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!

Next Steps and Continued Hormonal Funtimes

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!

I Guess the 37th Week is the Cupcake Week

Oh, memories. This week I started the official paperwork for my maternity leave. I get no cell service at my desk, so I had to step out of the building for a few minutes to call our HR system to kick off the process, and as I sat down on the bench in the patio I realized that it was almost a year to the day to when this whole mess started. Last October, I was calling HR to work out how many consecutive days off I could take after my surgery to remove the endometriomas on my ovaries, and I had forgotten that when you call the first thing you hear is the automated message: "If you are calling regarding a pregnancy claim, press 1. For all other claims, press 2." It was tough to hear that last year, knowing that I might never get pregnant. This year, even with my unborn child doing his best to tap out messages in Morse code from inside my uterus, it was still bittersweet.

What else is new? Well, my hips have started hurting in a way that simply cannot be ignored (and, like Shakira, my hips don't lie.) It's probably that the ligaments are starting to relax in preparation for, gulp, delivery. I've also switched over from once-daily Lovenox injections to twice-daily injections of unfractionated Heparin. They are incredibly uneventful, especially since I've had so many months to refine my technique (don't pinch the skin too hard as you inject!) and the bruises have been kept to a minimum. It is kind of daunting to inject, look at the clock, and think "well, if I go into labor right now, how many hours before I can get an epidural?" Oh! And last week's ultrasound confirmed that the little one is indeed vertex, or head-down, so there's nothing to worry about there. No transverse presentation here.

Also, this happened:

:-)

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!

MFM Appointment: Legitimately Good News

Despite a super-long wait, my Maternal-Fetal Medicine appointment yielded a host of good news. There continues to be no new bleeding, I'm not contracting, the baby is very active, etc. Here were the main talking points:

- The baby's fine, looking ever-so-slightly larger than average in most measurements, which is good because if he does have to come early we want him to be as big as possible.

- My cervix is still long and closed. They were baffled that I was worried about a measurement of 35mm and said that there was absolutely no reason to be concerned.

- There are still no placental abruptions or sub-chorionic hemorrhages. Thank goodness!

- They did a fetal echocardiogram just for funsies and it was very normal and very boring.

- Are you sitting down? :::pause::: How about now? Okay, so get this: on their very detailed ultrasound machine, looking transvaginally for the most accurate view possible, my placenta is 1 cm away from my cervix. That means it's not a previa anymore.

Whoohoo! Break out the sparkling cider, everybody! Except that means we don't have a good reason for the bleed anymore. I was really leaning toward my OB's guess that it was just the usual previa complication and staying as quiet as possible would help avoid it happening again, but now we're back to square one in terms of unraveling the mystery. My MFM doctor said that he would bet it was somehow related to the original hemorrhage, but also said that there are a million reasons that women bleed in pregnancy and the important thing is that we don't see anything worrisome on the scan right now. This doesn't mean I can start doing back handsprings in celebration (ha! Back handsprings, that's a good one. I think the last time I did a cartwheel was in 1996, and I didn't exactly stick the landing) but it's all good news. It also means that I'm back on the lowest dose possible of Lovenox effective tomorrow morning, yippee.

One more thing. You know how I had unexpectedly lost five pounds as of Monday? On MFM's scale, I had actually only lost two. The nurse said that it was probably just normal variation and I should keep doing what I'm doing. In other words, perhaps I shouldn't have made this Mocha Icebox Cake yesterday? Oh well. I make no apologies. It's delicious!

OB Appointment: Still Hanging On

Yesterday's OB appointment went about as well as expected. Overall, I'm not experiencing any new bleeding, my cervix remains long and closed, I am not contracting, and the baby (yes, everyone needs to say this as soon as they start the ultrasound) is "very active." My OB's best guess about what happened is that it was related to the placenta previa - after all, painless bright red bleeding is the classic presentation and in the pre-ultrasound days it was evidently how they found out about previas. She thinks that the placenta probably bled a few days ago internally, it formed a clot, and then the clot made its dramatic escape on Friday night. She also said that stopping the Lovenox was the best thing I could have done right now.

