No More Vag Pills

Just got the call: hcg is 20. Stop the progesterone and estrogen, send the clinic a note when I start to bleed, repeat beta to make sure it hits zero after bleeding stops. I'm grateful it's resolving on its own.

Topics to cover before trying again:
Acupuncture
Autoimmune protocol, especially prednisone
Need to do doxy again?

It took us three losses to get Alexis and Zoe. I try to hold on to the hope that as awful as more losses are, maybe they'll bring us back to a better place again some day.

BFNQNE

It's been a long week.

Tests turned to negative at home, and I chalked it up to either a chemical or just the trigger. Reached out to the nurse on Wed to see if I should stay on Estrace and was told to stop and come in for a regroup appointment before cycling again. That would have been nice to know earlier than the day my period was expected. So, regroup scheduled for today. Hit CD1 yesterday.

Talked to the doctor today and agreed on a plan. Did a baseline ultrasound, which showed an 18mm cyst on my left ovary. Ran bloodwork to see if the cyst was estrogen producing, meaning we couldn't cycle, or not, meaning we could.

The cyst isn't estrogen producing.

But my hcg is 1.1. The clinic won't let me cycle unless it's under 0.5. In other words, I did have my third chemical pregnancy, and now I've got a Big Fat Not Quite Negative Enough (BFNQNE).

On one hand, it's nice to know I wasn't going crazy with symptoms and lines. On the other hand, having to push out a month because of a miscarriage is brutal.

Sorry, little embryo, that I didn't make a better home for you.

Again

Once again, I see two pink lines. Once again, they're faint. Once again, in these early days, they don't seem to be getting darker. Once again, I wonder if theses are my lines - the lines that will lead to a THB.

Things I know:
These lines are definitely lighter than the ones with Alexis and Zoe. No twins thsi time, for sure.

Wondfos are notoriously inaccurate in gauging hcg levels, but the presence of two lines indicates there is an embryo in there.

Blastocysts grown in vitro can produce hcg in concentrations > 5. Wondfos can pick up hcg at concentrations of 8 or greater (based on my past CPs, with hcg of 8 and 14, both of which produced two lines on a Wondfo).

I had horrific night sweats Tuesday night. Soaked through the bed and needed to chnage clothes twice. This typically happens to me during the follicular phase. I can't recall if it happened during early pregnancy.

My BBT has not shifted up yet, although it didn't with the girls, either.

I felt lightly sick - sore throat and stuffy nose all weekend.

We'll see what the next few days bring. I'm much more zen about things this time. I'm ready to get on to the next cycle, as I never expected this one ot work, but I'm also talking ot the little embryo daily, telling it ot hang on and grow up healthy and strong.

Here's to the mind fuck that is pregnancy after many losses.

Risk Hope?

In early pregnancy, doctors expect hcg levels to double every 24-72 hours. A 48 hour doubling time is considered good and a promising sign. There is a bit of data to show that longer doubling times, while not automatically a problem, are correlated with worse outcomes.

My initial hcg was 249.9 on 13 DPO.

My second hcg was 837 on 15 DPO.

That's a doubling time of 28 hours!

Those are really damn great numbers. (That's the first time I've been able to say that about ANY of my test results in the last 8 months.) Those are numbers that mean this isn't another chemical pregnancy. But my first pregnancy ended in a blighted ovum, which would have had much higher hcg levels than those above. And that means these numbers don't automatically mean a "take home" baby.

So, do I risk having hope? I want to be hopeful that this pregnancy is going well and will stick around. I want to be hopeful that I'll see a heartbeat in 16 days. I want to be hopeful that maybe, just  maybe I'll get a happy ending.

Don't know what the answer is, but I'm going to stick with an affirmation a woman in my loss group shared: Today I'm pregnant and I love my baby.

I Told You So

For the uninitiated, hcg is a hormone created in early pregnancy. While the starting number isn’t too important (although there’s some solid research suggesting that the value at 14 DPO is predictive of outcomes), the speed with which the number goes up is critical. A viable pregnancy will see hcg double roughly every 24-60 hours, with a 48 hour doubling time being expected. My 12 DPO beta was 14. My 14 DPO hcg was 14. Saying ‘I told you so’ is rarely as rewarding as you hope. This time is no exception.

So, we’re on to miscarriage #3.  During the call with the office, I did a few things: asked to find out which doctor would be a better fit for me (answer: Dr. J), paid the bill from my d&c (high deductible health plan deductible met for the year now), and booked my saline sonohysterogram for May 6. I should know at that time if there’s anything structural causing these losses. I had a hysteroscopy years ago to remove a traveling IUD, so I know there’s no septum or other permanent structural issues. I could have a polyp or other adhesion that’s grown since Jan ’13, though, which might explain the issues. The sonohysterogram will determine if that’s the case.

To give a  quick summary of how a saline sonohysterogram works, the goal is to get a good picture of the inside of the uterus. Despite all the medical diagrams that you see in school growing up, the uterus doesn’t actually have an open space in the middle during normal life. While there is space there, the tissue presses up against itself. Thus, to be able to see clearly, a small catheter is threaded through the cervix and the uterus is filled with sterile saline. Following that, an ultrasound is conducted. At my clinic I’ve been told that the sonographer will do about 30 minutes of prep work, then the doctor will come in to perform the ultrasound and remove anything she sees. I’m to take 800 mg of ibuprofen before the procedure and arrive with a full bladder. Sounds like fun, right?

