P.A.L.

  1. Pregnancy After Loss (miscarriage, stillbirth or infant death)
  2. also Parenting After Loss

PAL

 

I am excited to be writing the final installment of my fertility series. I have written this post a thousand times in my head, but I have waited a long time (9 months to be exact) to get the words just so. I am thankful to all of you who have followed me as I navigated the back roads of infertility and pregnancy loss. Your kind words, prayers and shared stories have meant a lot to me. If you have stumbled upon my page because you are also unwillingly on this journey, allow me to reach out and give your hand a virtual squeeze. I will never stop praying that you too find your rainbow.

rainbowbaby

Pregancy after loss is … uneasiness. 

It’s carefully comparing the pink lines on the multiple HPTs (home pregnancy tests) you have taken and wondering if it’s just you or have they gotten lighter instead of darker. It’s then googling “pregnancy test line getting lighter” to see if this has happened to anyone else and how it turned out.

It’s finally having fantastic off-the-charts beta hCG numbers and naturally assuming that you are having a molar pregnancy because it is the only type of miscarriage you have yet to experience.

It’s having having ultrasound after ultrasound in early pregnancy and always being the most surprised person in the room that this baby is ACTUALLY still alive and growing inside you. It’s reaching deep down inside yourself- where that baby lives- to find the courage to hope. The courage to talk to this baby, to give it a nickname, to try to guess its sex. Because these are the things that normal people expecting a baby do. Except you are not a normal person expecting a baby. And because you know that sometimes hopes are dashed, and the pain from that is long lasting.

It’s sensing that first flutter of movement and immediately feeling the relief wash over you and then recede as quickly as the tides. Because before you know it, that flutter is gone, and you can’t remember when you last felt it. The kicks get stronger and more frequent as the months go on. Of course, this is reassuring, but there are times that the baby goes quiet (how dare that baby sleep!) and, at those times, the uneasiness returns. You lie quietly on your side. You wiggle and shake your belly. You hold your breath. Soon, you enlist the help of your five-year-old who sings lovingly to your belly.  There is a kick and a wave of movement, and you squeeze that five-year-old tight as you both chuckle over how the baby likes her the best. What a great big sister she is going to be!

It’s making an appointment with a perinatologist for a fetal cardiac echo because some study somewhere said that IVF babies may have an increased chance of cardiac defects (Rest assured, this is standard protocol and has nothing to do with the fact that you are neurotic). It’s squinting at the screen while the ultrasound tech explores the chambers of the babies heart trying to spot a defect before she does. It’s being told that that baby looks great and is still measuring ahead and thinking, surely now I can relax. Except you don’t. Not really.

It’s cursing God just a little bit for allowing mosquitos to carry something called the Zika virus that only really affects the unborn children of pregnant women. Like you really needed something else to worry about. Now you can’t leave the house without applying mosquito repellent. And you have to let your husband and daughter travel to FL without you, and this is not ideal because Daddies do things like let little girls drive in golf carts without wearing a seatbelt while an unlicensed driver is driving. And do they really reapply sunblock every 90 minutes and brush the very back molars like you do? You find solace in the fact that your baby’s head is measuring in the 90th percentile, so it seems highly unlikely that it has microcephaly.

It’s not going into labor early, as you had with your daughter, and hardly being able to stand the anticipation. It’s finally scheduling an induction to take place two days after your due date because you don’t think you will be able to handle it any longer than that. It’s going into labor one day prior to your induction and packing up your bags and heading to the hospital with contractions five minutes apart only to have them completely stop as soon as you arrive.  It’s rejoicing that they find a reason to keep you because, in your mind, you refuse to go home.  This baby has to come out now.

It’s having the most grueling, unmedicated, knee-knocking, teeth-chattering delivery. The bed is soaked. Your glasses keep slipping down on your nose. You barely feel present in the room, and a nasty thought creeps into your head. “Oh my God, I’ve come this far. Is it me who is going to die? How is it possible to feel this bad.” It’s summoning your inner Goddess. The one they talked about in prenatal yoga. The one who can get you through anything. You give one last push and hear the most beautiful sound in the world. It’s a boy, and he’s peed all over you.  And although you are too tired to fully digest this moment, you know it is one of the greatest moments of your life.

