Friday, April 27, 2012

FAQs: (in)Frequently Answered Questions



There has been a build-up again of questions, so I thought I would take a post to answer some of the ones that have come in lately. Sorry if this post is boring - since many people have asked the same or similar questions, I thought this might be an efficient way to handle answering them.
  1. I was wondering what your immune issues were/are and how they were treated? What?! You don't have our reproductive nightmares committed to memory? Of course, you don't. You have a life. So long story short, after our fifth consecutive loss, I saw a reproductive immunologist for some of the more controversial/ less mainstream testing that REs don't usually do. He did a ton of blood work and told me I had the following abnormalities:

    positive for antiovarian antibodies, abnormal TH1:TH2 cytokine ratio, high natural killer cell assay, abnormal leukocyte antibodies, DQ Alpha partial match with my husband.

    He recommended IVIG. Because it was so expensive, and I wasn't convinced by the lack of science behind it, I tried intralipids for pregnancy #6 (much cheaper and easier on the body). After I lost that chromosomally normal pregnancy, I tried IVIG for pregnancy #7.

    I'm not totally convinced this is what did the trick, but things are definitely going better than ever now, so I am sticking with it. My fourth IVIG is coming up soon.
  2. What are you going to do with this blog once you have the baby? Um, keep writing it? Honestly, I haven't considered this exactly, because I'm so busy with the trying-to-stay-pregnant and being-pregnant thing. It's actually a good question, because I know some bloggers stop writing or create a new space. I'm imagining I'll keep writing here, although obviously the writing will change. We've always hoped to have 2 or 3 children. Now that it looks like we might actually get to have one (one step at a time - not getting ahead of myself!), we are starting to talk about what we would and wouldn't be willing to go through to have another child. I certainly won't spend another five years and have six more losses to do it, I'll tell you that. But if we decide to try for more, we might adopt, or use a donor egg, assuming the frozens we have can't make a baby (which they likely can't). Point being, even if we reach the miracle outcome of a real live baby, I'll still be super infertile (just damned lucky). So I think this space is still the right place to write.
  3. Does your list of blogs on the sidebar get a lot of traffic? Does it bring a lot of traffic to your blog every day? i have to admit, sometimes i come to your blog just to find new blogs, the blogs that you have stumbled upon somehow. i wonder how much traffic they get coming from your blogs every day?! Some of those on my blogroll may have to step up here and comment, because I don't know how much traffic their sites get from me. To be honest, I don't really put a lot of emphasis on traffic. I write because it helps keep me sane, and because I've grown fond - very fond - of this community and the people in it. I'm lucky to have a strong readership who've stuck with me during some really tough times. I'm super grateful for that. Occasionally, someone who I've newly put on my blogroll will email me because they've seen readers coming to them from my blog, so I know some folks definitely click over. But honestly, I put blogs on my blog roll that touch me in some way, or that I can relate to. So mostly it's something I do for myself, so I can follow those blogs. But it would be a nice bonus if they got some new readers that way.
  4. I see you're using the term "gender" of the baby. Do you make a distinction between sex and gender? Just curious since you and Will both are in the medical field and you're in psychology. Ooh. Good question. There of course is a distinction, but no, when I wrote gender on my blog, I was commingling it with "sex" - as in, will the baby genetically be male or female. So to be more correct, I should have said "sex" of the baby. Good catch!
  5. How much does it cost to freeze your eggs? I don't really know, as I haven't done this (despite doing or thinking about doing so many other things!) I'm thinking it's about $10,000-$12,000 per attempt. And if you were trying to preserve your fertility you might want to freeze two or three cycles worth, because an egg is not an embryo. And an embryo does not necessarily a baby make. Believe me. If eggs = babies, I'd have 110 babies (move over, Octomom! But well, we may get one baby out of it all - which is unusually terrible luck, I grant you, but still, you get the idea). My recommendation? Call a reproductive endocrinologist's office and ask about egg retrieval/freezing costs. Much better than relying on my best guess. One other thing is that when I talked to Dr. Schl. about this in regards to my sister potentially needing it, he said he would only recommend two centers in the U.S. for egg freezing. His own (no surprise), and a well-known clinic in Atlanta. You'd want to do some research on the best places to be sure whatever clinic you pick has a top-notch lab and vitrification capabilities.
That's plenty of questions for today. Feel free to leave any other questions in the comments section. I promise to answer them sometime-ish soon. And yes, I know, absolute Yay!! that I'm not having any calamities and therefore can do things like post with answers to questions.

