6 weeks, 5 days: The most amazing sound

I spent most of the day wandering around in a terrified fog: palms sweaty, heart racing, butterflies in my tummy. But it was worth it. Before he even started taking measurements Dr. Reshef knew everything was fine and told me to start breathing again. I didn't believe him; the heart was beating so fast that I could barely see it (unlike last time, when 90ish beats per minute was easy to spot).

He measures gestational age from transfer, which puts me at 6 weeks, 2 days, rather than retrieval (6 weeks, 5 days). Since due dates are largely meaningless, it doesn't matter, as long as the bean looks healthy. And it does! It is measuring exactly 6 weeks, 2 days, with a heart beat of 131bpm (anything over 120 would have been good). So we are not even borderline! We were even able to hear the heartbeat -- the most amazing sound -- which is not always possible this early.

Dr. R was cautious (but optimistic): he put our ongoing chances of pregnancy loss at 15 percent for the next two weeks, when we have our next visit. But if everything looks good then, he will be confident to release us to ordinary prenatal care. Baby is expected to arrive in late April.

I feel a whole mix of emotions -- excitement, joy, fear, anticipation, anxiety. But I am hoping to enjoy the next two weeks as much as possible, preserving the worst of the anxiety for the day of the next ultrasound.

Symptom watch: still not much. I have the nose of a bloodhound, which is making life interesting. But I don't have any morning sickness to speak of, just some queasiness after eating, usually dinner. Maybe I'll get lucky?

Now for the moment you've all been waiting for: baby's first picture! The big fuzzy blob, marked by dotted lines, is the fetus. The smaller blob is the yolk sac.

6 weeks, 4 days: One more day

It's almost here, thank goodness, since I've managed to drive myself insane these last few days. I had a total meltdown this morning after a series of markedly lighter pregnancy tests. Why am I still taking them? Because it makes me feel like I have some measure of control. But, of course, I don't have any control. And the lighter tests -- which may mean doom or may mean nothing at all -- sent me into a tailspin. But tonight, after going to church and taking a luxurious nap, I'm feeling much better. And even if I hadn't taken the tests these last few days, I'm sure I would have found something else to panic about with the ultrasound 24 hours away. It will take a long time to recover from the rounds of failed treatment and the scary ultrasounds; even if everything is okay tomorrow, I will need to fight the feeling that I'm simply waiting for the other shoe to drop. Although I'm not feeling confident about tomorrow, at least I have some hope back. The appointment is in mid-afternoon.

Next steps

Well, I am certainly glad the last week is over! After a rough couple of days, I woke up Sunday feeling all better physically. A long night's sleep in a luxurious hotel bed without a snoring partner (love ya' babe!) after delicious alone time with my brother and his GF, my BFF, and my parents was just what I needed. Not surprisingly, perhaps, Sunday was a more difficult day emotionally. At brunch with my parents, brother, and his A, the hostess presented a rose to my mother. I LOST it and ran out of the restaurant in tears. It was the first time I had really cried about this miscarriage. It was probably good for me; my practical stoicism is not always healthy. After a hug from my dad and some whining about the unfairness of it all, a mimosa perked me right back up. And I was fine the rest of the day, focusing on my mom and grandmother.

And at Mother's Day dinner, all the women got roses. And it's appropriate, I think, because don't we all "mother" somebody or somebodies?

Then we were on to the next hurdle, having some early skin cancer removed from my back. The procedure went smoothly, though the incision now alternates between stabbing pain, burning, and itching. It's fun ... or not. The stitches will be in for three weeks, which seems interminable. But it's for the greater good, and I'm relieved to have the spot gone.

Today was my post-op visit with Dr. R. Mostly he wanted to talk about politics and the Dead Sea Scrolls. I was like, "Dude! You have other patients waiting. This is not a social call!" But we get good treatment because he likes us, so I can't complain. As I expected, he isn't particularly concerned that we've found only bum embryos so far. He said, "The class of July 2010 is different from the class of March 2010" and made an analogy to my law school students. And it's true, some years are better than others. He also reminded us that only 30 percent of fertilized eggs ever turn into babies and we just need to keep trying to find our 30 percent. He did send me for some bloodwork for autoimmune issues and an updated check on my thyroid. But none of us think that's the issue. We're just dealing with old eggs and bunk sperm and we have to be patient.

