Limbo

Gosh, it seems like a lot, yet not a lot, has happened since Friday.

My RE called me on Friday afternoon, which was incredibly helpful.  My OB had been kind enough to offer to send my RE a note letting her know what we discovered at my appointment on Thursday and she called me after she got the email. As a sidebar, I had always thought it was nice that both clinics are affiliated with the same hospital and use the same medical record system, but it wasn't until Thursday that it really made a difference to me.

Anyway, I was really touched that she called and we had a good conversation.  We talked about the options and the pros and cons for each, which was good because I really wasn't able to process anything that my OB told me on Thursday.  I was just so unprepared for the appointment to have a negative outcome that not much stuck.... We also talked about next steps and how long I would have to wait until I could start another cycle.  This wasn't something I wanted to talk about, but it was necessary.  She also told me again that I still have a very hopeful situation.  For me it's really more of a matter of tolerance to stay in the game. I was just so happy when we got pregnant to not have to go through any of this again.  We also talked about the appointment that I had scheduled for Saturday and she told me that I didn't have to go, but that if I were to opt for any treatment, they would want to see me before they took any action.

So I went to the Saturday appointment and met with her partner.  She did an ultrasound and confirmed that there was no heartbeat (not that I had any misconceptions that my OB had missed something).

I decided that I wanted to take Misoprostol to induce the miscarriage.  I considered this to be a good middle ground for me because my priorities were conflicting.  On the one hand, I didn't want intervention because aside from not wanting another procedure on my uterus, I felt that I would process the loss much better if I experienced the miscarriage.  On the other hand, I wanted this to happen sooner rather than later.  And with a natural miscarriage, you don't know when your body will let go of the pregnancy.  With the medication, you have the miscarriage, but the process is expedited.

I was told that the drug works for 80% of the people and the miscarriage would be complete within 24 hours.  10% have excessive bleeding and need to go to the ER (eek!).  For the other 10%, it doesn't work.

Not knowing what the process would be like, I decided to wait until Saturday evening to take the medication.  After all, I needed to go for a sanity-inducing run first!  Around 9PM, I put four pills in my cheeks and let them dissolve.  Over an hour later, they were still dissolving, but I was starting to feel some cramping.  I had some light bleeding right before I went to bed, and I thought I would be in for a long night.  Amazingly, I ended up being able to sleep and woke up with menstrual type bleeding.  Unfortunately, it never got worse.  I had some cramping, but the flow lessened throughout the day, and I realized that I would need to take the second dose last night.  I thought that perhaps it didn't work because the pills did not dissolve completely, so I decided to use the "other" delivery method.  I inserted the pills vaginally around 8pm and laid down to watch some tv.  Let me just say that nothing happened.  I slept very soundly and had absolutely no cramping.  I was/am so disappointed.  There I was, on a holiday weekend, waiting to miscarry a baby that I've wanted so badly, and it won't freaking work!  I even went running this afternoon (it felt great, by the way) and when I got back, there was hardly any indication of bleeding on my pad.  It's seriously disappointing to be in this kind of limbo!

So here's where I am right now.  I called the clinic again today and spoke with one of the doctors.  She gave me another prescription for misoprostol and I will take it again tomorrow night.  Apparently, it's a better delivery system to go through the mouth, so I will dissolve them again in my cheek.  If that doesn't work, I'll get one more chance, the following night.  And if that doesn't work, I will need to do a D&C, most likely on Friday.  I guess there's a risk of infection with the cervix being dilated for too long, so they don't want me to wait much longer.  And neither do I.  Fingers crossed that third time's a charm.

At least I get a break tonight and ramp up tomorrow for another round.

Hmm, that turned out to be a long post.  I just wanted to document what this process has entailed for me.  I have more on my mind that I want to write about, but it will need to wait.  Thanks for all the comforting comments.  As you can tell from my blog title, I really haven't told anyone that we're going through this (I've told one person and I still need to un-tell her), so it's been nice to have a safe place to share this experience.  

