22w0d: Overwhelmed but happy

So, I think that I may finally be accepting the fact that I am pregnant. This is helped by everyone around me pointing out that fact. The guy that served my lunch on Friday said "Had a great weekend. Both of you". Neighbours are stopping me to wish me congratulations. Honestly, I'm amazed at how brave people are to comment on my bump this early on. But it is nice to know that all those extra kilos have been collecting at the right places.

The fluttering has turned into kicking, and it is so reassuring. As I have an anterior placenta, the doppler is quite difficult to use, but with all those kicks throughout the day, I usually feel pretty certain that everything is okay.

I am trying to read some baby books, but will often feel overwhelmed with how much there is to learn, and how much we have to do before the end of July. I am excited too, though. Every day I am reminded how lucky we are to be in this situation, and how if everything continues to go well, what an extraordinary summer we will have.

Scan and bump photos here.

18w6d: Babymoon

We are having a wonderful time on our babymoon. It is so luxurious to get away from the daily stresses of life, and just kick back and relax. I am loving our two weeks by the sea, soaking in the sunshine and spending long hours with my husband. I now feel the little one wiggling away every day, which is so reassuring and delightful. We are both feeling very hopeful for the future, and I love the way that my husband rubs my belly when we sit side-by-side.

Now only over a week until our 20 week scan. If we can, I would like to find out the sex, but most of all I am hoping for a perfect bill of health for this little one.

11w3d: Exhausted

In exactly four days time I will be making my way to the hospital for my NT scan. I am scared of all the things that can go wrong, and excited about what a milestone it will be if everything looks good.

So in order to get me into the spirit of the occasion, I have been doing what any good scientist would do, and reading through the literature surrounding the tests that will be conducted at this appointment, mainly, the NT scan and the blood tests.

The nuchal translucency (NT) test measures the thickness of the sack of fluid behind the neck of the fetus. In general, a fetus with a trisomy (three copies of a chromosome, rather than two) has a thicker NT than a chromosomally normal fetus.

The first figure below illustrates this observation. Each black dot represents two measurements (the crown-rump length and the NT thickness) of a single fetus that was subsequently found to have trisomy 21 (Down's Syndrome). The dark grey rainbow is the distribution of 90% of chromosomally normal fetuses. As you can see, in normal fetuses the NT thickness gradually gets thicker as the fetus gets larger. However, in trisomy 21 fetuses, the thickness remains relatively constant during this gestational period, with a mean thickness of 3.4 mm.

(from Kagan, et al., Ultrasound Obstet Gynecol 2008; 31: 618-624)

The second test is a blood test of the mother to measure our old friend beta-human chorionic gonadotropin (beta-hCG) as well as pregnancy-associated plasma protein-A (PAPP-A). The values on the axis are multiples of the median (MoM), that is, by how many-fold does a result differ from the median value from all normal women. By definition, the median beta-hCG for unaffected pregnancies is 1.0, and the median PAPP-A for unaffected pregnancies is also 1.0.

This second figure below shows how the blood tests from women with trisomy 21 fetuses varies from women with chromasomally normal fetuses. Each dot represents the values from a single patient with a trisomy 21 fetus. The unfilled oval represents the lab values of 90% of women with chromasomally normal fetuses. The median beta-hCG values were 2-fold higher and the the PAPP-A values were 2-fold lower in women with trisomy 21 fetuses.

(from Kagan, et. al., 2008, Ultrasound Obstet Gynecol, 31: 618-624)

So here's hoping that all my dots fall in the normal range, and I can pass this test and start to look forward to moving into the second trimester. It is still feeling unreal, so I hope that seeing a wiggling little fetus on the ultrasound next Tuesday will put some of my anxiety to rest.

References:

Kagan, K.O., Wright, D., Baker, A., Sahota., D., & Nicolaides, K.H. 2008. Screening for trisomy 21 by maternal age, fetal nuchal translucency thickness, free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol., 31: 618-624

9w2d: Happy

Today was supposed to be the day of my post-failure consultation with my RE. We were going to discuss strategies to improve my endometrium thickness during the next round of stimulation. I was going to be leaving today with a cooler full of medication, ready to start my suppression injections.