He said to call when my cycle starts again. The nurse was, again, horrified, "Aren't you supposed to wait SEVERAL months? He's bending the rules!" Aaah, yes, but it'll be fine. After all, there's a rumor that women are more fertile in the months right after a miscarriage. So shouldn't we capitalize on it? Given how quickly I'm recovering, though, I anticipate that we'll wait two months, starting the birth control in early July and doing retrieval and transfer in early August, just before school starts.

In the meantime, we bit the bullet and filled out our first adoption application, for a very old and apparently well-respected agency in Fort Worth. They have a domestic infants of color program, as well as an Ethiopia program, which are our top choices. Even if we are ultimately successful with IVF in the next six months, we are very interested in pursuing adoption for child #2, so we figured it couldn't hurt to get the ball rolling. But I think we should probably fence the swimming pool if we have any hope of passing a home study. The to-do list grows longer.

Nagging worries

Physically, recovery has been a lot harder than I anticipated. I'm still having a fair amount of pain and other discomfort. Although I haven't done anything silly like go to the gym, or even walk the dog, I did have to get right back to writing my final when I probably should have taken a day or two to sleep this experience off. I don't think there's anything wrong: no fever or other signs of infection. It'll just take time. I'm heading to San Diego for Mother's Day. I know the travel will be physically draining, but I think running away to beautiful SoCal will be worth it for the soul.

As committed as I am to moving forward and doing another cycle, I have begun to have a nagging worry. In two years, we've had two pregnancies, both of which have ended in miscarriage. There doesn't appear to be anything wrong with my uterus, lining, or hormone levels; in fact, my body was showing no signs of letting this pregnancy go before the d&c, even though the fetus had passed at least a week before. Almost certainly, both miscarriages have been the result of bad embryos with chromosomal problems. I worry that maybe we can't make a healthy embryo. I worry that even if we get twice as many eggs next time, they'll still be bad and we'll have to go through this again.

I'll probably talk to the doctor about this next week. I suspect he'll tell me it's just been bad luck and we have a good chance of getting a good one next time. But I'm still curious about what he'll say.

I found a cool new blog today, with an awesome video for infertility awareness week. (Warning: if you have epilepsy or are otherwise prone to seizures, don't watch it. The choppy editing is a bit discombobulating.) The video is cool, and I love that the author named her blog after two of the barren matriarchs.

HT: Mo

Recovering

The d&c went smoothly today, with no complications. Dr. R was his usual charming and sweet self. He and B had a long talk about some book about the Dead Sea Scrolls that he is reading. They just adore each other! I had some pretty significant pain and nausea after I came out of anesthesia, but some pain meds and a nap had me feeling much better. I still feel a little bit like I got hit by a truck, but it's manageable. I've got Rx pain meds if I need them, as well as 5 days of antibiotics to ward off any future complications.

We'll go back in to the office next week to make sure everything is healing properly and to map out our next cycle.

I'm still waiting for the video from Brittany, though happily the state AG agreed not to enforce the laws while litigation is pending. After having been through the d&c today, I have some more thoughts about choice and abortion that I'll share when I have more energy!

Confirmed

We were able to confirm today that there was no heartbeat. And the fetus had again not grown at all. Although sad, it was also a relief to know that we can move on and get ready to try again. Unless I miscarry naturally before then, we have scheduled the d&c for Tuesday afternoon.

Our friend Brittany got lots of footage, so hopefully she'll be able to use it. I'm excited to see how it turns out!

If you're the praying kind, please send up good thoughts for our sweet friends M&J who also got bad fertility news today.

Making lemonade

After a pretty good weekend, where I felt okay with where we are, accepting of the impending miscarriage, and eager to try again, this week has been hard. Usually school is a good distraction, but I feel sluggish and tired. I'm sure part of it is normal end-of-semester exhaustion, but I also know that it's harder and harder to act like everything's normal.

