Mission failure

Today I am recovering from a curette. This is the third time I've had this procedure, which is necessary after a partial miscarriage. I'm certainly a lot more philosophical about it today than I was on Wednesday, the day before the curette. 

Wednesday morning started like any other. I happily rolled out of bed preparing for work. After going to the loo I noticed a very small streak of pinkish, redish blood on the toilet paper. I immediately grab more paper and wiped again - nothing. I repeat this again, still nothing. 

I've had bleeding in every pregnancy. Every time doctors have told me bleeding happens in loads of pregnancies and that it is fine. This is smallest amount of bleeding, it is so tiny, I actually consider if I should even bother with telling Matt. I know the effect telling him will have.  

I have a shower and think about all the possibilities, I wonder if it is because I stopped the progesterone support on Monday, perhaps I need to start taking it again. I decide I will ring my fertility specialist's office, even though I know my doctor is on leave still. I'm hoping they will have someone on back up who can make a call on what I should do. I tell Matt about the spotting and tell him I'll ring the doctor and see if I can get a blood test or even better another ultrasound. As I'm leaving for work I tell Matt I'll call him once I've spoken to a doctor.

On the train to work I keep thinking about it. I was going to wait until I got to work to make some calls in private, but I just can't get it out of my mind. I decide to make some discreet calls on the train. My first call was to my fertility specialist and again, with my doctor on holidays it is hopeless. The receptionist suggests I ring my obstetrician. I ring the obstetrician, her receptionist initially recommends I speak with my fertility specialist - once she knows he is on leave she suggests I make an appointment with my GP to get a referral for an ultrasound. I ring my GP, she is on holidays too, however now she is in a GP super clinic so I make an appointment with another GP for 4.30pm. 

I ring Matt and tell him I'm going to make a sneaky appointment, before I have the ultrasound referral, so once I've seen the GP we can go straight to the ultrasound. 

My fertility specialist's receptionist rings me back, she has spoken to another specialist who said the bleed might be a reaction to going off the progesterone and that I can start taking them again. Personally I didn't really find this helpful. Then my obstetrician's office rings me back, the obstetrician has given me a referral for an ultrasound and has already made me a 1pm appointment with the Women's Diagnostic centre at the Mater. The receptionist is even going to take the referral up to Women's diagnostic for me, so I just go straight there. Awesome, this is super helpful.

I'm really impressed and relieved. This obstetrician is supposed to be the best. She is really hard to get in to see. I figure now that she has organised the ultrasound that she'll be on hand to review the results of the scan and will take me on, two weeks before my initial appointment, if I need any medical intervention at this point.

At 12.30 Matt comes to pick me up from work and we head to the Mater. I was genuinely thinking this is just another crazy pregnant lady scan. I'm 99% sure everything is fine. Maybe even more than that. Our last scan was only 11 days ago and it was perfect, bleeding in early pregnancy is normal - I've been told that soooooo many times.

As per usual for these scans I'm busting to pee. You need to drink 600ml of water the hour before the scan as it is easier to see the uterus with a full bladder - or something like that. The sonographer gets the scan underway with squirt of cool gel onto my tummy. This room has a screen at the end of the bed, so it is really easy for Matt and I both to see the scan. 

I can see where the baby is, the sonographer zooms in. It is different to my last two scans. I can see the baby, it looks still, completely still, no flicker, nothing. The sonographer pokes around a little bit more and then says, I don't think I can see the heartbeat. She asks when the last scan was and suggests it is best to do an internal scan to get a closer look. She sends me off to pee before the internal scan and in the toilet I start crying. I can't believe it. This was supposed to a reassuring scan, not a confirmation of the worst scan. I try to pull myself together and head back into the room. When Matt sees me he looks a little shocked, I must look bad, or maybe he still had some hope, I'm not sure.

The internal scan is no better. Definitely can't see the heartbeat. Baby measures 8 weeks, which marginally smaller than the last scan. The sonographer wants to bring the doctor in to be extra sure. The doctor is also certain. They both say they are sorry. When they leave room for me to redress I lose it. I just can't believe it. I'm growling a series of questions out loud. Why is it always that the baby stops developing almost immediately after our last scan? Why do we have almost 2 more weeks thinking everything is great? Why do we get further along than before, with an absolutely perfect, no signs of trouble pregnancy only to once again lose the baby? How many times can this happen to us? How much of this can we take? I finally say I don't even know what to do anymore.

Matt is more the quiet thoughtful type, so he says nothing. We are both gutted. 

To their credit the Women's Diagnostic unit is all kinds of awesome, unlike the ridiculous situation that occurred last time we had the same result in the Mt Gravatt Qld Xray. This time they bring all the paperwork to me in our room, so we don't have to go back out to the front counter and pay in a distressed state at reception. They recommend we head straight down to our obstetrician's office, that they will ring in advance and let them know the outcome.