Instead, here I am, pregnant, and less than three weeks away from my week 12 scan. I don't know how one can be in shock for more than a month, but I still feel blown away by our luck.

On Tuesday we had our first appointment with an obstetrician. I had expected just a quick interview with a few routine questions, but they were very thorough. Full medical history, weight, height, blood pressure, urine test, and six vials of blood. They tested for anti-RBC Abs, STIs (syphilis, HIV, hepatitis, chlamydia ), infections (rubella, toxoplasmosis, CMV), blood type, hormones (TSF), and did a full RBC and WBC. I smiled as she said that since it had been over three months since my last SDI screen at the fertility clinic, they had better run it again. I guess they figure I must have gotten pregnant somehow.

Best of all, before she started the consultation, she gave us a quick peak at the embryo with an ultrasound. I whipped off my pants before she had time to realise that we had already had a scan last week, and we were greeted with a happy looking blob on the screen. I was a bit worried at first, as I couldn't see the heart beating and it looked the same size as last week. However, she she pointed out the heartbeat and measuring the embryo as measuring 9w3d, three days ahead of schedule.

Ultrasound and belly photos here.

Overall, I am feeling fantastic. I feel nauseous unless I am constantly nibbling on simple carbohydrates, which might explain the 4 kg increase in weight over the past two months. I however like to think that I am just growing the most comfortable womb ever. I have back pain if I twist or bend down, and heart palpitations keep me awake during the night. I am always thirsty, and I love pineapple and orange juice. My breasts are larger and slightly sore.

I love being pregnant. I was never convinced that this would happen for me, and I love every day that this little embryo grows inside me.

7w6d Tomorrow

I have seen a lot of scans of my uterus over the past few years. I even have a few photos from my laparoscopy. Yet I have no idea what I will see tomorrow.

One one hand, the queasiness, fatigue, sore breasts and lower back pain suggests that I might be gestating something. On the other hand, these symptoms are all psychosomatic, and I know of plenty of women who have received terrible news at their first ultrasound scan.

Seeing a heartbeat tomorrow is both imaginable and completely impossible.

Tomorrow, we open Schrodinger's box, and hope he didn't share it with Pandora.

7w0d Waiting

Today marks my seventh week of pregnancy, if indeed that is what I am. My husband likes to remind me that I can only claim five weeks of this as the true post-conception period. It has been three weeks since I saw those two pink lines. One more week until our first ultrasound.

During our last pregnancy, we had our ultrasound at seven weeks and received the news that I had already miscarried, like we suspected. This time around, I am feeling a little more hopeful. My betas were strong and doubling, I am feeling constantly queasy and tired, and I have not even had a single spot of spotting.

I am trying not to think about what any of this means until after the ultrasound. I keep imagining alternative scenarios - will we see a thriving little bouncing bean, or will we see nothing but a still and silent sorrow?

Seven days to go.

Grateful

Thank-you all for your excited comments and congratulations. There were over 100 exclamation points in your replies. I was really moved to read such excitement, especially as many of you have been through so much more than we have, and you are still waiting for your own good news.

Many of you asked why I didn't announce this sooner. There were two main reasons.

1. I wanted to wait for my husband to come back home so that I could share this news with him in person.

2. I am still skeptical that this all means what everyone think it means. Sure, I have an exponentially increasing amount of hCG in my serum, and I feel a little queasy and tired, and I haven't seen my period for over 6 weeks, but still, I don't know.

I look at those pictures of month-old fish-like embryos and read phrases like "the neural tube closes" and "small buds will soon become arms" and "heart contractions start", and they all sound preposterous. I bought a pregnancy book but then put it away because it seemed completely irrelevant.

I find myself remembering all over again 100 times a day, and every time it surprises me. I have spent so many years day-dreaming about getting pregnant that this feels like just another fantasy.

As I said before, pregnancy is what happens to other people. Not me. And especially not without an embryologist.

Twelve days until my first ultrasound. I hope to see some wonderful sights that day that change my mind.

