I'll probably be on the Lovenox until 6 weeks after delivery (for those of you keeping score at home, that's nearly a full year of painful, bruising, daily self-injections) was really upsetting to hear. My Lovenox bruises are a visible sign that something is not right with me. It doesn't take a genius to read what I've written to date and realize that the most traumatic parts of this experience were when I was most actively being treated for my infertility - the initial surgery on my ovaries, the start of injecting myself with leuprolide acetate, my egg retrieval procedure, my DVT diagnosis, the constant blood draws to check my hCG level. Now I have a messed-up pregnancy, too. I am deeply bothered by the idea of illness and being an ill person, and a lot of this probably stems from the experience my family went through recently with my mother's cancer treatment, but I'd venture to say that it's also pretty common. A lot of the literature on chronic and terminal illness mentions this feeling among patients, and the most vivid description I can find is what Susan Sontag writes in Illness as Metaphor:
Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. Read more here.
So every night, when I inject the Lovenox, I feel like I'm being kicked right back into the kingdom of the sick just when I was starting to think I might be able to live back in the kingdom of the well for a while. I start thinking about how I'm never going to be able to show off a baby belly and I'm probably going to have to do this right through New Year's Eve for 2013 and, you know, I still really want to tell my RE how much I hated my egg retrieval procedure (I'm concerned that now that I'm pregnant, all of our interactions are going to focus on my pregnancy and I'm never going to have a chance to tell him what my experience was like and how, frankly, I was right to worry and feel that I was justified in freaking out on him ahead of time.) I had hoped to move on from all of this unpleasantness, but no, it's still going on. And realistically, it may never stop - welcome to the world of chronic illness.
Still, eye on the prize, right? I like to sign off on a positive note, so I will say again how grateful I feel to be pregnant right now. I have felt a frisson of excitement for the future here and there - during the worst moments of morning sickness I've even started distracting myself by bookmarking cute maternity clothes online, but that's a story for another time. Keep your fingers crossed for a good report on Friday!
Monday, February 13, 2012
Unjustified Pity Party, Part 2: DVT Edition
So within moments of publishing my last post, my doctor called with the news that today's ultrasound of my leg had revealed that the Deep Venous Thrombosis was still hiding out in my calf. I didn't even mention it earlier because it seemed like such a nonevent; my leg has stopped hurting and of course last week's scan was negative. But no, it turns out the clot is still there, just smaller and with more blood flow around it.
Tomorrow morning, I am going to get a thrombophilia workup (translation: more bloodwork) and pick up my 3-month supply of Lovenox injections. I've been told that Lovenox burns like a mothereffer, so that's awesome, and of course I'm thrilled about the new lab I get to go visit at the crack of dawn. I'll probably make an appointment with a blood specialist this week to discuss next steps.
This seems like an appropriate time to take inventory of the good things I have going on:
1.) A probably-still-viable pregnancy.
2.) A husband who premade three nights of dinners because I can't stand to be in the kitchen near all that fragrant food.
3.) A job that is totally cool with me coming in late tomorrow and has been really understanding about all of my unexpected medical challenges recently.
4.) An adorable puppydog cuddled up next to me as I type this.
5.) A big bottle of top-shelf vodka just in case it all falls apart. It's important to be prepared!
Tomorrow morning, I am going to get a thrombophilia workup (translation: more bloodwork) and pick up my 3-month supply of Lovenox injections. I've been told that Lovenox burns like a mothereffer, so that's awesome, and of course I'm thrilled about the new lab I get to go visit at the crack of dawn. I'll probably make an appointment with a blood specialist this week to discuss next steps.
This seems like an appropriate time to take inventory of the good things I have going on:
1.) A probably-still-viable pregnancy.
2.) A husband who premade three nights of dinners because I can't stand to be in the kitchen near all that fragrant food.
3.) A job that is totally cool with me coming in late tomorrow and has been really understanding about all of my unexpected medical challenges recently.
4.) An adorable puppydog cuddled up next to me as I type this.