When we get downstairs the obstetrician has already left for the day and the receptionist will have to reach her to find out what to do now. She doesn't think they will be able to fit me in as the obstetrician is fully booked and besides doesn't have any of my complex medical history. Again she suggests I ring my fertility specialist and find out who he has on call for him. I already know the answer is no one, that is the answer every time. She suggests Matt and I hang around the medical precinct for a while so she can try to sort something out with our fertility specialist. 

Matt and I head down to West End and have some lunch. I can't believe the obstetrician can't help me. I thought that she would, given that she'd arranged the ultrasound. I know I need a curette, I know this is a really common obstetrics procedure, but my obstetrician won't take me, my fertility specialist is holidays until Monday and I'm stuck ringing around like a beggar trying to get someone else to take me. I ask my fertility specialist if the doctor who did my last curette, because my specialist was on leave, can take me? I tell the obstetrician's receptionist that another doctor in their group did my first curette, can she take me? The receptionists start ringing around for me. 

The first offer from the fertility specialist is a Friday appointment at 4.30pm. I know I won't be able to get the curette on the same day, so it will probably be Monday before I am having the procedure. I accept it as it is the best that can be done. Great we have days of carrying around the dead baby, with the chance that it could start to fully miscarry (which is apparently very painful and has the risk of me hemorrhaging and losing lots of blood). 

Matt and I decide to head home as there is little chance we will be seeing anyone today. We are almost home when the obstetrician's receptionist rings me back having made an appointment for me with the newest obstetrician in their group. She can see me right now. We have to get over to Spring Hill. We head back to town and meet another doctor. I think she's a good fit for me because she is a part of the Queensland Fertility Group (where I get my fertility treatment) and rivercity obstetrics (where I've had my small amount of obstetrics).

The new specialist has to ask all the horrible questions about my gynecological history:

• How many pregnancies? 4
• How many live births? 0
• How many miscarriages? this is number 3
• What other problems? 2 ectopics - 0 fallopian tubes left and I had my gallbladder removed.

At this point 3 + 2 doesn't equal 4, so I explain the last pregnancy was heterotopic, so I had the pleasure of ectopic and miscarriage. Once again, the new specialist tells me how rare heterotopic pregnancy is and reflects on what a tragic year 2011 was for us. 

Thankfully she has taken the liberty of already making a surgery time for us. At noon on Thursday at the same day specialist surgery most of the QFG stuff is done. She steps me through the risks of the procedure. She is very sympathetic. I'm really grateful she would take us on. 

Matt and I head back to the car. I tell him I'm glad we got with in with someone, I have a little moan about how stupidly hard it has all been. I then say, I'm not looking forward to having to ring the family. Matt says, neither am I. 

Mini milestone - drug free pregnancy

Tomorrow I reach a mini milestone in this pregnancy. Tomorrow I can stop taking all the supporting medications that are required when doing IVF, and I can't wait.

Since a few days before my frozen embryo transfer I've been taking progesterone (provera) and oestrogen (progynova) tablets orally morning and night. In addition, I've also had the pleasure of administering progesterone pessaries morning and night. Once inserted I have lie down for at least half an hour. At bed time this is no trouble. Mornings are a different story. For the past couple of months I've had to get up a half hour before I need to and administer the pessary and then go back to bed. This sucks. Weekends aren't too bad. Work days are bad and the days when I'm flying for work have been the pits.

The other hassle about the pessary is they need to be refrigerated, therefore all travel is a pain. At Christmas time Matt and I had a pessary esky that travelled with us everywhere. Every time we got to someone's house we whipped the drugs into their fridge and the ice packs into the freezer. Overnight travel for work is again worse. Early check in is inevitably unavailable and I have to ask the reception girls if I can leave my medications in a fridge somewhere.

Basically pessaries suck and I can't wait to stop having to take them. I've been reading up and apparently the placenta has now taken over the role of production of pregnancy support hormones and can reliably be trusted to make the levels I now need. Before now the corpus luteum (which is created when ovulation occurs) is supposed to deliver the progesterone required to support the pregnancy. I'm not sure why when doing a natural cycle like I did that my corpus luteum (surely I must have made one when I ovulated) couldn't still be trusted to do this role. I do know that high levels of progesterone are associated with higher pregnancy success rates, so perhaps the progesterone support increases the chance the baby will hang in there.

Tomorrow marks 10 weeks by my original numbers and all is still looking good.

Panic sets in and passes again

Exactly 2 weeks and 1 day after our first ultrasound I started to panic that our baby was going to miscarry or was already miscarrying. I had no cramping, no bleeding, basically I had no symptoms of miscarriage. However, I also suddenly had no morning sickness, my fatigue had dropped. I felt great and I panicked.

