Nov 21, 2012

our little squiggly & welcome iclw

Today we went in for our first ultrasound - a day earlier than planned due to some pretty bad cramping I've been having. I have been really terrified the past few days, so I was really happy to get it over with. Thankfully, the news is good.

We have one beautiful squiggly measuring a day ahead (6w6d) with a heart rate of 139bpm. I am happy. I am feeling more hopeful than I have in a very long time. I was terrified that we would see an empty sac, but I was also really scared we'd see more than one baby. Twins are so special and wonderful, but after losing Aminadav and Naava, a twin pregnancy is too risky for us. With a singleton, I hope I will have a good shot of carrying close to term. Of course we have a LONG way to go before we are back to the prematurity/PTL concerns.

I will do another ultrasound next Thursday and then we will take it from there. This was my first pregnancy-related ultrasound in Canada and it was weird to me that they didn't allow Y into the room, didn't let me see the screen, and would only give me results via my doctor. It felt really paternalistic to be honest. However, they did give me a nice picture of Squiggly. It feels so strange to say that I am feeling happy and peaceful, but it's true!

For those just joining us through ICLW, welcome! For a brief recap, we recently learned that we are rather unexpectedly though wonderfully pregnant after a long-shot Clomid/Prednisone cycle while waiting to start a new IVF. We started fertility treatments in August 2010 and since then we've done 6 IUIs and 5 IVF transfers (3 fresh, 2 frozen).

We've had many failed treatment cycles and several losses - two early miscarriages and the loss of our beautiful twins, Aminadav and Naava, who were born catastrophically early last March due to PPROM/PTL.

This blog has been an infertility blog turned pregnancy after infertility blog turned infertility blog many times over. Through the past few years, I've written quite a bit about unexplained infertility, the IVF process, miscarriage, high-risk pregnancy, and baby loss. The posts that are most meaningful to me are those about Aminadav and Naava, my lost hopes and dreams for them, and my grief.

Whatever brings you to our community, I am so sorry for your struggles. This is a sucky club to be a part of, but thankfully for us it is populated by many courageous, funny, resilient, and bright women.

Nov 17, 2012


I know I have slipped back into my cocoon the last week or so. There is not so much to say about my pregnancy. It is basically a black box until our first ultrasound on Thursday (7 weeks).

The days are passing very slowly and I constantly worry that my symptoms are too mild. But I suppose it boils down to something pretty simple -- either there will be a heartbeat(s) on Thursday or there won't be.

It is a little haunting how this pregnancy came almost exactly a year after my pregnancy with the twins. The two due dates are just 15 days apart. I can't help but be transformed back to last November -- every little detail of where we were, of how my pregnancy with the twins began to unfold.  But it is strangely comforting, too. I feel Naava and Aminadav's presence more strongly now. It is a sweet, bright presence that brings me nostalgia and warmth.

Israel has obviously been weighing heavily on my mind. Seeing on the news what it going on back home and not being there -- it is all very strange. Also, now living outside of Israel and seeing the way (some) of the outside world views the conflict is truly distressing and frightening to me. Those who question the right of Israel to exist and defend herself disturb me greatly.

Here's to a quieter, calmer week for everyone.

Nov 8, 2012

beta #4 and RPL appointment

Yesterday beta #4 (20dpo) was 2341, up from 955 two days before (I think I originally wrote that it was 956...I was off by the last digit!). I was pretty relieved and quite pleased with that. My progesterone took a nosedive though, which is weird. I think my dose probably needs to be upped a bit. Of course it makes me nervous...just like everything else.

I have another beta draw tomorrow (#5). Hopefully this will be my last. I find the betas really nerve-wracking, so I would be very happy to be done with them, but the RPL doc wants two to compare that were drawn at his clinic since there can be inconsistencies between clinics.

Speaking of which, we had our appointment yesterday afternoon with the RPL specialist. It was originally set up as an IVF consult, so I am quite grateful that he was still willing to see us in the context of this rather surprising pregnancy. I did all the first tri bloodwork as well as screening for a bunch of antiphospholipid antibodies.

Truthfully, I didn't look too carefully at the requisition sheets so I am not exactly sure of everything we did (very unlike me) but it amounted to 15 vials of blood. Apparently, false negatives for antiphospholipid antibodies are common during pregnancy, but a positive result could change our current management, which is why we still did the tests.

In the mean time, I am continuing on with the progesterone and Prednisone (until 12 weeks) and starting low-dose aspirin. I know I spoke to several doctors in Israel who don't believe that baby aspirin does anything, but this doctor felt pretty strongly about it, and I don't think it can hurt...hopefully it will help. He will continue to follow the pregnancy and then if I am lucky enough to make it past first tri, I will be referred to the high-risk clinic.

Overall, I feel like we have our bases covered and I am so relieved my beta didn't drop but we have a long way to go, baby - just 5 weeks today.