5.) A big bottle of top-shelf vodka just in case it all falls apart. It's important to be prepared!
Wednesday, February 8, 2012
Copy That, We Have Visual Confirmation
So although I was genuinely shocked yesterday when I got my lab results, I will confess to you now that it wasn't the first inkling I'd had that something weird might be happening down in ol' Uterustown. The sequence of events was as follows:
Monday - Embryo transfer in the morning, lay like a slug on the couch the rest of the day staring at the picture of my blastocyst. Cramps start around 3 PM.
Tuesday - Cramps continue and intensify.
Wednesday - Cramps continue and start to taper off in the afternoon/evening.
Thursday - Cramps are gone. Totally convinced that nothing was happening, besides the increasingly worrisome pain in my right leg.
Friday - Told I had a DVT in my calf and all hell breaks loose. Upon arriving home at 7 PM, decide to take a HPT even though it's only 4dp5dt since the result might have a huge effect on my treatment for the clot. It's negative, as expected. I sigh and toss it in the trash.
Saturday - Come down with a raging cold. Now I'm sneezing and coughing and my leg hurts and I'm lying around watching reality TV generally feeling sorry for myself. Near the end of the day I'm fooling around on my iPad and decide to Google side effects of Crinone, the progesterone gel I'm using instead of progesterone in oil. Sure enough, breast tenderness and enlargement are listed, which explains why the girls are starting to ache a bit. But then I look at a few message boards where women have discussed their experience with Crinone and most of them mentioned that their breasts started to hurt within a day or so of beginning Crinone, whereas mine only began aching a week and a half later. Huh. Before I go to bed, I take another HPT. It's also negative. This time I leave it on the edge of the sink and go to sleep.
Sunday - Harry was gone overnight, which was a good thing because I woke up early due to all the sneezing. This time I have some pretty concentrated urine to use for a test, so I take another one. It's negative again, so I flop back onto the bed and start Googling "6dp5dt BFN" to see whether it's possible that I might still be pregnant despite the negative result. But the cat is crying for his breakfast and the dog needs to go out for her walk so I drag my congested self out of bed to put in my contacts and start the day. I look back at the test and I see - no. No, wait, it's impossible. There's something there. It's a line. It's a faint line, but it's there. Wait, really? I have other tests under the sink. My hands are shaking so badly I can hardly get the box open. I take out a First Response Early Result, which is apparently the gold standard of early home pregnancy tests. While I'm waiting for the results, I compare the 6dp test to the 5dp test and the 4dp test. When you line them all up next to each other, you can see that there were very very faint lines after all. If I had seen them earlier, I would have chalked it up to wishful thinking or an evaporation error. I look back at the FRER. There are two lines on it. It's real. This is happening. I walk back into the bedroom and stare at my surroundings for a moment, bewildered, and then burst into tears. I think of Emma Thompson at the end of Sense and Sensibility when Hugh Grant tells her that he's not married and finally professes his love. I am not the only one crying. The cat is now standing on the bed meowing at me at the top of his little lungs that I am late in serving him breakfast. I can hear the dog down in the kitchen starting to whine that she needs to be let out. There is no choice but to start the day - pregnant. I am doing all of these things while I am pregnant.
When Harry comes home, I am incredibly impressed with my acting abilities. I'm in the kitchen doing food prep for the Superbowl later that night and I make some remarkably normal small talk. I say that I need his help changing the sheets on the bed and he follows me upstairs. We're standing next to the bathroom when my act starts to falter. I say weirdly "Oh, and there's something else I wanted to tell you" and I push the door open. I've lined all the tests up on the edge of the sink, including a digital with an unmistakable "Pregnant" result. He walks in, takes one look at them, and throws his arms around me. We're happy. We're freaked out. We're cautious because the lines are so faint. We're debating when to have a baby shower. We're wondering whether we should buy a house. We're speculating about whether it's a boy or a girl.