And you get to thinking it wasn’t so bad after all. It wasn’t all uneasiness. It was belly rubs, comfy pants and checking out your growing side profile. It was baby hiccups, strangers smiling at you in the grocery store, and having a best friend with you at all times.

It was being pregnant one last time, and it was beautiful. And so is he.

Cnewborn

 

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If you want to learn more about my fertility journey, you can read my fertility series and IVF series here.

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If At First You Don’t Succeed, Try, Try Again (IVF #2, FET#3)

When we last left off in my IVF series, I was blissfully recovering from a blighted ovum in Hawaii. It was my favorite family trip ever, and I was feeling really good about our little family unit.  My daughter and I discussed how it would be ok if we remained “The Three Musketeers.” J said she had her cousins, and we could always get a dog.  A dog! That seemed like the perfect solution.

The following Christmas break, I had two whole weeks off, so we looked into getting a Golden Retriever puppy.  Turns out, Golden Retrievers are a little hard to come by, so we started looking for chocolate, golden or silver labs. We found two litters that would be ready around  Christmas time.  Unfortunately, you have to wait until a puppy is 8 weeks old to bring them home. I guess that’s reasonable seeing as you are basically taking it away from its Mommy. Neither of these litters was available to go home until the end of December.  I started researching crate training and general puppy care. Did you know a puppy may need to pee as often as every 30 minutes? One week off was not enough. DH would need to work from home, or we would have to hire someone to puppy-sit. We could enroll the puppy in doggy daycare but not until the 12 week mark.  The more we researched, the more it became apparent- babies are just much easier!

So we returned to the business of baby making. I started my birth control at the end of Christmas break and began my stimulation cycle in January.  This time, my doctor recommended a Micro Dose Lupron Flare protocol.  I was a bit offended when I read that it was for “poor responders.”  We retrieved 17 eggs during my first IVF, and while only 2 panned out, that seemed to be an egg quality issue more than poor stimulation.  My doctor, who is a pretty smart guy, explained that the goal was not to produce a lot of eggs, but a good number of quality eggs.  I could hardly argue with his expertise, so I endured the five injections per day this protocol required.  You heard that right- FIVE! I injected myself with Lupron and Gonal F both morning and night and Menopur at night only. The Menopur requires a little more work than the other injections (see video here) and burns when it goes in. I had more symptoms during the stimulation cycle (flushing, headaches) than with the Long Lupron protocol, but less symptoms before and after the Ovidrel trigger, as I did not produce as many follicles and was, therefore, not overstimulated.

I was paying full price this time around as there are not too many studies wanting women with four miscarriages under their belt!  Being the thrifty girl I am, I learned a few tricks.  Namely, they had changed the Gonal F pen to where you dial a dose, and the window reads 0 if the entire dose is delivered or tells you the number of units left to complete that dose.  This comes in handy when using the pen’s overfill, which exists to give you the ability to prime the pen before first use and get rid of any significant air bubbles with use.  Each 900 Gonal F pen is supposed to have 126u of overfill and the 300s are supposed to have 115u (in my experience, I found that is not always true but there is always extra in there, and it’s like liquid gold so why let it go to waste). That is why so many people request 300s over 900s as you will use that many more pens and get that much more free Gonal F.  The proper way to utilize the overfill is probably to use 100% of each pen as you go along, which would mean giving yourself an extra injection every couple of days.  I saved all my used pens to the end, which  meant I gave myself 7 injections a day for the last days.  Saved me one whole pen, so worth every stick mark!