Nov 6, 2012

beta anxiety (second edition)

Last night Y got a script from his dad for a beta, if I wanted to repeat it today instead of waiting. I toyed with idea - I figured if this pregnancy is truly on its way out right now (a possibility), it would be reflected in a beta that is the same as yesterday or falling. But an equally likely possibility, perhaps even more likely, is that the number would be up, maybe another slow rise, and repeating it within 24 hours instead of the traditional 48 would just make it unequivocal and hard to interpret. The final possibility, that my hcg is playing nice again, is also definitely possible, but just having the 24h result, I'd still be nervous.

So...I decided I would POAS this morning and if the FRER was clearly getting lighter, I would go in for another draw this morning to confirm a fall, if it looked the same or even darker, I would wait 48h for the next draw....very scientific, I know :)

I had a really weird dream that I was getting some work done in an empty classroom, which apparently involved spreading my possessions about, including a massive collection of saved FRERs from this pregnancy. In the dream, I proceeded to pack up most of my stuff, forgetting the FRERs, and realizing only too late that a class had begun and a bunch of kids were now in the room...WEIRD.

In my second dream, this morning's FRER shattered before I could really interpret the result. And for what it's worth, in reality, today's FRER looked the same as the one from 2 days ago, but since the pregnancy line is so much darker than the control line, it is hard to interpret beyond safely saying that my beta is not likely plummeting.

So now I get back on the waiting train. I know I was a bit dramatic last night....but I was really so sad and disappointed. I know I have a tendency to jump right to the post-mortem before disaster has been confirmed (or sometimes even, denied).

What doesn't help this tendency to jump to the worst conclusion whenever anything is less than perfect is my history. It seems that anytime anything is slightly less than stellar for me pregnancy-wise, it inevitably leads to a succession of events that culminates in something bad.

The truth is, I am barely coping with my fear and anxiety when everything is going perfectly, so when stuff goes less than perfectly, it really throws me a curve ball. For now, I am just trying to get through the day.

I know that betas that stop doubling nicely can be ominous and unfortunately, the first sign of a pregnancy that isn't doing well can be jittery betas, even if it's only weeks later that the pregnancy actually fails.

Two rather innocuous possibilities for the slower rise:
1) There were two embryos and now there's one....a vanishing twin. My betas have been higher than average, even for a twin pregnancy, according to betabase, though I know there is no hard science to predicting multiples based on betas...high betas can also of course correspond to a singleton who implanted on the earlier side. If there was in fact a vanishing twin, my betas should recover with the next draw.

2) Y suggested that perhaps I was a bit dehydrated for beta #2, artificially raising the result. If you consider only the first and third beta values, the overall doubling time is still within 48 hours.

I am so anxious about the future, but like with everything else, unfortunately only time will tell.

Nov 5, 2012

beta blues

I wish those magical two pink lines didn't make my heart sing with glee every time I see them. I wish those magical two pink lines didn't tempt me to fantasize about my dream life, the life I took for granted that would be mine for so many years every time I see them.

Every time so far that I've seen those magical two pink lines, I've been duped, and yet, every time I seem them again, I am filled with renewed hope and anxiety and fear and forboding, yes, but also so much joy too.

Why? Why can't I view those magical two pink lines of a pregnancy test with the same detachment I view the two very unassuming lines on an ovulation predictor stick? Why can't I just learn my lesson? In my world, those magical two pink lines -- they pretty much mean...nothing. But I seem to be very late to the game in accepting this on an emotional level.

The doubling time between betas 1 and 2 was 33 hours -- from 146 at 13dpo to 391 at 15dpo. Those were some pretty strong betas. However, beta 3 at 18dpo was 956, a slowing to a 56 hour doubling time. Coupled with the awful headache and lower back cramps I've had today, I can't help but worry that this pregnancy has begun to fail.

Also, this is ridiculously subjective, I know, but I POAS yesterday morning and the pregnancy line was soooo much darker than the control (it stole most of the dye from the control line), I really think that it would have corresponded to a beta of at least 1000 and that things just took a downturn in the past 24 hours.

I know a beta can take 72 hours to double and it can still be okay. I know the 48 hour doubling time rule is a little arbitrary and that there is a whole spectrum, but I have never had betas not double in 48 hours and had it been okay. Also, these cramps are for real. So, I think I might be pretty close to bidding pregnancy #4 goodbye. I only hope that if it's not meant to be, it won't be a protracted ordeal with unequivocal betas and ultrasounds and that it will end quickly.

I am sad tonight. I really believe in my heart every time that this is the time that will be different, but sometimes to continue trying just feels like punishment. I also believe in my heart that this is a problem with my body and not our embryos.

Nov 4, 2012

that other 2ww - TO2WW

The 2ww (or more) between a +hpt and an ultrasound to confirm the heartbeat(s), now fondly dubbed 'TO2WW': biggest mindf*ck ever. Of course its redeeming quality is that it is for a great cause, because until proven otherwise, you are pregnant. Its undoing  is that the stakes have been upped over the previous 2ww yet the potential for disaster is still quite high.

 After the two pink lines is both the best and worst place that an infertile can be.