For your viewing pleasure, here's the picture of the FRER at 6dp5dt:
And here is the progression of Wondfo tests from 4dp5dt to this morning:
And while everything looks promising so far, I want to say that I have been convincing myself about once every hour since Sunday morning that this is a chemical pregnancy. Or that I am destined for an early miscarriage. Or a stillbirth. I'm so freaked out about all the things that can go wrong. I feel like I have never read a blog written by a woman who went through one IVF cycle and actually had a healthy pregnancy at the end of it. And those Wondfo tests are particularly worrisome: um, they are nowhere near as dark as I would like. If the amount of HCG in my body is doubling every day, then why aren't the lines twice as dark? I'm out of FRERs and I've debated buying more just to put my mind at ease, but that seems silly since my clinic is going to give me a much more accurate result after my second blood test tomorrow morning. And they're going to keep testing me to make sure my HCG keeps increasing, and then do ultrasounds to make sure that the pregnancy is progressing normally, and the reality is that this is a level of uncertainty I am just going to have to live with until the day I hold my baby in my arms. Then a whole new level of worrying will begin!
The only thing that helps is repeating a mantra that I've seen recommended for women who are pregnant again after a loss: "Today, I am pregnant." And it helps - today, I am pregnant. Today, I am grateful. There is nothing I can do except cultivate patience and calm for the tiny person growing in my belly. In a way, I think that everyone who gets pregnant after struggling with infertility has already struggled with a loss - the loss of our innocence. I feel joy about this pregnancy, but I know it can be taken away in an instant, so my joy is nearly equal to my terror. I also feel honored to have received so many positive comments on yesterday's post - thank you, thank you, thank you all. I hope to have more good news to report soon.
Monday - Embryo transfer in the morning, lay like a slug on the couch the rest of the day staring at the picture of my blastocyst. Cramps start around 3 PM.
Tuesday - Cramps continue and intensify.
Wednesday - Cramps continue and start to taper off in the afternoon/evening.
Thursday - Cramps are gone. Totally convinced that nothing was happening, besides the increasingly worrisome pain in my right leg.
Friday - Told I had a DVT in my calf and all hell breaks loose. Upon arriving home at 7 PM, decide to take a HPT even though it's only 4dp5dt since the result might have a huge effect on my treatment for the clot. It's negative, as expected. I sigh and toss it in the trash.
Saturday - Come down with a raging cold. Now I'm sneezing and coughing and my leg hurts and I'm lying around watching reality TV generally feeling sorry for myself. Near the end of the day I'm fooling around on my iPad and decide to Google side effects of Crinone, the progesterone gel I'm using instead of progesterone in oil. Sure enough, breast tenderness and enlargement are listed, which explains why the girls are starting to ache a bit. But then I look at a few message boards where women have discussed their experience with Crinone and most of them mentioned that their breasts started to hurt within a day or so of beginning Crinone, whereas mine only began aching a week and a half later. Huh. Before I go to bed, I take another HPT. It's also negative. This time I leave it on the edge of the sink and go to sleep.
Sunday - Harry was gone overnight, which was a good thing because I woke up early due to all the sneezing. This time I have some pretty concentrated urine to use for a test, so I take another one. It's negative again, so I flop back onto the bed and start Googling "6dp5dt BFN" to see whether it's possible that I might still be pregnant despite the negative result. But the cat is crying for his breakfast and the dog needs to go out for her walk so I drag my congested self out of bed to put in my contacts and start the day. I look back at the test and I see - no. No, wait, it's impossible. There's something there. It's a line. It's a faint line, but it's there. Wait, really? I have other tests under the sink. My hands are shaking so badly I can hardly get the box open. I take out a First Response Early Result, which is apparently the gold standard of early home pregnancy tests. While I'm waiting for the results, I compare the 6dp test to the 5dp test and the 4dp test. When you line them all up next to each other, you can see that there were very very faint lines after all. If I had seen them earlier, I would have chalked it up to wishful thinking or an evaporation error. I look back at the FRER. There are two lines on it. It's real. This is happening. I walk back into the bedroom and stare at my surroundings for a moment, bewildered, and then burst into tears. I think of Emma Thompson at the end of Sense and Sensibility when Hugh Grant tells her that he's not married and finally professes his love. I am not the only one crying. The cat is now standing on the bed meowing at me at the top of his little lungs that I am late in serving him breakfast. I can hear the dog down in the kitchen starting to whine that she needs to be let out. There is no choice but to start the day - pregnant. I am doing all of these things while I am pregnant.
