Ectopic

This is the final installment (for now) in my infertility series.  I have delayed in posting it because the emotion is  still raw.  I do want to pause to give thanks for the number of personal notes I have received in response to my writings.  There have been words of encouragement, stories of hope and similar struggles and gratitude for having the courage to speak out.  Writing has always been an outlet for me, and I am glad to have a made a small impact on others, if only for a moment.

For DH and me, our miscarriage experience brought to light the fact that we were “trying.” They say ignorance is bliss, and we certainly found this to be true.  We were well aware that we were taking no precautions to prevent pregnancy, and at least 15 months had passed in this manner. We probably should have been concerned, but I think it helped that we were terrified by the notion of a second child for at least half that time period.  The fact that pregnancy #2 occurred without overthinking it was, well,  lovely.

Now we were determined more than ever to give J a baby brother or sister.  I, for one, was not looking forward to “trying,” but it ended up being less stressful than I anticipated.  DH was 100% on board, and it was like an unspoken agreement between us. I charted only once to make sure my cycle had not changed.  My periods were still like clockwork every 28 days with ovulation occurring around day 15. Seemingly perfect. Twelve months went by without success, and my OB-GYN urged me to go back to the reproductive endocrinologist. I was, after all, 35 and the clock was ticking.  Fifteen months went by, and this time it was DH who was dragging me to the RE’s office. What pushed me over the edge were the results of a blood test my OB-GYN ran. Anti-muellerian hormone, or AMH, is a substance produced by early ovarian follicles. It is thought to be an indicator of a woman’s remaining egg supply, her ovarian reserve. The normal range is 1.5-4. My result came back at 0.6. Time to see Dr. Magic.

The RE was not concerned with my AMH value quite yet. He said, it being a new test, there was a lot of potential for error if not performed by a reliable lab.  He sent me for a very thorough panel of bloodwork via ReproSource in Boston. All my values, including AMH, fell within the acceptable range, and my egg retrieval score was good, meaning average for my age. On my 36th birthday, I had a repeat HSG, and this was also normal. DH’s swimmers were deemed plentiful as well. We were so normal that we were given a diagnosis of “unexplained infertility.” Our recommended treatment plan was either continue on our own or try fertility drugs in an effort to speed up the clock.

We chose Clomid, which I took one time while trying to conceive J. As you may recall, I hated it.  I experienced all the listed side effects- hot flashes, night sweats, bloating, headaches, breast tenderness, extreme irritability. It was an evil little pill, and I was not excited to give it a second try.  I started my 5 days of pills and waited for the ugliness to begin. I waited. And waited. And waited. Still, I felt nothing. I told the doc as much when I saw him for my follow-up ultrasound.  My ovaries told a different story.  I had several mature follicles in each ovary. Sneaky Clomid!

The protocol is to have extra friendlies every other day while tracking luteinizing hormone with an ovulation predictor kit. Once the luteal surge is detected, ovulation is anticipated to occur the next day.  They gave me a lab slip to go for a pregnancy test 2 weeks after my surge. Not one for unnecessary bloodwork, I called the office the day the lab was due and told them I was going to skip it as I had taken several home pregnancy tests in anticipation and had yet to get a BFP. The secretary agreed but urged me to go if AF did not arrive within two days.  I decided to take one more HPT, and this time there was the faintest positive. When I looked back at the previous day’s test, there was also a very faint positive I had missed. Oh glorious Clomid!

I quickly snapped a pic of my test and made J pose for this adorable picture with her Cabbage Patch Doll (mine from my childhood). The shirt was handed down to us by her cousin, and I was saving it for a time when it rang true. I sent the pics off to DH and hopped in the car to get my bloodwork done.  DH was ecstatic. I was cautiously optimistic.  The projected due date was Oct 9, the day before DH’s bday and a week before our anniversary and my birthday. How could this fail?

A slight miscommunication between the hospital and lab resulted in a delay in receiving the results.  The blood test came back positive, although the HCG level was low. My progesterone, on the other hand, was through the roof, indicating that I had ovulated more than one egg.  My second blood test two days later revealed that the HCG had more than doubled so I was cleared to go one week before my next blood draw. I was feeling pretty confident at this point. My breasts were sore and enlarged. I was having minor cramping in my expanding uterus as I had with J. My belly was hard and swollen likely due to all the progesterone on board, but I preferred to think of it as a little baby belly.