Happiness today, Hope tomorrow

No Baby Ruth was kind enough to nominate me for the "happiness today, hope tomorrow" award, created by Miss Ruby. Her instructions are to acknowledge something that's making you smile and a hope for one amazing thing to bring you even more happiness. Then pass this award on to anyone who would benefit from looking at their life now and finding happiness in it..



Previous recipients of this award include:
non geordie mum
The life and times of KitVonD
All In One Basket
one donor. one husband. one month at a time.
Adventures in Infertility-Land
My Cheap Version of Therapy
Blawnde's Blawg
The Elusive Embryo
Little Looman Log
My words fly up, my thoughts remain below
Our Fertility Journey
Mommy-in-waiting...
Half as Many Chances
The Road Less Travelled
And Baby WILL Make 3!
Going For It
Time Well Wasted
phoebe gone wilde
Serenity in Chaos
No Baby Ruth: Playing Baseball Without a Bat

I enjoyed reading through their entries and learning about their current joys and wishes for the future. Common themes included

Things that make us happy...
Job
Community
Beauty
Friends
Family
Food
Pets
Travel
Rest
Autumn
Vacation
Play
Sports
Body
Health
Home

Our hopes for the future...
Pregnancy
Birth
Adoption
Travel
Relationships
Friends
Family
Home
Relocation

As for me, I am so happy to be married to such a wonderful person. My husband is the best part of my life, and makes me smile with joy. I am hopefully that I never lose perspective, and that I remember that no matter where life takes us, as long as we have each other we will make a beautiful family.

I am passing this award along to anyone who wants a bit of hope and happiness in their life.

IVF#2: scheduled

Thank-you for all your advice yesterday.

I called the clinic today and spoke with a lovely midwife. She said The Professor had very recently put a big note on my file saying that he must meet with us before we proceed with our next cycle. My husband suspects that The Professor wants to talk to us about my thin endometrium and suggest some further tweaks to our protocol.

However, I managed to convince her to let me start BCPs before the consultation, and schedule me to put me into the system to start injections a few days after the consultation. So this is my tentative calendar:

November 16: Start BCPs
December 23: Consultation with The Professor
December 27: Start suppression with decapeptyl
January 6: Start Gonal-F stimulation
January 24: Tentative transfer
February 4: Tentative beta

I am so happy that I can ring in the New Year while in the midst of an IVF cycle, full of hope and excitement for the year ahead.

FET#1: CD14

No more injections! We trigger tonight.

Right ovary: follicle 16.1 mm
Left ovary: nothing big here
Endometrium: disappointing 6.7 mm

Transfer is scheduled for Friday.

The Drawer of Hope

If you took a quick glance looked around our home, it would look like that of any other child-free couple - holiday photos, thick novels, delicate glass ornaments on display. Open a few cupboard doors, though, and you would find some clues as to our hopes for the future. The shelf containing books like "The Land of IF". The pre-natal vitamins in the kitchen. The Pregnyl in the fridge. The needles and sharps container in the bedroom.

And if you were to open the very bottom drawer in my husband's wardrobe, you would find our Drawer of Hope. The outfit I bought to tell my husband I was pregnant the first time. The hat we bought before our last IUI.The onesie we picked out when I was pregnant the second time. The clock that would be perfect for the nursery.

We don't open the drawer very often, but I am glad that we have it.

Cleared for take-off

I had my baseline check today, and we are cleared for stimulation.

I was a little put-off by the midwife who did the scan for me this morning. She wasn't very gentle with the wand, and she couldn't even find my left ovary. She just told me that it would stand out if there was a cyst on it, so it must be okay if she can't see it. Nor did she do a blood test.

I told her that I responded very quickly to Menopur, so she booked me an appointment for Tuesday (day 6 of stims), only to call me and move it to Wednesday (day 7 of stims).

I am not very good about standing up for myself. I don't know what is normal and what is not. Should I have requested a baseline blood test? Should I have insisted on a Day 6 scan? Or do I just need to relax and trust that this clinic knows what they're doing?

My Dream Cycle

I was inspired by Ms Egghunt today. She wrote about her flowchart for a perfect cycle, and said that she stuck it in on her door for inspiration, ticking off each milestone as it comes.

I think that this is a really positive and energising act, so I too have created my own flowchart for the next few months. Here's hoping that the Chief of the Universe gets the memo, and we both get to tick the boxes all the way to the end.