The other thing I plan to cover during that appointment is a question about my luteal phase. Research indicates that most blastocysts implant between 7 and 9 DPO. Once implantation happens, hcg begins to be produced in detectible qualities, and that hcg helps to prevent your period from starting. Thus, it’s important that your period not start early (14 DPO is the norm). In my case, the few periods I’ve had recently have started on 10 DPO. My progesterone this cycle was 14 at 12 DPO, so perhaps it isn’t a problem, but I want to delve into it further after 3 losses, so I understand better what’s happening.

Doing what PhD's do: Researching shit

As noted earlier, I’m a pretty logical person. I have a PhD, and I know my way around a good journal article. I can differentiate between a well run study and the crap that is produced by people with vested interests. Further, I genuinely enjoy reading research articles (horrifying confession, I know!). Thus, it was a no-brainer for me to start doing reading on the topic of repeat pregnancy loss. I have full access to MedLine through my job, so I did quite a bit of digging. I found many good peer-reviewed research studies on related topics. As a result, I decided to make several changes: I started taking 1000 mg of DHA, 200 mg of Ubiquinol, and 3mg of Melatonin each day. That was in addition to my normal prenatal.

As always, I used opks again in late March and early April, and although I had some mid-cycle spotting around CD12, I the opks started to darken at CD16. We had good timing again. I told myself that no one gets pregnant three cycles in a row. Normal chances are around 25% per cycle. I told myself not to get my hopes up, and to remember that an April pregnancy would mean a December birth, which would be suboptimal here in the frozen tundra of MN.

I told myself a lot of things, but I guess it didn’t matter because my period didn’t show up on day 10. Or 11, or 12. A faint line DID show up on day 11, and it stayed faint on day 12, so I went in for hcg and progesterone. Values – hcg: 14, progesterone: 14. Verdict, return in two days for repeat testing. Meanwhile the home tests are staying uber-light, so I can already tell what the call will be when it comes: “I’m sorry. . . “

If nothing else, at least I’m consistent, right?

Well, Hello There!

Hi there. My journey started in October ’15, when I had my IUD removed, just days after my 36th birthday. I remember my OB’s words: “Congratulations, you’re fertile!” Having been on birth control that prevented menstruation for nearly 15 years, I wasn’t sure what would happen next, but I knew my periods during high school and college were infrequent and light. I figured “fertile” might have been a bit of an overstatement, but we agreed that I’d wait 6 weeks for a period and call in for Provera if none arrived. I truly expected that the husband and I would spend 6 months trying to conceive through irregular cycles before starting fertility treatments in April 2016. I was the girl who’d gone 12 months without a period as a healthy 18 year old, so there was no expectation in my mind that 36 year old me could get pregnant, or probably even menstruate, without help.

To my utter shock, two weeks later I had a super light period, and 13 days after that, the opks I’d bought from Amazon showed an LH surge was approaching. Of course, life interrupted when my job was eliminated that day due to corporate restructuring. Nothing puts you in the mood to get pregnant quite as much as suddenly being unemployed, so that month our timing wasn’t great. Ten days after I ovulated, AF arrived, and by that time I had secured a new job and we were ready to try again.

Month two worked out better. Once again, the opks showed a surge starting on day 13 and peaking on day 15. Our timing was perfect. My online tracking software gave us a ‘high’ score, but hey, I’m 36, so I wasn’t expecting much. Still, day 10 post ovulation (DPO) came and no period arrived. Day 11 came, still no period. Since DH had to leave town for a week at 5 am on day 12, I decided to get a FRER and test that night. Within the 3 minutes, a second line showed up. Cue a straight-out-of-the-movies scene of DH picking me up and hugging me. We were ecstatic. The due date was our 10th wedding anniversary. It seemed like a sign and couldn’t have been more perfect.

Days passed and the lines got darker on the home pregnancy tests. I scheduled a first ultrasound, but due to DH’s travel schedule, it wasn’t until 9.5 weeks. I spent the time with mild nausea, the worst cramps of my life, and a few other nasty side effects, but otherwise all was well. Except that it wasn’t, because the ultrasound revealed a blighted ovum. Development had stopped weeks ago and my body hadn’t figured it out. I opted to have a d&c at 10 weeks in January. It was one of the roughest experiences, emotionally, I’ve ever had.

My doctor told me as long as we were emotionally ready, we were cleared to try again as soon as I’d had a period. It took a full 6 weeks for my hcg to hit zero and AF to start, but it did in late February. While March’s cycle had a longer follicular phase than normal, I got a strong positive on an opk roughly day 17, and our timing was once again good. Twelve days later, when my period still hadn’t arrived, I tested and got a faint line. The lines stayed faint, and when I went to the doctor for a beta around 17 DPO, it was 8. “Chemical pregnancy” they told me. I had therefore joined the 1%. That is, the 1% of women who experience repeat pregnancy loss.