My scan appointment is for late in the day so that Matt can be there too. Waiting, waiting, waiting all day. I've come down with a terrible cold so I've had the day at home resting up and waiting, waiting, waiting.
Early scans like these are all done internally, so when I get into the ultrasound room I've given a few minutes to strip off the lower half and then recline on a funny half bed covered in a sheet. It is a lot more modest than the embryo transfer, so I don't mind too much.
In strides the doctor and he quickly gets to the scan. Within a minute he has ultrasound probe prepared, inserted as required and is showing us a gestation sack that is firmly in the middle of my uterus. Good news! He tells us it is little too early to see anything else. He takes a bit of a look around just to be sure the other embryo that is transfered hasn't taken up residence in my remaining fallopian tube. It looks all pretty good. The specialist leaves me to get dressed and asks me to come across to his consultation room.
Matt and I are really happy - one baby in the right spot. Really it is the best outcome. The safest for the baby and for me. Our best chance for a healthy baby.
We sit down with the specialist and I ask about the bleeding. It has been going on, just very lightly for nearly a week and a half. The specialist tells me (again!) that it is really, really, really common in early pregnancy. He goes on to say that placentas are very complex and that they are continuing to implant and establish for the first 10 or so weeks, so that is the most likely cause. I just have to hang in there.
As my specialist is about to head off on about three weeks leave he gives me a referral to have a diagnostic ultrasound done. He says I should get it done in about a week and a half. By this time we should definitely be able to see a heartbeat and the like if all is progressing well. The diagnostic scan timing falls for when we are on holidays too, but we won't be to far from a major regional centre, so we are confident we will be able to find a radiology clinic to do the scan.
Matt and I are super happy. It is only a few days until our holiday, we have a little baby growing in the right spot. And the bleeding is normal. My new mantra - the bleeding is normal.
That night I drift off to sleep happy and thinking about our one little baby.
At 10.45pm I'm awake and in pain. It is very localised on the right side of my lower abdomen. I wake Matt and tell him I'm in pain. I decide to ring the 13 HEALTH number - a new service introduced in Queensland where you can ring and speak to a nurse about your symptoms. I'm on hold, the pain is not improving, no matter what I do. I hang up and go into the bedroom and say "that's it we are going to emergency."
Matt quickly gets dressed and we are on our way. Really, I was only ringing 13 HEALTH to get permission to go to emergency. Why do I need permission? I'm in pain, I know I'm pregnant, I know I had two embryos implanted and only one is in the uterus, the pain is on the right side (and radiating down my right leg) where an ectopic would most likely be, or it could be a miscarriage. I should be in hospital.
We go straight to the Mater, because we know where that is, and they have a big mother's ward - so I assume obstetrics is in their specialty. I actually rang the Mater Private emergency to ask if I came there if I would be able to see a specialist of my choice, given I have a number of doctors who are involved in this pregnancy and a whole fertility specialist group that my specialist is a part of. They say no, so we figure we may as well go to the public hospital.
At the public hospital emergency I'm admitted to a bed immediately. They are asking what I give my pain out of ten. Now, only two months earlier I had the same question with the gallbladder and it was really high. I think my pain threshold was confused because this was so localised to one spot and I kept saying maybe three or four.
Once again I have the needles in (a cannula to be precise) and blood coming out.
I couldn't sit still. I was rocking on the bed, and then I was crouching on the floor, trying to sit in the seat beside the bed, pacing around. Nothing helped. The nurse kept suggesting I should take some pain relief, but I didn't want to, I was worried about the baby being affected. This went on for the hours. The nurse trying to convince me, me rejecting the offer.
I feel the bleeding is picking up. I panic that it is a miscarriage. I go to the bathroom to change my pad to a hospital issue surf board size pad and have to leave my old pad wrapped up for the nurse (a male nurse) to inspect. Again, modesty is not a helpful trait when needing medical treatments. The nurse assures me that it isn't too much loss, not really all that heavy at all. Really? This is like 100 times what I've been having everyday and has been sending me into a panic and they don't think it is too bad. Crazy. How much blood does there need to be for it to be bad?
A doctor comes in to see me and immediately asks the nurse to bring me some pain relief. She doesn't even ask if I want it, just tells me I need it. I swallow down the pill. We discuss all the things I know about the IVF cycle, the pregnancy, the dates and the pain. I cry because I tell her I think it is miscarriage. She says she will do an examination of cervix to determine if it is a miscarriage once they have my blood test results back.
