update & more on our situation

Thank goodness - I am home from the hospital and now on bedrest at home. Nothing like our sweet mattress and being able to sleep uninterrupted. Our cat is really happy to see me:)

The problem with the placenta seems to have been caused by those jerk fibroids I have. I started off with one stubborn fibroid in late summer 2010 when we began fertility treatments. After a lot of IUIs failed and IVF was put on the table in winter 2011, I had a hysteroscopy to check out the fibroid and assess whether it might be hindering my fertility.

At the time, it was just that one lone fibroid. We did see that it was not subserosal (the most innocuous kind that grows on the outside wall of the uterus), but it was termed "minimally invasive" and it was still quite small. We were advised that it probably wasn't quite worth the risks of surgery to remove it, but that we should keep an eye on it.

So on we went with a couple more cycles of FSH injections with IUI and then ultimately with several rounds of IVF. By virtue of the protocol, of course every time I cycled, my estrogen was brought to unnaturally high levels, and the fibroids love estrogen. So a few more fibroid friends popped up, and the original fibroid continued to grow. With the IVFs, I was taking oral estrogen pills as well, which I think was basically like fish food for my fibroids.

Anyhow, when I finally did get pregnant (hooray!!!) this past November, I had 3 fibroids, all of whom were enjoying growing along with the growing babes and my increasing estrogen levels. To make things a little worse, my E2 levels plummeted after this past IVF transfer and were dangerously low (~39 pg/ml), so low it was pretty shocking these little ones implanted (same thing happened to my friend T with the low estrogen that cycle). As a result, I was popping the oral estrogen pills like candy for a few weeks, hoping to make up for lost ground.

In short, what started off as a little fibroid problem, gradually became a bigger fibroid problem, Still, most fibroids aren't usually that dangerous during pregnancy. Even though they typically grow, you generally have to be pretty unlucky for a pesky fibroid to threaten a pregnancy.

My problem is it seems that one of these now quite large buggers is behind our son's placenta and as its been growing, its been jutting out putting stress on a weak spot in the placenta, which is what caused the partial detachment (ha, I prefer 'detachment' to 'abruption', it scares me less…if you want to google partial placental abruption be my guest…it's scary stuff).

Thankfully, fibroids generally grow the most during first tri and then stay relatively stable. We have a chronic problem in that this fibroid will be constantly putting pressure on the area of the placenta that separated from the uterus. At this point in the pregnancy, the hope is that the placenta will be able to mostly heal itself at the point of detachment, though my understanding is that on ultrasound, all we can really see is the area of bleeding around the detachment and from that estimate the size of the tear itself - the actual tear doesn't show up on ultrasound.

I actually had an earlier and less severe bleed at 9 weeks that landed me on bedrest at home for a week. In retrospect, we can see from the ultrasound that the bleed looks to have been in the same area the first time around, but at the time, that bleed was seen as an isolated event and hadn't yet been connected to one of the fibroids causing trouble.

Of course the problem is that each successive bleed has the potential to be larger and more threatening as the babies continue to grow, and at this point of pregnancy, unlike during the very beginning, if something catastrophic happens to the placenta of one of the babies, the whole pregnancy is threatened. If I have a major bleed post-viability (24 weeks), there are big decisions to be made and more options for intervention, since the babies could be delivered, but before then it is mostly just sit tight, rest, and pray.

Even though this whole thing is hanging over me like a dark cloud, I am eternally grateful to be home from the hospital still pregnant with my babies - and since we know the genders, I can now say, our son and daughter. When I went to the ER during my first bleed the notes from the doctor read "threatened abortion" and when I was being admitted this time around, the admittance note read "imminent abortion." How about "imminent live birth in 3.5+ months"? That is what I am going for here.

On Wednesday, we have an appointment with the OB where we will come up with a long-term plan. I am not sure if there is any chance we will get to Toronto before the birth of these babies. On one hand, I am thinking if it still might be a possibility assuming I can fly non-stop and lying flat, it might be worth it to still try to make it happen if the NICU at the hospital we would deliver at has better stats than here in Israel. There is a MFM in Toronto (Y's cousin's doctor), who is willing to take us on, and it sounds like she is really amazing, so I think I would be comfortable with that aspect.

We have been told it is very unlikely this pregnancy will go to term, so I feel like I should already start researching NICUs and reading up on preemies, since I am doing my best to adopt the positive attitude that I will have these babies post-viability and they will grow and thrive - trying hard to think positive and not dwell on the the dark thoughts.

Oh and on the hospital - so thrilled to be out of there! Almost a week and I was so ready to leave. We were 4-5 women to a room in an old ward from the 70s. They would often use the 5th (temporary) position in the room for a woman in the early stages of labor, among us high-risk pregnancies and miscarriages, too.

I realize they are so limited in space, they couldn't help it, but it's pretty horrible to hear a full or nearly full-term woman moaning with her contractions when you are a high-risk pregnancy before viability and likewise, it is pretty cruel for women miscarrying to be among us preggos, even if most of us are very high-risk. There was one woman in my room who was in her 12th week and had been there for a month for heavy bleeding - I really feel for her.

It was also so hard to sleep with the constant monitoring AND the occasional super loud snorer husband who would stay over. Luckily, I had many wonderful visits from friends and nightly visits from Y, which helped keep me sane (but that first night, I was so, so terrified). The hospital was the right place for me to be at the time, just really not so pleasant!

in the hospital

I guess I will start at the beginning. Monday morning I woke up in a spectacularly horrible mood. I was insufferably cranky towards Y. By mid-morning I was having fairly intense cramping. Unfortunately, I have had quite a bit of cramping throughout this pregnancy and as a result, I have spent a lot of time wondering whether my pain means something bad or whether it's in the realm of normal. The pain was pretty persistent and honestly I was very uncomfortable, so I decided to leave work in the early afternoon to rest.

That afternoon I was gripped by panic - not because of the cramping, but because I was feeling terrified by the pregnancy in general. It was like a red panic light was going off in my head and I had no idea why. I just was very scared that something terrible was going to happen. I told Y that I thought maybe I should see a therapist - that perhaps after all we had been through infertility-wise, my anxiety was out of control and I wasn't coping well.

In the morning I was still a little uncomfortable but excited to head to our first detailed (aka level 2) scan. The scan went really well - both babies look great and we found out we're expecting a little boy and a little girl. The only thing that was totally bizarre was that I broke out in a cold sweat during the middle of the scan and suddenly felt extremely nauseated.

I went to work in the lab and when I went to pee there was a little blood. I thought it was probably a little irritation from the cervical length check, but then blood started gushing out. Not what I was expecting to see at all. Thankfully, the emergency room is within a 5 minute walk of my research lab. I was very confused given that I just had a good ultrasound, but the ultrasound in the hospital showed a 5cm placental detachment of baby alef's (our son's) placenta. I have been hospital since then. There is really nothing to do at this point but bedrest and to pray that the separation heals. This morning's ultrasound was good, but needless to say, we're pretty scared and we've got a long way to go.