Mo

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Thursday, April 26, 2012

A very special OB appointment (13w4d)


I went in for my weekly live baby check yesterday. I knew that a very dear friend of mine was likely to overlap at the OB's office with me. We've known each other since 2005. She is also a psychologist in academic medicine and works at a nearby institution. She is due at the end of May with her first, after IVF. She and I have the same doctor, and she is one of a very few friends who knows we are pregnant.

She and I sat together in the waiting room. And she hugged me and then she just started crying. She said this was the best appointment ever. That she was so thrilled I had gotten pregnant, and so far have stayed pregnant, after everything and after all this time. That it is her strongest wish come true for us to both be pregnant. And here we were. At the same time in the same doctor's office even. When the doctor saw me, she called me back right away, but my friend's appointment was first. My friend said - "Come with!" And we ended up having a joint appointment.

It was amazing to see her enormous belly and watch her ultrasound, see her (huge to me!) baby moving around, us only able to see one baby body part at a time because of the size. She had a cervical check and got advice on what to call the doctor's office about immediately should it occur.

Then I had my ultrasound. This was the first one Will couldn't attend, because he had a meeting that conflicted. And what a gift that my friend was there, holding my hand, oohing and aahing over my little itty bitty baby, who was kicking all over the place and had lots of amniotic fluid, heart beating strongly as ever. (My friend said she thought it looked like a girl. Because she thought it was moving gracefully. Of course, I think, maybe it's a graceful boy!...)




My friend kept saying to the doctor - "Isn't this amazing? Look at her baby! She's been through so much to get here. No one deserves this more than her! Have you ever heard of a story this bad? And now she's pregnant! She's in the second trimester! " The doctor of course (just like you guys) has indeed heard of stories this bad (and even worse). But my friend's generosity - her enormous excitement and enthusiasm on our behalf - well, it was heartwarming.

I think it was good for the doctor to see me with my friend, to see me in a more normal interpersonal context. To see me be relaxed, and warm, and happy. Because usually when she sees me, I'm a bit of a nervous wreck, and I have a ton of anxious questions, and I probably seem very, very serious. (My sense of humor, too, is very dry...and kind of dark...so is kind of hard to read until you get to know me well.) So I think the OB was taking all this in - this new sense of Mo - a Mo who is smiling and hugging and...funny. So that's good. Wouldn't want her to think I'm a dark cloud all the time, because I'm not. I'm just frequently terrified.

My friend and I made appointments for the next two weeks at basically the same time ('cause she's weekly at this point...and I'm neurotic and so being seen weekly)...so unless our spouses are uncomfortable with this setup, it looks like we'll be doing group appointments - or at least waiting room rendezvous - for the next little bit.

Makes me smile just to think about it.

Mo

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Wednesday, April 25, 2012

Tuesday, April 24, 2012

Doppler reassurance


I think the doppler is saving my life.

At first, the doppler was a device I feared, because picking up the heart beat was so tricky and iffy. I didin't try it much, because I knew I would panic if I couldn't find the heart beat.

I'm still a little scared of it, but I can find the heart beat now usually within a second or two and easily distinguish it from my own even if the number isn't appearing on the monitor.

It is so reassuring. It is wonderful.

In a funny way, I am more scared now. Because I feel like we have a whole lot more to lose. The thing is that now that we are this far, at 13 weeks 3 days, I feel like we've got the real deal going on. There's an actual (but very small) baby in there. According to one of my pregnancy e-newsletters, the baby has fingerprints now! It is starting to grow hair! The first trimester this time I didn't feel like it was a real baby so much. I felt like we had a pretty neat blob in there and we'd see if it would keep progressing or if it would just stop, as it has the six previous pregnancies.