The aftermath

Gosh, I have been so sad.  I went into work yesterday afternoon and it provided a good distraction for several hours.  This is a lot to process.  I couldn't bring myself to tell my husband what had happened until it was getting close to bedtime.  Part of the reason was that the kids were pretty excited about all the fun they had at preschool for Valentine's Day and I needed the house quiet to bring up the subject.  I felt so bad telling him.  Throughout the evening I kept trying different approaches in my mind and I just couldn't find one that didn't make me cry.  I was hoping to break it to him easy, but I guess that's just not possible.

So we cried together and talked a little bit about whether we had it in us to go through this again.  Everything about this hurts.

We both feel such a sense of loss of what could have been.  I know this is natural and part of the process, but it's just so hard.  I keep thinking of various events over the coming months and how different they will be now that I'm not pregnant anymore.

I called my RE this morning, and lucky me, I get to go in again tomorrow to "have a look and discuss next steps".  I guess they need to document the situation for themselves since my appointment yesterday was with my OB.  What a great way to spend a long weekend.

As for the future, it's so hard to think about going through all of this again, but I don't have time to waste either, so when we talk about the options tomorrow, I'll need to consider what is the best option in terms of getting back on the horse as soon as possible.  It's like a punch in the stomach.  I guess I'd better go back to my mantra: one day at a time.

Shattered

Or is it karma?  Either way, I went to my OB appointment this morning and there was no heartbeat.

My husband wasn't with me, and I'm dreading telling him tonight.  I don't want to do it over IM because I know he has a packed day, so I'm going to keep my status as "Busy".  Regardless, tonight is going to suck.

I haven't decided what my next steps will be (D&C, pass naturally, or take drugs to induce the m/c).  I'll decide in a few days.  Any suggestions/preferences?

I've been nervous about this appointment for a few days and have been preparing for bad news.  And then I told myself that I could chide myself tonight for being overly worried.  I even told my OB that I just wanted to see the heartbeat because I was nervous.  

This pregnancy has felt different from the others and while I let myself look at minivans and plan my time off, etc., I just couldn't shake the feeling that whatever was different may not be good.

It didn't feel so good to be right today.

Sorry for the jumbled thoughts.  Just not thinking clearly this afternoon.

7w5d - Ultrasound #2

Today's ultrasound brought mostly good news.  Embryo #1 had good growth (measured 6w1d last Thursday and 7w2d today).  Embryo #2 was unchanged in size, so it's safe to say that it's a singleton pregnancy (big sigh of relief!).

One thing I didn't mention after the last ultrasound was that the gestational sac was measuring just below normal in size.  When she measured it again today, it is still small.  I think it measured at 5w4d.  That doesn't sound good to me.  Apparently this is the least important of the three measurements they take (embryo, yolk sac, gestational sac), but it sounds like there is a higher risk of miscarriage.  Sometimes it catches up and everything is fine, and sometimes not.  My RE seemed to think that things are "still very hopeful", but this is definitely something to still watch.  I will be going back in a couple of weeks to take another look.  Perhaps a little bit of karma for all my initial confidence?

In the mean time, I made an appointment with my OB for next Thursday.  I wanted to get in to see her so that I can make my appointment for the NT scan.  It takes a few weeks to get an appointment and I don't want to miss the window.

I think it's going to be weird doing an overlap of an OB appt next week and then back to the RE the following week, but I am grateful for the opportunity to get a peek at things next week to see how they are progressing and hopefully get some reassurance.

Nerves

I've mentioned before that I haven't worried about my pregnancies once I saw that second line.  Well, I think I have to take that back this time around.  Seeing that second sac last week worried me.  It worries me that I could be pregnant with twins.  It worries me that somehow this second sac will continue to grow and cause problems with the good one.  And of course...bad timing...I've been feeling great.  Other than the growing breasts, I wouldn't know that I'm pregnant.  Yes, I know this is common.  I even remember off and on during my first pregnancy thinking that if I hadn't seen the test myself, I would not have suspected that I was pregnant.