So it was a good report, overall. However, there were still some things that were ever-so-slightly worrisome:

- Finally, someone did a transvaginal ultrasound to measure my cervical length. They could see it pretty well transabdominally, but I knew it wasn't an accurate measurement, and even though I have no risk factors for Incompetent Cervix, of course I'm worried about it. The good news is that the transvaginal ultrasound confirmed that my cervix is "long and closed." The bad news, according to this chart, is that my 35mm long cervix is still below the 10th percentile for singleton pregnancies at 21 weeks. I know, I know, it could be so much worse. And it seems like most OBs consider anything above 25mm to be fine. But now I've got that on my mind, too.

- The transvaginal ultrasound, even though it was as gentle and noninvasive as possible, dislodged enough of the bleed that it started up again. (That's why you apparently never want to touch a cervix with placenta previa - even a small amount of activity can disrupt the fragile blood vessels right above it.) It was pinkish-brown and I actually showed some of it to a nurse on a tissue after they told me to clean myself off and she said it was nothing to worry about. Still, for the rest of the day, every time I went to the bathroom, there it was. The mental torture of seeing more blood was the worst part of yesterday, because I just kept waiting for it to turn into a full-on hemorrhage... even though it didn't.

- Finally, here's one for you to puzzle over. Yesterday the intake nurse who did my blood pressure and my weight (and obviously hadn't looked at my chart) said "Oh, looks like you've lost five pounds since your last visit, congratulations!" To which I replied, "Um, I'm actually pregnant... aren't I supposed to be gaining weight?" Awkward pause. I then had two separate nurses as well as my doctor ask me, all polite concern, "Are you eating?" And my response was yes! Yes, I am eating! I had a burger for dinner last night! I haven't had any morning sickness in weeks! I'm lying around on the couch all the time doing as little exercise as possible! My bottom should be the size of Brazil! How entirely bizarre. I mean, at any other time in my life, my reaction would have been - unexpected weight loss, score! But now I'm just baffled more than anything. Why on earth would I be losing weight? My doctor didn't seem terribly worried and said that it was more important to just watch the trend, and Dr. Google doesn't seem to have many resources on this particular problem. I mean, I want to gain weight in the healthiest way possible, so noshing on a tube of chocolate chip cookie dough seems like rather an immature response, but I will admit it's tempting. How often am I going to have this opportunity, really?

That's all for now - hopefully today will be quiet, and then tomorrow it's off to see the Maternal-Fetal Medicine doctor. There's no Yellow Brick Road leading the way there, but fingers crossed for at least one wizard who can make all of this better.

Another Bleed, Another Midnight Trip to the Hospital

Headline: I am okay and the baby is okay. For now.

So there I was, minding my own business, lying in bed wasting time on the Internet when I should have been making progress on my book club assignment, the cat curled up next to me, and it occurred to me that before I nodded off to sleep I should use the bathroom. I'd had a huge glass of water earlier, and who likes to wake up an hour after they fall asleep to go pee? I went, and I looked at the toilet paper, and... no. NO!!! Red blood. A goodly amount of it. And, a moment later, a clot about 1/2" across.

I walked back into the bedroom and was about to look up my OB's number when I realized I knew it by heart. The answering service took down my name and information and put me in touch with a very nice doctor in their practice who I'd never met before. I was oddly, supernaturally calm as I explained what was going on and gave her the ten-second history of this pregnancy: G1P0, 21w1d, tubes blocked from endometriosis, subsequent IVF, DVT at 5 weeks, SCH at 9 weeks, complete placenta previa, red blood and a clot, blood seems to be slowing down, should I go to the Emergency Room? No, she said. You should go to Labor and Delivery.

I'll pause for a second to let you take that in. Labor and Delivery. At 21 weeks. As I drove to the hospital, hating every song the radio station played because I knew I'd forever associate it with this moment, I got ready to hear: There's nothing we can do for you. We've made a certificate with the baby's footprints for you to take home. Would you like to speak with the Chaplain?