When Harry comes home, I am incredibly impressed with my acting abilities. I'm in the kitchen doing food prep for the Superbowl later that night and I make some remarkably normal small talk. I say that I need his help changing the sheets on the bed and he follows me upstairs. We're standing next to the bathroom when my act starts to falter. I say weirdly "Oh, and there's something else I wanted to tell you" and I push the door open. I've lined all the tests up on the edge of the sink, including a digital with an unmistakable "Pregnant" result. He walks in, takes one look at them, and throws his arms around me. We're happy. We're freaked out. We're cautious because the lines are so faint. We're debating when to have a baby shower. We're wondering whether we should buy a house. We're speculating about whether it's a boy or a girl.
For your viewing pleasure, here's the picture of the FRER at 6dp5dt:
And here is the progression of Wondfo tests from 4dp5dt to this morning:
And while everything looks promising so far, I want to say that I have been convincing myself about once every hour since Sunday morning that this is a chemical pregnancy. Or that I am destined for an early miscarriage. Or a stillbirth. I'm so freaked out about all the things that can go wrong. I feel like I have never read a blog written by a woman who went through one IVF cycle and actually had a healthy pregnancy at the end of it. And those Wondfo tests are particularly worrisome: um, they are nowhere near as dark as I would like. If the amount of HCG in my body is doubling every day, then why aren't the lines twice as dark? I'm out of FRERs and I've debated buying more just to put my mind at ease, but that seems silly since my clinic is going to give me a much more accurate result after my second blood test tomorrow morning. And they're going to keep testing me to make sure my HCG keeps increasing, and then do ultrasounds to make sure that the pregnancy is progressing normally, and the reality is that this is a level of uncertainty I am just going to have to live with until the day I hold my baby in my arms. Then a whole new level of worrying will begin!
The only thing that helps is repeating a mantra that I've seen recommended for women who are pregnant again after a loss: "Today, I am pregnant." And it helps - today, I am pregnant. Today, I am grateful. There is nothing I can do except cultivate patience and calm for the tiny person growing in my belly. In a way, I think that everyone who gets pregnant after struggling with infertility has already struggled with a loss - the loss of our innocence. I feel joy about this pregnancy, but I know it can be taken away in an instant, so my joy is nearly equal to my terror. I also feel honored to have received so many positive comments on yesterday's post - thank you, thank you, thank you all. I hope to have more good news to report soon.
Tuesday, February 7, 2012
Beta Results: I'm Pregnant
So. Um. I'm pregnant. My beta HCG at 7dp5dt, or 12dpo, was 54. That's two days earlier than they normally would have tested, and even at 14dpo they consider anything above 25 to be positive. So that's happening.
In other astounding medical news, the ultrasound yesterday afternoon could not find the clot in my leg. They were quick to caution me that this result doesn't mean there's no clot, so I need to have additional ultrasounds to make sure it wasn't a false negative. They saved the images from the original scan and everybody agrees there was a clot there as of Friday, and clots take several months to go away, so it may have moved (to where?!?) or it may be a problem with instrumentation. I'll probably have my next leg ultrasound on Monday 2/13 but for now they are not starting me on Lovenox or anything else.
Anyway, I may or may not be growing a clot, but I am definitely growing a baby. Holy... [fill in expletive of choice here].
In other astounding medical news, the ultrasound yesterday afternoon could not find the clot in my leg. They were quick to caution me that this result doesn't mean there's no clot, so I need to have additional ultrasounds to make sure it wasn't a false negative. They saved the images from the original scan and everybody agrees there was a clot there as of Friday, and clots take several months to go away, so it may have moved (to where?!?) or it may be a problem with instrumentation. I'll probably have my next leg ultrasound on Monday 2/13 but for now they are not starting me on Lovenox or anything else.