I had hoped to wait until next week to have my follow up appointment with my RE (just to give the situation more time to develop), but instead I scheduled an appointment for tomorrow morning.  It will be good for me to know what I'm dealing with.  And if it's still unclear, I'll just make sure to make my initial OB appointment for as soon as possible.

Fingers crossed that I'm feeling good just because I've been lucky this time around.

6w4d - A "hmm" day

I had my first ultrasound today.  The good news is that there is a healthy looking heartbeat (yay) and a baby that is measuring 6w1d.  My last pregnancy had the same measurements on the same day, so I was prepared for it to be a couple of days behind.

The "hmm" news is that there appears to be a second sac.  What?! This second sac is about half the size of the first one and appears to have a fetal pole, but nothing else.  My poor RE was confounded since we only transferred one embryo.  The sacs were not so close together for her to think that it was an identical twin, so the only other option was that it resulted from the egg that was released during my frozen cycle.  Apparently I didn't believe everything I read several years ago in the Taking Charge of your Fertility book.  We had intercourse the night before trigger (2 1/2+ days before ovulation), but made the decision to "trust the process" by abstaining the night after trigger.  Argh!  Seriously, cannot I not do the math to understand how long sperm can survive????  I felt so sheepish having to confess that we didn't take her advice.

So, here's the deal.  The hope is that the second sac stops/has stopped growing and just disappears and gets re-absorbed.  The risk is that it continues to grow or that the uterus tries to expel it, causing contractions, and endangering the good one.  There's really nothing to be done.  She said to come back in a week or two, either is fine, to see what happens.  I don't think there's anything that we can do other than watch and wait.

I'm in a bit of shock.  After all, I was so adamant about doing IVF so I could avoid twins, and then I went and did something to risk it.  Dumb dumb dumb.  I think/hope that it will all work out in the end, but there's a little bit of worrying going on over here.  Luckily, fatigue hit me like a ton of bricks yesterday and it's all I can do to get my work done, get a workout in, and help with the kids before I crash out.  There's not much energy left to worry too much.

I haven't made my appointment yet.  I can't decide whether I should just get back in there on Thursday or Friday, or if I should extend the "not knowing" and go in the following week.

Reality check

When you've worked so hard to get pregnant, and follow the stories of many other women who have worked harder, it's sometimes hard to keep the doubts from creeping in.

Other than the normal miscarriage statistics, I don't have any particular reason why I shouldn't see that heartbeat flicker when I go to my ultrasound appointment next week.  Yet I've found myself wondering a few times this week whether everything is okay.  Do I have pregnancy symptoms?  My A-cup bras are still too big..shouldn't those boobs be bigger by now?  Should running really feel this good?  I thought my boobs would be more sore by now? And on.  And on.  And on.  

One thing I've always wondered is whether there is something more fragile about an IVF pregnancy vs. a natural pregnancy?  And what about fresh cycle vs. FET?  Other than taking special care not to harm the enlarged ovaries during a fresh cycle, do you need to be more careful of anything?  When I asked my doctor about any restrictions after the transfer, she advised me just to make sure that I tailored my activities so that if the embryo didn't implant, I wouldn't wonder whether I had done anything that could be the cause.  I decided to take 5 days off exercise, starting with the day after transfer.  Since then, though, I've gone back to my normal running schedule and am running 35+ miles per week.  Excessive?  I hope not.  I don't think so.  It's comfortable for me.  I exercised much more during my first pregnancy and it was fine, but there's still that question of whether I should consider this one different from that one (Clomid cycle, natural pregnancy vs. Clomid cycle FET).  Is the embryo less tough because I did PGD?  So many questions without any answers.

I really don't think there's an answer.  I'll just try to continue the "one day at a time" mantra and try not to worry.  At this point, I just need to eat healthy, get enough rest, and not stress.