My fertility specialist is obviously used to his patients who have struggled through infertility going crazy and thought to send me two referrals for ultrasounds, despite only really needing the one to confirm the pregnancy at 6 and half weeks. I grabbed that second referral and booked in for another ultrasound to find out what was going on.

Last Friday Matt and I were super pleased to find out our baby was still there and kicking arse with a whopping 167 beat per minute heart beat. Baby (which I think is still technically called an embryo) measured 8 weeks and 1 day. While I had our numbers at 8 weeks 4 days, the sonographer assured us that in early pregnancy the days can commonly be out by up to 5 days.

I do wonder about just how accurate the measurement in ultrasound is. Apparently those little tiny babies, ours measured just 1.8 centimentres, can be doing crunches or stretching out, making their crown to rump measurement relatively shorter or longer. Then, what about naturally different growth? I wonder if our baby is more likely to be short, like me, rather than a tall, like Matt.

Over the past week my unpleasant pregnancy symptoms have remained at bay. Queasiness has disappeared altogether giving way to previously unknown urges to eat chips or vegemite sandwiches. Peeing in the middle of the night has picked up, making an uninterrupted night's sleep a thing of the past - which I understand is good practice for when the baby is born.

I am also having vivid dreams that I remember about nothing especially important. I had a very detailed dream about one of my colleague's hair. Last night I had a lovely dream where I was holding our new baby. I don't know if it was a boy or girl, but it was only a dream...

Right now I feel really positive about the pregnancy. I'm the most pregnant I've ever been and absolutely nothing is going wrong. I want to stay this way, excited, happy, confident. It has only been 6 days since the last ultrasound and it is three weeks until my first obstetrician's appointment. It seems like a long time to wait. I hope I will remain panic free and happy until then.

A happy new year

As of today I'm eight weeks pregnant and I've seen in the new year with everything looking rosy on the baby-making front.

We had a pregnancy viability scan in Cairns while we were on holidays and it was everything I could have hoped for. Only 1 baby, measuring 0.49cm, which equates to 6 weeks and 1 day with a heartbeat of 113 beats per minute. I asked the sonographer to have a good look around to check that another gestational sack wasn't implanted somewhere it shouldn't be, but nothing else could be found. This is the first time I've left an ultrasound place happy. The result was conclusively excellent!

I felt mixed feelings of relief and disappointment that only one embryo took. Having two babies seems like a great long term outcome and takes the pressure off needing to try to get pregnant again any time soon. However, I know that one baby has a much better chance of progressing to healthy, trouble free pregnancy and birth. That's exactly what we need, fewer troubles.

In the last couple of weeks early pregnancy symptoms have truly kicked in. Fatigue is my worst symptom. I nearly always need a nap. I'm also experiencing a touch of morning sickness, which for me has been a lot more like all day sickness. I feel a little bit sick, not enough to vomit as yet, nearly all day. I'm trying to pin point what makes it better and what makes it worse, but haven't been able to nail it down. I've also become a champion burper.

At eight weeks the baby is still really small. Apparently it would now be around 1.4 - 2.0 cm and would still have remnants of a tail. Gross. If all continues to go well, the tail should be gone soon enough.  :)

Slow news days

For the first time in pregnancy I have experienced slow news days. Literally nothing is happening.

Last Thursday I did my follow up blood test and my HCG levels had more than doubled to 420 - which is great and exactly what should be happening in those early weeks. In my three previous pregnancies I had spotting/bleeding to different degrees by this time. But this time, I have nothing.

This week Matt even asked when my next test will be. I had to tell him I don't need to have any tests because nothing is going wrong. We were both kind of laughing about it. How strange it was that I wasn't running in to do blood tests every other day and then waiting for the result. I told Matt that I actually don't feel like I'm pregnant because my experience of pregnancy has always been so stressful and worrying. Without the worry, it feels just like normal.

We do have a viability ultrasound referral. Unfortunately due to the Christmas holidays I can't go into the specialist's office for the viability scan. The good thing about going to an ultrasound place is they have better equipment so we should be able to see the baby (or babies - slightly freaking out about that now it seems it could be a real possibility). The bad thing is if something is wrong I then need to track down a doctor to interpret the scan.

I know exactly what I want to see during the ultrasound. A great big strong heart beat. A baby (or babies - still freaking out) that measures within a day or two of the size it should be. I want to see a conclusive result so we know the baby (or babies...) is well and doing what it should do.

Occasionally I catch myself and I know I am really excited. It feels like this time it is for real. Then I have days, like today, where I wake up and think "maybe it's blighted ovum, I've never had that happen and that would be just our luck." There is no reason to believe this is blighted ovum, I just can't believe that finally this could be it.

Today I am 5 weeks and 3 days pregnant and everything is looking good, although it is still super early days.