Anyway, I may or may not be growing a clot, but I am definitely growing a baby. Holy... [fill in expletive of choice here].
Monday, February 6, 2012
How to Get Yourself a Beta HCG Test at 7dp5dt
It's easy! All you need to do is develop a blood clot in your calf that makes everybody freak out. I am leaving work soon for an afternoon of medical fun that includes a repeat ultrasound of my leg, bloodwork, and maybe - if I'm lucky - a phone or in-person meeting with a doctor who specializes in these clots. Thank goodness I brought a good book with me today, everyone is "squeezing me in" which is code for "I hope you like this copy of Better Homes and Gardens because we're going to give you a full hour to read it in our waiting room."
The catch is that my beta results won't be back until tomorrow. C'est la vie. I'm surprisingly unconcerned about it because there's so much other craziness going on. I'm going to send good vibes out into the universe and hope that they come back to me - it would be a nice change for something to go right for once!
The catch is that my beta results won't be back until tomorrow. C'est la vie. I'm surprisingly unconcerned about it because there's so much other craziness going on. I'm going to send good vibes out into the universe and hope that they come back to me - it would be a nice change for something to go right for once!
Saturday, February 4, 2012
Deep Venous Thrombosis
1. That could be a name for a band; and
2. I've got one. In my right calf. Which is just ridiculous.
What happened was this: on Tuesday afternoon, as I was sitting at my desk minding my own business, my right calf muscle began hurting a little bit. It was as though I had sprained it while running, or had a charley horse cramp. Weird, but no big deal. I was walking normally and it didn't hurt that badly and, yeah, so I hadn't done much exercise lately but these things just happen to muscles sometimes, right?
Except that it didn't go away. Sometime on Wednesday I started to think that I had a real problem, and began looking up my new (almost certainly non-pregnancy-related) symptom. Dr. Google said that Deep Venous Thrombosis, or DVT as the cool kids call it, was a possibility. But! I am not on the birth control pill, and haven't been at any point in this cycle. I am not overweight. With the exception of the past few weeks, I am not sedentary. The leg wasn't swollen or red or hot to the touch. And when I massaged it, it really felt like the muscle itself was sore and not any kind of underlying structure. So I just ignored it, and hoped it would get better.
By Friday morning it was clear that this problem was not going to neatly resolve on its own. I woke up to use the bathroom in the middle of the night and when I staggered back to bed my leg felt like it was on fire. I couldn't get back to sleep because of the pain. I decided at 4 AM that even if this was musculoskeletal, I clearly needed medical help to deal with it. When their office opened later that morning, I called my RE and described what was going on. They said I needed to talk to my primary care provider, who said I needed to get an ultrasound, and it took until 4:30 PM for someone to finally take that little wand to my calf in order to see what the heck was going on inside it.
"Okay. So you do have a clot." The ultrasound tech (and let me just pause for a second to say that I had forgotten how nice it is not to have a transvaginal ultrasound) found a DVT in my right peroneal vein, beginning underneath my knee and extending several inches down my leg. Um, what? But it was true. Even I could see that the image on the screen showing nice flowing red and blue blood on the normal section of my leg stopped almost completely when the tech got to the painful part. Cue me totally freaking out and telling her about the IVF, and I've been on all these hormones, and what do we do now, and all she could say was that she had to finish the exam and then I could talk to the doctor. I texted my husband, who of course also freaked out, and my parents, who did the same thing, and then I went back upstairs and tried to freak out very quietly in my doctor's almost empty waiting room (very fortunately, her office is in the same building as the ultrasound place. Otherwise this could have been even more exciting.)