Harry met me at Labor & Delivery and, mercifully, led me right back to the triage unit where they were expecting me. They led me to a little room with a whole bunch of monitoring equipment that I could just tell was meant for a much larger bump than the one I sported. A nurse came in with a Doppler and tried to find the baby's heartbeat - over and over, putting it on different spots on my belly, and distinctly not hearing the familiar thumpthumpthump that my OB has always been able to find on the first try. Harry and I were quiet, me thinking silently "But I can feel the baby moving, he can't be dead! Oh G-d, maybe this is what early labor feels like! Or maybe I've been wrong the whole time and that's not fetal movement at all!" Finally I said out loud, "Is there any way we can check with the ultrasound? The suspense is killing me." She agreed and brought in the ultrasound, which was turned off so we all sat there as the machine booted up. Seriously, I guess it runs off Windows because it was going through all the screens and hourglasses and everything, and I have never hated a computer more than I did at that moment.

The ultrasound showed within seconds that the baby was fine. His heartbeat sounded strong and regular, he was just curled up against the top of my uterus. Oh, now he's moving around and his heartbeat can be heard over here. Wait, now he's over here, try this spot. By this time two separate doctors had seen him on the ultrasound and they both remarked that he was a very active baby! Sigh of relief #1. They also saw, wonder of wonders and miracle of miracles, that there was no placental abruption and my cervix was long and closed. I wasn't contracting (I hadn't felt any pain the entire time, which obviously was a good thing) and the bleeding appeared to have stopped. Sigh of relief #2.

The final doctor who examined me was the OB I had called earlier that night from my practice. She did a speculum exam (don't want to irritate that cervix further by rooting around in there!) and said that everything looked okay although there was still a small amount of blood visible. It could have been any number of things that caused the bleed, ranging from a random event aggravated by the Lovenox to a final clot coming down from the original sub-chorionic hemorrhage to the classic problem of placenta previa: painless bleeding caused by the cervix dilating slightly. Basically, there's no good answer. I didn't bring it on by doing anything (for heaven's sake, I was lying around reading blogs and watching YouTube videos, about as sedentary as it gets) and the only thing they could recommend was that I take it very, very easy over the weekend. I'm off the Lovenox for now so nobody was willing to actually say the words "bedrest," and they emphasized moving around my legs as much as possible without using my abdominal muscles or exerting myself in any way. And, just like that, I got to go home. Total time door-to-door: 2 hours.

I left Labor & Delivery with my baby still alive inside me and an appointment with my OB on Monday. Not a bad outcome given what I was steeling myself to face earlier that night, but who are we kidding, this was not a good thing. Do I need to tell you that bleeding in two different trimesters significantly raises my risk of any number of other complications, including preterm delivery? Do I need to mention the statistics surrounding complete previa when the first bleed appears at 21 weeks? Should I cite the research about infant survival at a gestational age of 24 weeks (my new so-close-yet-so-far-away, crossed-fingers-and-toes goal)? Probably not.

This entire experience has been such a rollercoaster. I didn't know that my infertility blog would turn into a complicated-pregnancy blog, and I'm trying to prepare for the possibility that it'll turn into a pregnancy loss blog in the next few days or weeks. We had about five weeks recently where things were stable and we started seriously thinking about having a baby come fall - planning a shower, signing up for a birth/parenting class, actually buying a onesie. I was beginning to visualize myself with a giant belly, fantasizing about holding our son for the first time, wondering if the previa might clear so I'd have a shot at a vaginal delivery. Now my best-case scenario involves CPAP, an NG tube, surgery for ROP, cerebral palsy. And my worst-case scenario, well, I can't even bring myself to type it. I really, really don't know which way this will go. But I'll let you know as things unfold.

Other News of the Moment

Obviously, we are beyond thrilled that our anatomy scan went so well. Finding out that we have a normal-looking baby, and that he's got some little-boy parts, was wonderful. But... what about all the other crazy things I've been diagnosed with over the past few months? How is that stuff going?