Back on birth control.

As of today, I am back on the pill, and starting my first IVF cycle, using the standard long suppression protocol. However, my clinic is closed over the summer, so I don’t start Menopur injections until Thursday August 19, which is another seven weeks away.

I am so excited that the time has finally arrived for us to start this cycle. After two clomid IUIs and two injectable IUIs, I am hoping that the process will be familiar, though hopefully with a different outcome.

With my IUIs, I always spontaneously ovulated before my lining had time to thicken. Hopefully the supression from Suprefact will hold everything back a bit so my endometrium has time to mature, if not with a fresh cycle, then maybe a frozen cycle.

I am hoping that work is not too busy around that time, that I don’t have too many early morning meetings, and that there isn’t anything critical when I suddenly have to take a few days off. Once again, I will begin the familiar pattern of trips to the clinic in the morning, anxious afternoons waiting by the phone, and then injections in the evening.

I am still a bit nervous about the retrieval. The nurse assured me that they administer plenty of pain relief during the procedure, and even put a special note in my file that I can have a Xanax before the procedure. I took something like that before my laparoscopy, and it made the world of difference. Funnily enough, knowing that I won’t be feeling anxious before the procedure is enough in itself to substantially decrease my worries.

So it is time for me to make my way twice around the circle of birth control pills, and then the real adventure will start to begin.

2009 and 2010

Well, our second IUI did not result in a pregnancy. Even though 2009 we may not have succeeded in getting pregnant in 2009, it was still a wonderful year. In my opinion it is much harder to find the perfect spouse than the perfect baby. As long as I have my husband by my side, I am content to wait for a bit longer to expand our family.

Last year we got the ball rolling, started our journey into assisted reproductive technology. We are now in the system, and hopefully a series of injections and probes this year will finally flip the odds in our favour.

Laparoscopy next week

The midwife called me back last week, saying that she had heard that I had some “not so good” news. She was really kind and gentle, and she has me booked in for a laparoscopy next Monday. At first I was really frightened, but then I had a long talk with my husband and he was very pragmatic and thoughtful.

He said that if I was too worried about the procedure, then I should cancel it. If I thought that the benefits outweighed the risks, then I should go ahead but stop worrying. He also gently reminded me that the best possible outcome will result in childbirth, which is much more risky and more painful. And then it hardly gets easier after that.

So, I thought to myself, am I in, or am I out?

I’m in. Now I’m focussing on the short term and long term positives. A low fibre diet the week before means lots of rice bubbles, white bread, and peanut butter. After the surgery I get a week at home with the cats and a pile of DVDs. We also get an answer to the question of endometriosis. And then our first IUI in December.

Raising a child brings joy and delight, but it also involves dealing with crises, disappointments, and pain. It is messy and complicated and stressful. So I am viewing this process as an educational experience. I need to learn how to communicate my thoughts, fears, and needs. To avoid panic attacks, and to act calmly and rationally. To enjoy the delights of each day, and aim directly for happiness and not for proxies.

55 orange pills

It was quite a shock to take my pill this morning - not the automatic process that it has always been. This time, as I looked down and ran my fingers across my rows of pills, they didn't float off into infinity like they always have before. I take one pill each morning for eight more weeks, and then I stop. And then, after a while, for the first time in forever, I become fertile. And then we try to make a baby. Not by doing anything too differently, just with the absence of a tiny little pill each morning. Then perhaps, one day, almost out of the blue, we become parents. How terrifying.

How do I decide that I'm ready? That I'm all grown up and I know enough about the world to start teaching another? Am I an adult? How did that happen? I don't know how people do it. How they decide that they're good enough. That they're worthy.

The one thing that makes it not completely terrifying, that makes me think that it is also exciting and right, is of course my husband. I've never known anyone like him - so extraordinary. I love him, and I trust him. Not only his heart, but his head. His values, his ethics, his wisdom. I can imagine no better role-model for our child. We are a team, and I don't have to be everything, I just have to be myself. We have so much joy in our life together as two, it would be a delight to make it three. So with him beside me, I think that I might have the courage to soon stop taking these tiny orange pills.