When my doctor finally saw me - and it was now after 5 PM on a Friday evening so she is a rock star - I was surprised to learn that she didn't want to immediately start me on anticoagulants. (I had decided while waiting that the posted signs about no cellphone use did not apply to patients who were sitting in a nearly-empty waiting room watching the receptionist pack up, so I was back to asking Dr. Google what was safe to do for a DVT in a possibly-pregnant woman, and he had recommended Lovenox injections.) My clot is, happily, below the part of my leg that would put me at risk for part of it to break off and travel to my lungs and - ha! ha! ha! - possibly kill me. And starting me on Lovenox now, when we still don't know whether I'm pregnant, could have long-term effects since I might end up staying on it for the entire pregnancy and beyond. If I'm not pregnant, I would probably be on Coumadin rather than Lovenox, but we can't start me on that until we know I'm definitely not knocked up since it would be harmful to a developing fetus. Right now, she's recommending that we do follow-up ultrasounds every few days to make sure the clot doesn't extend up into the lung-killing section of my leg, plus I'll probably get a blood workup to see if I have any thrombophilia factors that might account for this having happened in the first place. In the meantime, I'm elevating it when I can and applying the occasional warm compress. And although I was really surprised that I didn't walk out of there with a prescription for some kind of blood thinner, or even a note of admission to the hospital, it is true that with this particular kind of clot anticoagulant treatment might not be necessary.
That's not to say that it wasn't exciting to receive calls - on a Friday night! at home! - from my regular Ob-Gyn and my RE. Both agreed with my primary care doctor's plan for now and said that it was crappy timing what with the whole no-way-to-know-if-you're-pregnant thing. And now I'm horribly conflicted about whether I think it would be a good thing to be pregnant this cycle. I mean, no amount of wishing or hoping or praying either way is going to change whether the embryo has implanted, and if it has, we'll take each day as it comes and manage the DVT as best we can. If it hasn't, then I want to make sure I am personally healthy before we make another attempt to create a new little person. I want to have a serious discussion with my RE (in his office, just the two of us, time blocked off on his calendar) about why this might have happened and how to prevent it in the future. His initial recommendation was that we do another cycle immediately while the endometriomas are still small enough to manage without more surgery, but my Ob-Gyn said that the only risk factor I really had for this DVT is that my estrogen levels have been high lately thanks to all the ovarian stimulation. I'd want to know how we're going to manage that in future cycles, and what other changes we can make (for instance, I think we can safely say that I will not be on bed rest after transfer in the future. It's not proven scientifically to help, after all.) I do wonder if this has something to do with my propensity to grow endometriomas, and grow them quickly. And of course if this cycle fails I will now wonder if that had something to do with a clotting problem, too.
At one point last night someone said "You know, you've just become a very interesting patient!" Yeah. I'm very flattered, but I could have lived without the medical mystery. I know that things could be so much worse and I'm unspeakably grateful for the medical care I have been given, and will continue to get. But I will say: this is just crazy. Who would have thought?
2. I've got one. In my right calf. Which is just ridiculous.
What happened was this: on Tuesday afternoon, as I was sitting at my desk minding my own business, my right calf muscle began hurting a little bit. It was as though I had sprained it while running, or had a charley horse cramp. Weird, but no big deal. I was walking normally and it didn't hurt that badly and, yeah, so I hadn't done much exercise lately but these things just happen to muscles sometimes, right?
Except that it didn't go away. Sometime on Wednesday I started to think that I had a real problem, and began looking up my new (almost certainly non-pregnancy-related) symptom. Dr. Google said that Deep Venous Thrombosis, or DVT as the cool kids call it, was a possibility. But! I am not on the birth control pill, and haven't been at any point in this cycle. I am not overweight. With the exception of the past few weeks, I am not sedentary. The leg wasn't swollen or red or hot to the touch. And when I massaged it, it really felt like the muscle itself was sore and not any kind of underlying structure. So I just ignored it, and hoped it would get better.
By Friday morning it was clear that this problem was not going to neatly resolve on its own. I woke up to use the bathroom in the middle of the night and when I staggered back to bed my leg felt like it was on fire. I couldn't get back to sleep because of the pain. I decided at 4 AM that even if this was musculoskeletal, I clearly needed medical help to deal with it. When their office opened later that morning, I called my RE and described what was going on. They said I needed to talk to my primary care provider, who said I needed to get an ultrasound, and it took until 4:30 PM for someone to finally take that little wand to my calf in order to see what the heck was going on inside it.