Sub-Chorionic Hemorrhage This is the best news we got: it looks like both SCHs are gone, all gone! The tech hadn't seen me for any of my earlier ultrasounds and didn't even know this had been a problem for me until I told her. Happily, in an hour of moving the wand all over my belly, she saw no evidence of any hemorrhages or placental abruptions. I'd like to give a shout-out to the very first OB I talked to on the night of my big bleed, who said that these things often didn't fully resolve until 18 weeks. At the time that seemed unimaginably far away, but true to form, it did clear up sometime between 15 and 20 weeks!

DVT and Clotting Issues My leg hasn't bothered me since February, even though they insist on checking it at every appointment, and knock on wood I have had nothing to suggest another clot at all. However, when they test my Lovenox levels - which involves making an appointment at the lab exactly 4 hours after I inject myself and then skipping the line of irritated waiting people who didn't know they could make appointments and who then give me the hairy eyeball - they have consistently come up higher than would be optimal. We're adjusting my dose, which right now means that I have to squirt a little Lovenox into the sink and hope that I'm getting something close to 30 mg. I should also mention that the bruises have almost entirely subsided, so injecting myself doesn't make me anywhere near as depressed as it did in the past. We'll keep testing this.

Placenta Previa This could still go either way. The good news is that most of my placenta is now over on the left side of my uterus, which also explains why I haven't been feeling much kicking on that side. If it's now a side placenta, could it keep pulling away from my cervix as my uterus grows, thus resolving the problem? Maybe. Maybe not. Right now it's still covering the cervix entirely, so I'm on the same restrictions for complete placenta previa that I've been on since April. However, I'm considerably more optimistic about it becoming a partial previa or even just a low-lying placenta than I was after April's gloom & doom diagnosis.

Everything else is going pretty much according to plan. My cervix is long and closed, though they didn't bother with an internal ultrasound to measure it precisely; they could see enough transabdominally that they weren't at all worried. With the exception of a few bad moments in May (I think I threw up three times?), my morning sickness has disappeared. I get round ligament pains just about every day, on both sides, but if I sit or lie down for a few minutes they ease up. My belly is growing and I'm keeping up with the cocoa butter in a vain effort to avoid stretch marks - none yet, but I'd be shocked if I avoid them entirely. And our unborn son would like to add to this list: he says, and I quote, "KICK! Kick kick kick! [pause] Kick kick KICK!" I'll leave you to interpret that however you want.

A Serious Question About Lovenox and Bees

I am terrified of bees. Fuzzy little bumblebees, graceful shiny wasps - I totally panic when any one of them flies into my airspace. I do this elaborate bee-evasion dance and seek shelter as quickly and awkwardly as I can. No, I'm not allergic, I just have a few too many traumatic childhood bee stings tucked away in my memory bank. If and when the kid I'm carrying around in my belly emerges into the world, I will have to strike a delicate balance between "Every creature has a purpose in life, this is how flowers are pollinated, we wouldn't have strawberries if we didn't have bees" and "Run for your life!"

Oh sure, it looks all helpful and pretty NOW.

As the seasons change I've been seeing more bees around, which is why it occurred to me the other day as I was injecting my Lovenox (yes, I'm back on it now that the immediate sub-chorionic hemorrhage danger seems to have passed) that I was now basically "stinging" myself voluntarily. Think about it - I jam the needle into my skin, inject a whole bunch of painful liquid, and the injection site hurts afterward for about 20-30 minutes. It's not entirely dissimilar to a bee sting, although it avoids some of the things about bees that make my skin crawl the most: one sting somehow alerting all of the other nearby bees to come sting you too, stepping on an underground nest and being surrounded with no warning, the tracker jacker scene in The Hunger Games... shudder.

This brings me to my question. It has been, what, 15 years since I was last stung by a bee? Longer? So, no, I don't really remember what it was like. It might be way more painful than a syringe full of enoxaparin, or I might be psyching myself out over nothing. Has anyone out there experienced both a bee sting and a Lovenox injection lately? Are they remotely similar experiences? Important stuff, this.