So things feel very real now. And at the same time, it's too early to really look too pregnant (I just look fat) or to feel the baby move. My symptoms are also subsiding a bit. I'm still tired but it's not so bone crushing as it was a few weeks ago. My appetite is still off, but my sense of smell  has calmed some, no longer making it so hard to walk down the Manhattan streets. And sometimes because of all this, my mind gets the better of me.

I have scary thoughts like, "You're not so sick (or tired) because it's over." Or "You don't feel so pregnant because you're not."

Hence the miracle of the doppler that one of you generously sent.

If the fears become too great, I can just do a quick check that night - usually lasting only for 10 seconds or so. And so far...voila! Instant reassurance.



Instant heart beat.

Instant bonding.

It's pretty amazing, really.

I thought I would only use the doppler once a week or so, but it's come in handy to have it every other day(ish) recently. It's been an incredible sanity saver.

Mo

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Monday, April 23, 2012

I'm in trimester WHAT?



Today marks 13 weeks, 2 days.

I can't believe we've gotten this far after so many false starts over the past five years. It is so strange to have pregnancy things magically seem to be working. Knock wood, not taking anything for granted, one moment at a time. Hard not to wonder what is different now? So many fresh IVFs, and transfers, and three natural pregnancies on top of three IVF pregnancies. But all that didn't work. And now? Now it seems like this baby is practically growing itself (knock wood, not taking anything for granted, one moment at a time).

Will's mom says that the difference this time is that when Will's father passed away this summer, he began overseeing our trying to conceive journey and has helped this last transfer actually (finally) be the one to work.

Sounds as likely as anything.

Whatever it is, it feels so miraculous. So hard to fathom.

I'm thrilled right now, even if I am a bit confused about where I am trimester-wise in pregnancy land. I think I'm maybe in the second trimester? According to some sources, apparently. Other references make it sound like I need to get to the end of 14 weeks first.

How do you count the trimesters? Is one method more popular and accepted than the others? I'd be most curious.

But count the days and weeks however you want. We are decidedly, amazingly (knock me over with a feather) pregnant. Pregnant enough that I have purchased one pair of maternity pants and some drapey shirts (hoping to hide this another month or so from the prying masses at work). Not so pregnant as to really be showing, but pregnant enough to feel like I'm looking rather fat. Pregnant enough to be off all hormone support now for over a week (and yes, we snuck in an extra blood draw at the end of last week and estrogen and progesterone looked just fine...rising some even off of the meds).

It is absolutely crazy to behold,

but I am pregnant.

At least for today.

And I still can't believe it.

Mo

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Friday, April 20, 2012

Telling (parts 2 and 3)



On Easter Sunday, we told Will's sister that we are pregnant (a little over 11 weeks pregnant). She was hosting the whole family, but we went over briefly several hours early to be able to break the news before her preparations were in full gear. She was very happy for us - and gave Will a huge hug, which was nice. When Will went outside to play with our dog Moxie and her sons, she said she knew I must be very nervous, but that I would start to feel better as time passed, in particular once we got to 23 weeks. I nodded, but inside, I was thinking - 23 weeks! I won't feel better at 23 weeks! It would be very dangerous - maybe fatal - if the baby came then!! I'll feel better maybe around 28 weeks, when if the baby comes it stands a high chance of being ok!! But this didn't seem constructive, or even really her point. So I kept it to myself. She also started comparing me to other women who in her mind have struggled. I'm not sure why she did this. We weren't even talking about the pain or difficulty of anything. This was a happy news moment. And then unfortunately her examples of women who struggled didn't go over so well with me. One example was one of Will's cousins. Poor woman has four kids but hasn't been able to conceive another despite her desire to do so. I do feel bad for her...some...but it's not really the same thing. Her other example was someone else who conceived her first child accidentally, but now had had a miscarriage and had already spent six months trying to conceive her second. I felt myself wanting to say something. Wanting to say how these women aren't like me at all - how it's different when you have spent five years doing many IVFs, have six miscarriages under your belt, and zero children, and are at the stage you are thinking you aren't ever going to have any. But what would have been the point of that? She was trying to...trying to...well, I'm not sure, really. But saying something wouldn't have helped. I know she only meant good things.