"Okay. So you do have a clot." The ultrasound tech (and let me just pause for a second to say that I had forgotten how nice it is not to have a transvaginal ultrasound) found a DVT in my right peroneal vein, beginning underneath my knee and extending several inches down my leg. Um, what? But it was true. Even I could see that the image on the screen showing nice flowing red and blue blood on the normal section of my leg stopped almost completely when the tech got to the painful part. Cue me totally freaking out and telling her about the IVF, and I've been on all these hormones, and what do we do now, and all she could say was that she had to finish the exam and then I could talk to the doctor. I texted my husband, who of course also freaked out, and my parents, who did the same thing, and then I went back upstairs and tried to freak out very quietly in my doctor's almost empty waiting room (very fortunately, her office is in the same building as the ultrasound place. Otherwise this could have been even more exciting.)
When my doctor finally saw me - and it was now after 5 PM on a Friday evening so she is a rock star - I was surprised to learn that she didn't want to immediately start me on anticoagulants. (I had decided while waiting that the posted signs about no cellphone use did not apply to patients who were sitting in a nearly-empty waiting room watching the receptionist pack up, so I was back to asking Dr. Google what was safe to do for a DVT in a possibly-pregnant woman, and he had recommended Lovenox injections.) My clot is, happily, below the part of my leg that would put me at risk for part of it to break off and travel to my lungs and - ha! ha! ha! - possibly kill me. And starting me on Lovenox now, when we still don't know whether I'm pregnant, could have long-term effects since I might end up staying on it for the entire pregnancy and beyond. If I'm not pregnant, I would probably be on Coumadin rather than Lovenox, but we can't start me on that until we know I'm definitely not knocked up since it would be harmful to a developing fetus. Right now, she's recommending that we do follow-up ultrasounds every few days to make sure the clot doesn't extend up into the lung-killing section of my leg, plus I'll probably get a blood workup to see if I have any thrombophilia factors that might account for this having happened in the first place. In the meantime, I'm elevating it when I can and applying the occasional warm compress. And although I was really surprised that I didn't walk out of there with a prescription for some kind of blood thinner, or even a note of admission to the hospital, it is true that with this particular kind of clot anticoagulant treatment might not be necessary.
That's not to say that it wasn't exciting to receive calls - on a Friday night! at home! - from my regular Ob-Gyn and my RE. Both agreed with my primary care doctor's plan for now and said that it was crappy timing what with the whole no-way-to-know-if-you're-pregnant thing. And now I'm horribly conflicted about whether I think it would be a good thing to be pregnant this cycle. I mean, no amount of wishing or hoping or praying either way is going to change whether the embryo has implanted, and if it has, we'll take each day as it comes and manage the DVT as best we can. If it hasn't, then I want to make sure I am personally healthy before we make another attempt to create a new little person. I want to have a serious discussion with my RE (in his office, just the two of us, time blocked off on his calendar) about why this might have happened and how to prevent it in the future. His initial recommendation was that we do another cycle immediately while the endometriomas are still small enough to manage without more surgery, but my Ob-Gyn said that the only risk factor I really had for this DVT is that my estrogen levels have been high lately thanks to all the ovarian stimulation. I'd want to know how we're going to manage that in future cycles, and what other changes we can make (for instance, I think we can safely say that I will not be on bed rest after transfer in the future. It's not proven scientifically to help, after all.) I do wonder if this has something to do with my propensity to grow endometriomas, and grow them quickly. And of course if this cycle fails I will now wonder if that had something to do with a clotting problem, too.
At one point last night someone said "You know, you've just become a very interesting patient!" Yeah. I'm very flattered, but I could have lived without the medical mystery. I know that things could be so much worse and I'm unspeakably grateful for the medical care I have been given, and will continue to get. But I will say: this is just crazy. Who would have thought?
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