At retrieval, 12 eggs were retrieved: 8 fertilized normally, 3 were discarded and 1 was held for observation.  By day 3, 8 embryos remained in culture and 6 of these looked promising.  By day 5, the first day to freeze, none of my embryos had made it to freeze quality (expanded blastocyst), and I began to panic.  If you’ll recall from my first IVF, I had a large number of embryos make it to blastocyst, but only two of these ever made expanded blast, and that happened on day 5.  I began to prepare myself for a cycle that could potentially yield no usable embryos.  <By prepare myself, I mean I shed copious amounts of tears> Finally, on day 6, two embryos of good BB and BC quality were frozen.  The rest were allowed to go to day 7, but no more made it to freeze quality.

Again, we found ourselves in the position of having only 2 embryos and the decision whether to implant two to give us a better chance of one making it, or do an elective single embryo transfer.  Last time around, it was an easy choice as my doctor was 100% on board with SET.  This time, however, he mentioned that the protocol for my- ahem- advanced maternal age was to implant two.  We struggled and struggled with this decision, and in, the end, decided to implant just one.  I saw another RE on decision day, and (money aside) he thought we had made the right choice, so I felt pretty good about it.  I was also encouraged by the fact that I had been attending acupuncture throughout my stimulation cycle.

On the day of my frozen embryo transfer, I went to acupuncture both before and after the transfer (and voted in the presidential primary!). I ate  warming foods and brazil nuts and pineapple core to assist implantation for five days because I had nothing to lose at this point.  I also continued with my acupuncture appointments. I was scheduled for a blood test nine days post transfer.  My husband begged me not to pee on any sticks until the blood test, but I don’t like surprises so I was UNABLE to comply. Six days post 5 day embryo transfer (6dp5dt), I had my first positive home pregnancy test. 9dp5dt and the morning of my blood test, I had my second. This embryo became known as “Pinky” in honor of the two pink lines on the pregnancy test, and we decided instead of being cautiously optimistic, we would go “all in.” We recruited an army to pray for Pinky, prayed ourselves and talked to my belly daily, encouraging this little baby to grow, grow, grow.

We entered the infamous beta hell, except it turned out to be not so bad after all. My first beta at 4w0 days came back at a whopping 451, progesterone 10.9 and estradiol 187.  I began to wonder if they messed up and implanted two embryos. The rest of my betas were as follows:

4w2d: HCG 1456, Prog 12, Estradiol 225 (doubling time = 29 hours)

5w2d: HCG 15, 956, Prog 15, Estradiol 347 (doubling time= 48 hours)

6w2d: HCG 55, 319!, Prog 12, Estradiol 357  (I began to get nervous about a molar pregnancy vs. triplets???)

I intentionally scheduled Pinky’s first ultrasound for the end of the sixth week at 6w5d so there would be no ambiguity as to whether we should see a heartbeat.  I spotted the flicker on the screen as soon as the image became visible. Tears stained my eyes.  Dr S. congratulated us, and DH and I  began talking and laughing so much that he had to scold us so he could carefully listen to Pinky’s heartbeat. Pinky was healthy and measuring ahead at 7w1d!

6w5dultrasound.JPG

A little shy of 8 wks, we had our second ultrasound and Pinky’s heart was still beating away. He/she had done quite a big of growing and was measuring a whole 5 days ahead. Dr S. informed me that he would be cutting me loose. Whereas, just two years ago, I was puzzled as to why he was following me at all after achieving pregnancy, now I was hesitant to let go.  I fought the urge to beg him for weekly ultrasounds and accepted my transition paperwork to return to my OB-GYN.

At 10 wks, I saw my OB-GYN. It had been a while since we had connected, and I know she was truly happy to see me viably pregnant.  No one was more surprised than me to see a very ALIVE, dancing baby on ultrasound, measuring in the 88th percentile. My due date was set as November 13, just weeks before J’s birthday. We had opted not to perform pre-implantation genetic testing on our embryos, but we did agree to the Harmony testing.  All the results came back normal.

By 12 wks, I was visibly pregnant . . .

11w5d

And soon after, we announced it to the world.

sidekickannouncement3

We had moved beyond trying to conceive (TTC) to pregnancy after loss (PAL), and THAT was a whole new ballgame!

 

 


 

If you want to learn more about my fertility journey, you can read my fertility series and IVF series here.