The old adage no news is good news rings true.

How long can the lady resist?

I out did myself, in my opinion, making it all the way to Saturday before home pregnancy testing. I forgot about testing first thing in the morning, so I peed without the test. Then a few minutes slipped past and I remembered I was going to test. For about 1 minute I thought, oh well, I'll just wait until tomorrow. Then for the next 10 minutes I couldn't stop thinking about it.

Once again I decided to stretch one of my rules, the don't test on anything other than first thing in the morning pee rule. I figure if I can squeeze out a little more pee right now, then it is still really first thing in the morning pee and will still contain the stronger hormone. Back to the loo I go, with my expensive in stream pee test. As I'm trying to squeeze out my last bit of morning pee I start to worry I'm not going to get enough pee on the stick to get a result. Damn. I will have wasted one of my tests by getting a tiny bit of wee on it. I resort to the old school cup collection method, so that the precious first thing in the morning pee wasn't just wasted.

With my cup balanced in the sink I dip the fancy instream test. The test screen starts to change immediately. I'm so pleased I went to pee capture mode, I would never have got enough pee on stick otherwise. I see the control line appearing straight away, quickly followed by a faint positive pregnancy test line. The faint line is becoming stronger. It is definitely there.

I can't believe how good this test was. The result came up so quickly, no need to discard and pull back out of the bin later. The expensive test was so worth it.

I tell Matt and I'm reasonably excited. He smiles, but doesn't seem too excited. It is too early. I want to be excited, like I was the first time we were pregnant. A little part of me is. The rest of me feels nervous.

On Sunday I started to think perhaps my test was wrong. Perhaps because I got a little bit a of pee on it, and then went for pee capture mode, maybe the test got confused and counted my hcg twice. I'm not even sure if this is possible, but I decide I must re-test with first morning pee on Monday.

On Monday I decide not to mess around with in flow and go straight to pee capture mode to prevent loss of precious early morning pee. I'm convinced the more expensive in flow tests are better, but then fail to use them that way (hmmmm...). The test quickly returns a positive result again. I'm reassured, I'm definitely pregnant.

I decide I have to speak to the fertility specialist as mid week last week my belly button started leaking out a small amount of yuk again. I confess to him that I've done a home pregnancy test and that now I'm worried about the return of the ooze somehow impacting the new pregnancy. We again discuss the colour, smell and amount of yuk coming from my belly button. He decides I should do my blood test on Tuesday so we know where I'm at (yay! Blood test brought forward 4 days!) and I should pick up a script for antibiotics. I don't need to take them right now, but hold onto the script in case the ooze picks up.

My blood test result today confirms I am pregnant. HCG was 178. That's fine for 4 weeks pregnant. Clearly it is way too early to tell anyone I'm pregnant, so shhhhhhh, it's a secret. Let's hope we make the 12/13 week hurdle and then I'll let the cat out the bag.

Obsessive much?

Transfer was less than 1 week ago. When do you think I might have started thinking about home pregnancy testing? I'd say, about 1 week BEFORE transfer!!!!

I just can't help myself. I'm a terrible home pregnancy addict when I reach this point. Having been through a full cycle recently, I have had some learnings that I'm already trying to implement.

Firstly, no more cheap pregnancy tests. The day after transfer I invested in an expensive pharmacy (no more crappy supermarket) 3 pack of pee on a stick tests. These ones are supposed to pick up traces of HCG at fairly low levels. Why do I need a 3 pack? I held the 2 pack in my hand for some time, but then I thought about how long it was between then and the blood test. I also thought, even if I do get a test that is positive, I will no doubt need to test again the next day just to be sure. And if I got a negative test, I'd definitely need to test again, and then if the second test was positive I'd still need to do the third to be sure. What if I got two negative tests? So you see, there was no way around it, I needed the 3 pack or two 2 packs. I felt I showed restraint. I hope I don't end up buying more to feed my addiction!

Secondly, don't test too early. Testing too early made me feel really bad last time. That first negative rocked me, and then I became crazy bin diving test re-check lady. Today I resisted a very strong urge to test. I had that packet open and was looking at the three tests, but said no, not yet. I initially told myself I could do my first test on Friday after transfer, that's tomorrow. I'm wondering when should I test. Blood test is still a week from tomorrow. But by the numbers, tomorrow will be 11 days since ovulation. The test packet says 99% accurate for test taken from 1 day before period is due, that would be Sunday. Because I'm using progesterone medications, I shouldn't get my period even though it would be due, so I can't just wait for a period to show up. Can I wait until Sunday? Should I go with my original plan and test Friday and then re-test on Sunday? That is sounding like a plan to me. That way if Sunday is negative, I can retest on Tuesday (trying to obey my 2-days before re-testing rule).

Maybe I should have bought two of the 2 test packs...