Here is a (maybe not so) brief history of the reason why TO2WW makes me nutty:

October 2010 - pregnancy 1 (IUI 2):
Looks like a late implanter, but in Israel all of the drugstore hpts are pretty crappy, so….the most expensive stick I could find, the "Yes or No Professional" test, doesn't yield a faint positive until 14 dpIUI. And the underwhelming 1st beta …
14 dpIUI: 42
18 dpIUI: 279
25 dpIUI: 3576

Guiding initial thoughts of pregnancy 1: Betas start off low but the numbers (more than) double nicely. It is my first pregnancy and I am pretty anxious but I haven't yet actually had a loss so oblivion is still (sort of) my friend at this point. An ultrasound at 5w2d reveals just a GS - but again, I am too naive to think disaster at every turn. I still have some trust in the process and in my body. Brown spotting for a few days during week 6. Ultrasound at 7w3d - no heartbeat - missed m/c. Game over pregnancy #1.

new neuroses developed: Late implantation is an ominous sign of bad things to come. Brown spotting means the baby has died.

November 2011 - pregnancy 2 (IVF #2):
Guiding initial thoughts of pregnancy 2: I am a smart girl and stockpiled FRERs during my trip to the states so pesky subpar hpts won't keep me from a successful pregnancy test this time around (since that was clearly the problem last time). First +hpt 6dp5dt - see these pee sticks are worth their weight in gold! Initial thought: Not a late implanter this time, an auspicious start, in my mind timely implantation = successful pregnancy.
beta 1 (11dp5dt): 308
beta 2 (13dp5dt): 849

Guiding thoughts con't: Well this is definitely different from last time, so hopefully it is going to work out. Wait, no, not enough symptoms…they come, they go away. This shit is crazy. Night before 1st
u/s (6w2d) -  I'm not even tired anymore, another missed miscarriage, I think.  Arrive to clinic for ultrasound dejected - we both expect bad news (I have also convinced Y without doubt that the pregnancy is doomed because, well, I am not tired anymore, I am not nauseated, etc.). Ultrasound #1 - 2 heartbeats!

Week 9 - start bleeding bright red. Previous experience dictates that blood = dead babies. Shocked and relieved to find out that bleeding is 'only' from a SCH - the same SCH that rears its ugly head again at week 16 and leads to the succession of events that ultimately result in the death of both my beautiful babies, but I don't know that yet.

Week 19-20 - Aminadav's water breaks - PPROM. I lose both my little loves to PPROM/PTL.

new neuroses developed: It's never too late in pregnancy for your bab(ies) to die, either inside of you, or by arriving a few weeks short of viability (or as it also often happens, after…). Bleeding is a harbinger of disaster. If you PPROM before viability, you are in a bad, bad place.

June 2012 - pregnancy 3 (IVF 3):

Day 3 SET after a bumpy cycle and premature luteinization (premature progesterone rise). SET on day 3 is pretty low yield and at this point 6/8 of the embryos we have transferred via IVF have not implanted, so our IVF history doesn't bode so well for day 3 SET, but it is what it is. We are super surprised to get a +hpt at 6dp5dt.

Guiding initial thoughts of pregnancy 3: A singleton pregnancy with strong implantation bodes well for us. There is no reason to believe this won't work, other than the fact that it never has in the past.

beta 1 (12dp3dt): 138
beta 2 (14dp3dt): 139
very early m/c at 5w2d

Continued guiding thoughts: So clearly early implantation and a solid first beta doesn't necessarily stop the pregnancy from falling off a cliff with style. Weird…I thought most chemical pregnancies started with dubiously low betas and late implantation. Seems more likely due to a maternal factor than a genetic problem, but that's just a guess.

new neuroses developed: A +hpt early on or a nice first beta doesn't protect against a chemical pregnancy or early miscarriage. Those beta hCG numbers can come crashing down from anywhere.

October 2012 - pregnancy 4 (Clomid/Prednisone/TI…surprise!)

+hpt 11dpo (I just corrected that from '6dp5dt' - apparently I am still in disbelief that this wasn't an IVF cycle!)
beta 1 (13 dpo): 146
The pee sticks keep getting darker.

Guiding initial thoughts: Expect nothing. All bets are off. Well, a nicer way of saying that is "expect the worst, hope for the best."  My symptoms come and go. I understand that every tiny thing could mean either nothing or everything, but only time will tell, and the wait is maddening. I have now been waiting over 72 hours for the results of beta 2 (in Israel I never waited more than 2.5-3.5 hours for a beta result!) and the wait is driving me nuts, as is the knowledge that by the time I receive the result, it will be obsolete (i.e. so 3 days ago!).

new neuroses: Everything. Pregnancy is a mine-field that can be cut short or go wrong at any point due to an endless combination of disasters. But with each new chance, there is always the possibility for all of the stars to align so that we bring home a living child, and that little bit of hope propels us forward, and so we keep on keeping on. In the meantime, I think I need a therapist.