And then it all fell apart.  I received a phone call after my third blood draw informing me that my HCG levels had remained low and had not come close to doubling as expected. The doctor was concerned I may be experiencing an ectopic pregnancy and wanted me to come in for an ultrasound the next day. DH was out of town on business, and I had to break the news to him on the phone. I also had to arrange for childcare for J so I could go to the ultrasound by myself. DH and I stayed up late talking on the phone and googling “HCG not doubling” and “ectopic.” We clung to hope from stories of other women with low HCG or suspected ectopic pregnancies who had gone on to birth healthy babies.

When I finally went for my ultrasound, all hopes were dashed. Although my HCG was rising just a tiny bit with each new set of bloodwork, the number was less than 500, grossly below what one would expect at nearly 6 wks pregnant. The words “not a viable pregnancy” passed from someone’s lips and attention turned to determining whether the pregnancy was in-utero or ectopic. They were unable to make that determination.  Two doctors and an assistant probed me. They debated it while I held my breath and pressed my lips together hoping to hold back the tears for a few minutes longer.  I was sent home with firm instructions to call the doc on his cell phone and report to the ER if I experienced any severe right sided cramping. I was to come back in two days.  The worry was that if the pregnancy was in the tube and continued to grow, it may rupture my fallopian tube and cause me to bleed internally. This is one of the leading causes of maternal death and not something I wanted to experience.  Also, as someone who has a hard time getting pregnant, I could not afford to lose my right tube. I did not go home with a picture of my suspected ectopic, but it looked similar to this.

Because my HCG number was still rising, I  felt a glimmer of hope. Maybe this baby was in my uterus and was a late bloomer? I didn’t want to feel pressured to terminate a pregnancy if there was still hope, so I turned to my OB-GYN for further guidance.  I found her to be more personal and sympathetic than the RE. She took the time to explain what the HCG numbers meant, why mine indicated a failing pregnancy and my options should it turn out to be ectopic. Talking to her was like a breath of fresh air.  I may have mentioned earlier that my RE is slightly cocky, and he has every right to be. He is very talented at what he does. However, as appreciative as I was for the close monitoring, I was not ready to herald him champion for saving my tubes just yet.  I simply wanted him to pause for a moment and acknowledge my loss. Was this too much to ask?

DH accompanied me to our next visit which fell on Valentine’s Day. Seriously! DH has long been boycotting VDay as a commercial holiday, so I was not expecting candy and flowers, but this was ridiculous! They were still unable to make the call,  and the HCG number continued to creep up, so it was getting urgent. The recommended protocol was a shot of methotrexate. This is a chemotherapy drug that would effectively terminate the pregnancy to stop it from growing. If it became too large, I would require surgery and risk losing a tube. Still, no one wanted to inject me with a chemo drug if this was a natural miscarriage waiting to happen. So I was send away again.  I was told not to panic over bleeding as this was sure to occur, but to call with significant right sided pain. I experienced both and ended up having to call my doctor at home on a Sunday evening. Fortunately, the pain was not severe enough to be emergency-worthy, but my next appointment was moved up to 7:45 am on Monday.

We had arranged for childcare for J, but she woke up with a fever. So the three of us piled into the car- my pursed loaded with children’s ibuprofen and tylenol- and drove in silence to the office.  My HCG numbers had fallen significantly over the weekend. What was troubling was the spot that was still clearly on my right fallopian tube as well as the right sided pain I was having. I opted for the methotrexate shot and spent much of the morning waiting around to see if my liver was healthy enough to allow this option. Finally, I received not one but two injections and was sent home to rest. Except that I had a sick child, so rest was not possible.  In fact, all three of us ended up getting sick, which was a welcome distraction from the nightmare of the previous week.

As before, time was relentless in its insistence to march on and on and on. I may or may not have thrown a tantrum over planting some peach trees, which I refer to as my miscarriage trees. I remember reading somewhere that it was therapeutic, and I was planning on planting some fruit trees anyway. J named them Ariel and Belle. Please remind me never to ask her opinion on baby names or, surely, she will end up with brother Kristoff or sister Rapunzel.

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We are still trying, and I am not going to lie to you, it is the pits. Most days, I am ready to move on from this chapter in my life. Should God entrust us with another precious life, I will hold him or her to my bosom, breath in the heavenly scent of baby and cry tears of joy. And should we remain parents of one, I will look at my little J with pride and adoration, as I have for the last three and a half years, and know her love is big enough to sustain me.

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Good news, my next post will be significantly more uplifting as I am going to write about J’s Ariel Pool Party (because every three year old needs a pool party).