But I'm determined to ensure that something good comes out of this ordeal. The state this week enacted very strict abortion laws, over the governor's vetoes. One of the laws requires women to have ultrasounds and listen to detailed descriptions of the fetus prior to having an abortion. Although emotionally painful, this may not sound particularly invasive until you realize that a first-trimester ultrasound is done internally, with a large wand. I have these done regularly to check for follicle development (and more recently, to check on the fetus). And fortunately, I have never had much discomfort. But many women find these ultrasounds to be painful and even violating. The basis of the governor's veto of the law is that there is no exception for victims of rape or incest. I just can't imagine a woman who has already been sexually assaulted being forced to have an internal ultrasound. I don't expect to change anyone's mind about abortion, but I wish my fellow citizens knew what this law actually requires. So a local politician friend of mine is accompanying us to our appointment tomorrow to videotape various aspects of the procedure (preserving as much privacy and dignity as possible, of course). She had expressed a desire on Facebook to make a video about the law, and I just happened to have this appointment already scheduled. I emailed my awesome doctor yesterday to make sure this plan was okay, and he's totally on board. I don't yet know how the video will turn out; but if I can use this experience to educate people, then I will feel like I made the best of a bad situation.

I'm turning comment moderation on. I have had an influx of readers from yesterday's posting; and I assume most of them are conservative Christians who will object to this project. If I get unpleasant responses, you don't need to read them!

UPDATED: The green-eyed monster

For many people, infertility causes a lot of anger. I've heard that from fellow infertiles, and we have certainly seen that in the waiting room and IVF classes at our clinics. The anger at the unfairness of it all, at the doctors for not fixing it quickly, at themselves for failing is palpable. But for me, anger is rare. Instead, my uncomfortable feeling is jealousy. It's harder and harder to feel joy for friends and family as they get pregnant and have healthy babies easily. When is it going to be my turn?

UPDATED to add: If you are one of my loved ones expecting a little one of your own, please don't be afraid to share your joy with me. I am thrilled for you; it's just more work than I'd like it to be.

Hope (or why I love my doctor even though I'm having a miscarriage)

These stories are probably not going to come across as funny in the translation as they did in the moment, but here goes:

It was clear to me from the ultrasound that the pregnancy was not viable; I didn't need the doctor to confirm it. So when we went into his office for the post-ultrasound consult, he said, "If you weren't academics, I'd talk to you about hope. But since you are, I'll be realistic."

His (or maybe the hospital's?) policy is not to do a d&c until the fetal heartbeat stops naturally. This is probably a good thing, even though I was ready to march on over to surgery then and there. So we return in a week for a follow-up ultrasound to be sure. He said that normally he wouldn't plan the d&c until then, but since it was us, we should stop by the nurse's desk on the way out and get on the surgery calendar for after next week's appointment. Her jaw hit the floor and her eyes bugged out when we told her this; even though he's still not going to do the d&c until after the heart stops, I guess he doesn't usually concede that there's virtually no hope and that the patients should go ahead and plan for the d&c. I was like, yeah, but he's never had us as patients before.

And finally he said, "I suspect I'm preaching to the choir, but we should definitely do this again." And normally he'd say, wait two months and then we'll figure out where to go from there. But since it's us, he told us to go across the hall to the clinic and get on the IVF calendar for our next cycle (late June/early July start date). The nurse over there was also not prepared for us to show up before the miscarriage, but she took it in stride.

All in all, the doctor hit all the right notes with us. He was frank, realistic, practical and gave us a plan. But he was not insensitive: I got a pat on the cheek when he came into the exam room and a big hug on the way out of the appointment. I know CCRM in Denver is the best, but I can't imagine a better doctor for us. It helps that he thinks Brent's scholarship is fascinating. Plus, we get to see his benevolent face smiling down at us from a billboard each time we drive south on I-35, and that amuses us.

As for next time, the tentative plan is to switch me to the 35-and-over protocol. I've always been something of an old soul, so that makes sense. You may recall that we had roadblocks at each step of the way this time: I didn't suppress, then I over-suppressed, and then I under-stimmed (two weeks to get 7 eggs instead of the >10 he expected). Frankly, it's amazing that we got pregnant at all. The over-35 protocol basically works with the natural cycle and the natural hormones. Among other benefits, it's about two weeks shorter than the normal 7-week cycle, and there's a lot less loopyron involved. I'm excited to try it.

As Dr. R said yesterday, we swung the bat and made contact, we just didn't hit it out of the park. (See, he can read me like a book: a baseball analogy!) Brent and I are feeling really optimistic about cycling this summer.