We also told my mom on Easter morning. I had sent her a framed picture of one of my ultrasounds. I knew from package tracking that it had arrived on Saturday AM. I'd wrapped the frame and put a note on it that said to call me before opening... but no call came... so come Easter morning, I called her. We chatted for a bit and then I asked her about the package. Package? She didn't know what I was talking about. Hmmm...she said, maybe she should check the front porch. And lo and behold, it was there. She opened it, and then started making strange noises. She wasn't able to speak really. Finally she said my name, and Oh! several times. She said this was such a surprise. She said she'd been hoping for us and wondering, but didn't want to pressure us by asking anything. She started to ask me if we'd gone to Denver for this...and then halfway through stopped herself, saying aloud, "It doesn't matter how you did this. This is just wonderful!" Good answer, Mom! She was just over the moon. It was wonderful to get to hear her excitement and enthusiasm. She is still that excited now...many days later. It makes me happy to hear her elation about this.

Mo

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Thursday, April 19, 2012

12 weeks 5 days ultrasound


Everything is still looking good!

The baby was kicking up a storm and waving its arms around. you could see it opening and closing its hands. it was quite something.

The OB didn't measure the heart rate or size this time - just showed me the baby moving around like crazy and answered my questions. She feels all is going well.

We asked about incompetent cervix. She said that she is not concerned by my history (four D&Cs after miscarriages and a cryosurgery in the 1990s) - that usually the women who have losses due to IC just have it happen out of the blue. "So I won't be considered high risk unless and until I lose this baby?" I asked. And she said, technically, yes. But that she would treat me as though I am high risk for incompetent cervix because she knows I am nervous about it. She said they would start monitoring me for it soon.

She also said that the cramping I'm experiencing is normal: the uterus is expanding. And that if I think I'm feeling cervical pain, I'm not, because the cervix doesn't have pain receptors. I didn't ask about rechecking my progesterone levels with her. I'll go back to my RE and have them draw it or have Will write me a prescription for the blood work tomorrow.

She asked what else I worry about with the pregnancy, and I told her my other concerns were potential cardiac issues (because they are relatively common), P-PROM, and pre-eclampsia (god, she must think I'm nuts). She said cardiac problems are not so common and that they will check everything thoroughly if we can get to 20 weeks (ok, she actually said "when we get to 20 weeks" but I can't bring myself to type it). She said  that in her experience, P-PROM is usually associated with second trimester bleeding, and is unusual and can't be prevented (so no use worrying). And she said that pre-eclampsia, while more common in older women and first-time pregnancies (me! me!), is something they'll be watching me for like a hawk. And she said there is some evidence that the lovenox I'm on may offer some protection against it. (Cool!)

I told her the reproductive immunologist is planning to take me off of the lovenox at 20 weeks, and she said that she will continue me on it (!) until 36 weeks and then switch me to sub-q heparin. I found this funny. I'm sure she would never have put me on it herself because I don't have clear indications I need it, but now that I'm on it, she doesn't want me off of it. That's fine with me.

She also told me that cooked sushi is fine to eat (I'd been wondering if it was safe or if it was a listeria risk). So things like California rolls and shrimp avocado rolls are back on the menu (with gluten-free soy sauce). Yay! I love those things. She said regular sushi should actually be fine too, because in NYC everything is flash frozen before serving, which kills any parasites. But she said I shouldn't eat it anyway, just out of an abundance of caution, given my history (bummer).

The OB shared at the end of the appointment that she was starting her day with me (six miscarriages, now pregnant at end of first trimester) and ending her day with a woman now 38 weeks pregnant after seven miscarriages. That she thought this was a great way to have a clinic day. That good things do happen sometimes. And that she looks forward to me being 38 weeks too.