I'm again rocking and rocking on the bed. The nurse comes over and says to me "you see, you don't look to me like you are not in pain. You look like you have a lot of pain. What do you say to me giving you something that will make it possible for you get comfortable and maybe get some rest." I finally agree. I get a shot of morphine straight into my IV. It hits me instantly and I say "whoa - I need to lie down".
It is a lot better without the pain. Matt is wide eyed beside the bed. I keep telling him how glad I am we came into the hospital.
The doctor comes back and has a tray of instruments to look at my cervix. Basically the duck beak thing they use for pap smears and some long skinny tong/tweezer things and dressings so she clean up the cervix (of the supposedly not too heavy bleeding) and have a good look. She tells me the cervix is still closed. If I was miscarrying this probably wouldn't be the case. In her opinion it is not a miscarriage. She also doesn't think it is an ectopic - just because of my symptoms and my pain. To her the pain I describe and exhibit seems more like stones, kidney stones. She is poking around my sides and back asking if I have any pain.
Once she goes Matt and I are kind of in disbelief - more stones! This is getting ridiculous. How many things can possibly go wrong with me. At least we are a little more at ease that it isn't likely we are miscarrying. Our one little baby is still tucked away in there.
Whenever I see my nurse I ask if my blood tests are back and if he can tell me my HCG number. I want to know it. I manage to snooze a little, but Matt is on guard by the bed. He gets no sleep at all and is looking weary. I ask my nurse again about the HCG and he looks it up. It is in the mid 7000s. The nurse doesn't know really what it means, just that it is in the normal range for how far along I am. I know it is okay based on my other HCG results I can quickly calculate that number is fine.
The morning shifts are changing over. We are meeting new nurses and doctors and I am advised we are waiting on an ultrasound to have a good look around my pelvis. I decide I'll let my sister know I'm in the hospital. She lives just up the road and will be a good place for Matt to have a rest, once we know what is going on.
Time flies in the hospital. There is so much going on and I'm half out of it on morphine. Around 10am I'm wheeled off to ultrasound. The external scan doesn't show anything, so we need to do an internal again. Pretty quickly the sonographer is onto the issue - there appears to be a second pregnancy and there is bleeding in my abdomen. A ruptured ectopic. The pregnancy that is in the uterus is measuring 5 weeks and 1 day by the gestation sack. This seems a little small to me. By my numbers gestation wise I should be around 6 weeks and 1 day, but this is not the issue right now.
The sonographer leaves to speak with the doctor for radiology. The doctor comes back with her and has a look at the scans. He tells me we have an heterotopic pregnancy and that even though they are more common with assisted fertility, they are still pretty unusual. He says unassisted heterotopic pregnancies occur only 1 in 30,000. With assisted reproduction (like IVF) heterotopic pregnancy occurs in about 1 in 3000 pregnancies, which is still reasonably unusual.
I'm wheeled back to emergency. The emergency doctor tells me the gynaecology registrar will be down to see me and discuss what needs to happen next. Within 15 minutes the gynaecology guy turns up at the end of my bed and tells me again, that I have an ectopic pregnancy. He asks a few questions about why we started doing IVF. I'm surprised by the question and respond "to try to get pregnant". After a couple more questions it turns out, what he is getting at is that this surgery is likely going to result in my losing my right fallopian tube. I've already lost my left fallopian tube. Losing the right tube means we no longer can conceive naturally at all. He is trying to ascertain how we feel about that and whether we would prefer to try to save the tube.
I'm still coming to terms with what our decision will mean for us. Matt and I quickly discuss it and decide we'd rather not have the chance of having another ectopic pregnancy and as we are firmly down the IVF path we tell the guy to just take the tube. My aunty had three ectopic pregnancies, all at around my age. In her case the tube that they removed the pregnancy from and stitched back up just caused her to have another ectopic and then they took the tube anyway. I don't want that to happen. I really don't want to be back in hospital for this again. See ya later fallopian tube and last chance at natural conception in the future.
Before midday I am being wheeled up to surgery. It really is happening very, very fast. Matt says goodbye just outside theatre. An orderly takes Matt up to the gynaecology ward, so he will know where to find me after the surgery. Thankfully Matt has arranged to go back to my sister's and get some rest while I'm in surgery and recovery.
I'm wheeled into theatre. A whole stack of new faces. The anaesthetist is asking me questions - my asthma is always the issue - I haven't taken my medication. A new ventolin inhaler appears and I'm inhaling puffs, just to be careful. The consulting gynaecologist introduces himself - he is doing the surgery. They will do everything they can to protect the baby that is intrauterine. I'm sliding across onto the table. It is some different bean bag thing, I'm rustling into position. I already have the cannula in my arm so the anaesthetist is injecting me with what ever and I'm out to it.