SCH: The Truth Is Out There

No real updates since my last post - the old brown bleeding has slowed down considerably over the past few days, and I have no idea if that's a good sign or a bad sign. But I'm not having strong cramps and heavy red bleeding (knock on wood), so I have to assume that everything is still proceeding as planned.

However. Remember when I said I wasn't going to look up statistics for miscarriage after sub-chorionic hemorrhage? I've kept that promise pretty well, but I did start asking Dr. Google more questions about why these hemorrhages happen in the first place. I understand that none of the doctors and nurses I've spoken with care about the reason because they just want to see what happens next, but now that I have a second hemorrhage, I kind of want to get to the bottom of this. I mean, everything has to have a cause even if we don't know it yet, right? The problem is that there are a ton of possible causes, and they might all be complicating factors, or it might be something I haven't thought of yet. Without further ado, here are the theories I'm considering so far:

- Clotting issues, part 1. I did have that DVT during my two-week wait, and even though my bloodwork came back with no genetic predispositions for blood clotting issues, maybe I do have some as-yet-undiagnosed problem that led to tiny clots in the uterine blood supply that somehow created the bleeds. I should probably go back on the Lovenox ASAP to help resolve the existing bleeds and prevent any others from occurring.

- Clotting issues, part 2. The first bleed (the biggest and scariest) happened while I was on the Lovenox. So maybe I never had a clotting issue in the first place, and being on a blood thinner disrupted the uterine blood supply so it bled and bled and bled in a random weak spot. I should definitely stay off the Lovenox until these hemorrhages have resolved, and talk seriously with my doctors about whether it makes sense to go back on it at all.

- Pregnancy after IVF. There's some talk that SCH might be related to embryo implantation, and of course when you get pregnant using IVF, the embryo is transferred back into your uterus with a catheter rather than traveling down a Fallopian tube and then choosing the exact perfect spot to implant. Perhaps it implanted in a bad spot after transfer, and that caused the bleeding several months later? Doesn't explain the second bleed, however.

- Retroverted uterus. I've been told repeatedly by gynecologists over the years that my uterus is seriously retroverted, or flipped backwards from those textbook pictures you always see. As late as March 28, the ultrasound tech mentioned how far back it was. On March 30 I spotted briefly, and the next morning I was idly rubbing my hand over my belly and realized that I could really feel my uterus in a way I hadn't before. Sure enough, on April 5 I was told that it was no longer retroverted - it "stood up" sometime in the past few days, which tends to happen between the 10th-12th week of pregnancy - and I had a second SCH. It's possible that the action of the expanding uterus switching position put enough stress on the blood vessels that the new, smaller, nearly asymptomatic hemorrhage formed.

- The Cigarette-Smoking Man. It's all a conspiracy, you guys! I mean, our baby does bear a certain resemblance to an alien...

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!

Lovely Lovenox & Comfy Crinone

It occurs to me that advancing in a pregnancy is similar to the wisdom on advancing age that Garrison Keillor once mentioned on NPR: "Getting older is a cinch, you just wait around." And that's what I've been doing, waiting around. I go to work and I come home and I lie on the couch and I fall asleep immediately. I eat something bland every two hours and try very, very hard not to throw up. I review the stages of embryo development on Wikipedia. I obsess about miscarriage, missed miscarriage, birth defects, stillbirth, and what will happen at my ultrasound next week. And I read other IF blogs - more on that in a moment.

But in the meantime, as a sort of public service announcement, I want to write down a short synopsis of my experience with the two newest drugs I've been taking, Crinone and Lovenox. Your mileage may vary, but this is what I wish I could have told past-Charlotte back when she was eyeing these prescriptions suspiciously.