Here's a picture of the yumster (that's what the OB calls him/her). Pic isn't very good quality, and the amniotic fluid looks really low in this shot, but believe me, this little one was doing the bicycle in there, waving its arms around like a maniac, and generally having a grand time.





Mo

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Wednesday, April 18, 2012

Weaning, nervously, continued



I never heard back from my Denver nurse this weekend, which is unusual.

So I followed the "fill in" nurse's advice. I cut the meds to nothing (akkkk!) and went in yesterday for blood work.

My regular Denver nurse left me a message last night. She's been out with the flu, apparently.

Estrogen is still rising nicely at 1,343.

Progesterone seems to be holding steady at 21.76.

So I should be thrilled, right?

Problem is, I am nervous because I am very crampy. Crampy in a way I haven't been since the very first days of pregnancy. I feel uterine cramping and what feels like cervical pain. It's not all the time, but started yesterday and went on overnight, even when I was trying to sleep. I woke up with it.

So I am scared.

I'm telling myself that the blood work looks good. That all should be fine. And then a creeping worry sets in that because progesterone is a pulsatile hormone, that the 21.75 is maybe when it is at its peak, and the rest of the time it is much lower, hence the cramping. On the other hand, I'm trying to tell myself that the baby is growing rapidly now and I may be feeling uncomfortable from my uterus expanding, nothing to do with the progesterone at all.

I put in one endometrin suppository last night, as insurance, but it didn't stop the cramping.

I tried the doppler this morning and found a heartbeat right away in the 130s. Hoping that's the baby and that that's fast enough. I measured mine too and it was 80-something (a little anxious, Mo?).

I will try to stay super-hydrated today to make sure that's not contributing.

Tomorrow I see my OB for a little reassurance check. I'll let her know about all this. Maybe she'll even do a cervix check (we haven't ever done one).

I'm also hoping to sneak in some more blood work at the end of the week. Just to see that the progesterone level still looks solid.

I'll keep you posted.

Mo

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Monday, April 16, 2012

Oranges are not the only fruit


A few weeks ago, I noticed that I was having trouble drinking the amount of water that is recommended in pregnancy. That the water, along with most everything else, was making me nauseated. So one day, I tried orange juice instead of water.

I was instantly hooked. It was wonderful! I wanted it! More! More! More!

But really, a 40-year-old Mo can only drink so much orange juice before she starts to pack on the pounds, so I knew I had to get ahold of myself. I could only convince myself this was "healthy" to a point. In reality, it was healthy, but with a lot of calories, a ton of sugar.

So I tried to make it a bit healthier. No more juice. I switched to the oranges themselves. Which are incredibly cheap and delicious this year, and I figure are a better choice than orange juice because of their fiber and other nutrients, etc. (I imagine all the nutrients going straight across the placenta to create healthy baby connective tissue and to help baby grow!) Lately, I've been having at least a couple of small oranges daily.

So it's hopefully healthy(ish) and definitely tasty!! But odd. I'm not used to such a strong urge for fruit...or well...really for anything. I've been trying to expand my palette some (this weekend had a whole container of fresh pineapple). After all, in line with my nod to a very talented novelist with this post title, oranges are really not the only fruit. And more variety must be better, yes?

I am trying, but really it's only oranges that I want.

I could eat like five of them in a sitting, I think. I am dreaming of them at night. But I am limiting myself.

I will be curious to see if this sustains for the long-term, or if this orange frenzy will pass, transitioning to something else (a craving for spinach perchance? That would be healthy!). All in all, I am slightly in wonder of this strange body I'm inhabiting. That things I like don't taste good and other things are suddenly must-haves.

Pregnancy. It's a funny thing. Still kind of can't believe it's happening to me. Who ever would have thought? I mean, really, hadn't you almost given up hope on us too?

Thanks also for your thoughts on the weaning process...still waiting to hear from the Denver nurse. Will let you know what she says when/if I hear from her...

Mo

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