Things to know about Crinone: even though I was promised that it was a unique bio-adhesive gel, it's more like a regular old cosmetic cream. It's white and has the consistency of my facial moisturizer (although I have yet to confuse the two!) It's in a little tampon-esque applicator and it makes a farting sound when you apply it, which continues to crack me up because I am Not Mature. I haven't had any problems with it causing a huge mess, but it is true that it doesn't dissolve 100%, and what is left tends to look like cottage cheese. But since there's not a huge volume going in, there's not a huge volume coming out, either. And the absolute best thing about Crinone (with the exception of the fact that it is hopefully providing the progesterone support that my embryo needs to keep growing) is that it doesn't hurt. Not one little bit. It's a total non-event.

Things to know about Lovenox: this didn't go so smoothly for me at first. Shot #1 with the modified Lindsey protocol (ice for 10 minutes, in fast, push slowly, wait 15 seconds, out fast) was a success, but shots #2 and 3 were a nightmare. Giant, painful bruises that upset me to no end and prohibited me from wearing pants for a few days because they were right where my belt would have been. After some trial and error, I think I've identified the two factors that led to the bruising: one is that the ice, while numbing the initial sting of the needle going into my skin, actually drew more blood to the surface that then bruised spectacularly when exposed to a little Lovenox. Harry pointed this out to me one night when I took the ice pack off and got ready to inject - "You know your skin is all red now, isn't that from more bloodflow going to the cold area?" When I tried it without icing first, sure enough, I got a tiny pea-sized bruise instead of one measuring 3 inches across. The other thing that made the bruising worse appears to have been my pinching technique. As I had with the speedy Lupron and Follistim shots, I was pinching the skin to get the needle in and then holding it in the same position as I injected. The only thing is, when you're injecting a blood thinner over the course of a full minute, that's a long time to be pinching your skin. And that pinch was injuring the blood vessels in my belly just enough that when the Lovenox hit them, they had a field day. I tried not pinching at all as suggested in this video, but that made the needle entering my skin hurt like hell. So my new technique is to forget the ice pack, pinch briefly just long enough to get the needle in, then release, inject the medication very slowly, count to 15 with the needle still in my skin, and take it out quickly. I usually have little to no bleeding from the site afterwards, so I don't put pressure on it or anything, I just fan it a bit and maybe swipe lightly with the alcohol pad if there happens to be a dot of blood. Oh, and make sure you tap the air bubble all the way to the top of the tube before you start the injection, and inject it last rather than first. I read somewhere that it may actually help keep the medication under the top layers of skin where the rainbow bruises would form, and yes, it is safe to inject air subcutaneously. (Not a great idea to inject it into a muscle, vein, or artery, but hopefully that's not where you're aiming your Lovenox anyway.) My tummy is slowly looking less scary and I've even had a few injections go so well that I couldn't identify the exact site 15 minutes later.

Finally, we come to this crappy, crappy week in the world of IF blogging. Most notably, of course, is Mo losing her son at 22 weeks, but there's also Jenny, who had a miscarriage at 9 weeks, and so many BFNs: JM and Lola and Emily and far too many others.  Your words have touched my heart and I have struggled with how to respond - I feel guilty and angry and I wish I could reach out across the screen and give everyone a hug. Since I can't, I will just say that a community is a community in bad times as well as good times, and I'm honored to be a part of it. I hope things get better soon.

Beta #5

Great news - my beta hCG today showed that I'm up to 1510! I couldn't be prouder if it were an SAT score. (Although I understand that with the new SAT scoring system 1510 isn't that great... anyway. Cart before the horse much, Charlotte?) That's a doubling time of 39.47 hours, which makes me very happy. It also makes me think that I was right to feel that close monitoring is a double-edged sword; one result can make me flip out and the most important thing is to watch the trend. Of course, I know things can turn around at any time but at least today was a good day.

I did my first Lovenox shot last night with what I will call the Lindsey protocol: in very quickly, push very slowly, keep the needle in there for a while before taking it out. I also iced the skin before and after and kept pressure on the site afterwards. I have a veeeeeery faint bruise that you'd have to be looking for in order to see, so we're going to count that as a success.

My next blood test will be on Friday, so keep your fingers crossed for good news! Hopefully after that I'll be able to make an appointment for an ultrasound, which is great because then it gives me something new to obsess about.

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!