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.

17w6d: Quickening

On 10:30am on Valentines Day, I was sitting in front of my computer focusing on a Word document, when I felt a tiny little *something* in my lower belly. At first I didn't pay it much attention, and then, when I realised what it could be, the rest of the world suddenly disappeared.

All I could focus on was these soft little flutters above my pubic bone. Flutters the like of which I had never felt before. This was the day I first felt our little one move inside me. Now, about twice a day, after I have been sitting quietly for an hour or so, I feel these little wiggles and tickles and pokes that are delightful and charming.

Each day, it is starting to feel more real.

Now, we are off for a two-week babymoon to pass the time until our 20 week scan. Fourteen quiet days near the sea (and a world class hospital) to celebrate what will hopefully be our last vacation as a family of two.

16w1d: Up to speed

I had a great check-up yesterday. The doctor kindly explained that they couldn't do a routine 16 week ultrasound for everyone, but she would do a uterus palpatation, fundal height measurement, and a doppler check. If any of those looked off, then she would send me for a scan.

She said that she could feel my uterus sitting just underneath my belly button, and showed me how to feel it myself. My fundal height was 14 cm (at 16 weeks it should be 16cm +/- 2cm). She had a great deal of difficulty finding the heartbeat, which made me feel better about having trouble with my home doppler. She found the soft wooshing of the ubilical cord pulse quite easily, and some sporadic sloshes of the fetus moving, and finally about 20 seconds of the loud galloping fetal heartbeat at 160 bpm, before the fetus swam away again.

I know that we didn't get an ultrasound, but all in all I felt very reassured. The doctor seemed so calm and confident that I felt like any other pregnant woman in for a routine check-up.

And now only four weeks to go until we reach the half-way point and our big 20 week morphology scan.

15w6d: Check-up tomorrow

Since the 12 week scan, my emotions have varied from relief to happiness to fear to worry. Relief that nothing bad was detected, happy that I graduated from the first trimester, fear that bad things will happen, and worry that the heartbeat was in the bottom 1% for gestational age.

I now have a noticeable bump (latest photo here), and my pregnancy was publicly announced during the last departmental meeting. Most of our friends in this city have not experienced fertility or loss, however they seem understanding of my "let's wait and see" attitude. A few of them have said to me "can I be excited for you, on your behalf?", which is sweet.

While I have heartburn, round ligament pain, a runny nose, frequent urination, headaches, and breathlessness, there is nothing unbearable. I am surprised every time I see myself in the mirror.

I individually emailed the people in my IVF support group to tell them my news, starting with "I know that it can be difficult to hear this...". Some of them have replied with congratulations, others have remained silent, which I understand perfectly.

My next check-up is tomorrow. They told me that they will do a Doppler heartbeat check, but no ultrasound. I would really love a reassuring glimpse to know that the fetus is measuring properly. Does anyone know of any secret phrases that will convince them to do an ultrasound, without having to lie about my symptoms?

14w3d: Out

My belly and the word are both out. I have told my close friends, family, and my boss. I have booked childcare. Random colleagues are coming up to me to wish me congratulations. Presents are starting to appear in the mail.

Apart from the few moments of terror and fear, I am mostly starting to feel a little bit excited. Cautiously optimistic, sometimes. I am now officially in my second trimester.

Frustratingly, I am still having trouble finding a consistent heartbeat with my cheap eBay doppler. I am trying not to worry too much, as even the tech couldn't get a good abdominal scan at my last ultrasound with her fancy-pants machine. I have my next check-up in 11 days.

Finally, I will not be able to make it to my next IVF support group dinner. I have not yet told any of the ladies my news, as I do not see any of them outside these events. Should I send an email? Should it be individual or reply-all? What should it say?

The NT scan

This Tuesday last week I was anxiously counting down the hours until my NT test. I was a bundle of nerves, and had to break down the activity into tiny steps so that I could get through it (get dressed, leave house, get to hospital, walk through front doors, etc). My doppler still hasn’t arrived, so I had no idea if the foetus was even alive.

I arrived 30 minutes early and impatiently waited for my husband to arrive, as he left it to the last minute and only arrived 5 minutes early. Twenty minutes after that, they called us in. My first transabdominal ultrasound, I didn’t even have to take off my pants.

The technician pressed down on my belly and a grainy picture appeared. At first glance, it didn’t look that different from the scan three weeks ago, and my heart froze. But she pointed out the heartbeat and I started to relax. I thought that I had been a responsible patient by drinking a litre of water an hour beforehand, but the technician said that all I was doing was forcing my uterus further towards my spine. She sent me to the bathroom to empty my bladder, and then got down to business.

Everything looked great. The foetus was measuring 6.5 cm (12w6d) at 12w0d with a femur length of 0.68 cm and a NT thickness of 1.49mm (photo of the fetus with a hand on its nose here). I was so relieved when I saw that NT measurement. Then the technician went on to check all the organs, pointing them out as she went along: brain, stomach, kidneys, spine, fingers, feet, even the four chambers of the heart. Due to the position of my uterus, she switched to a transvaginal probe for some of the measurements, so I got a visit from my old friend too. All in all, she concluded “it is a good baby”.

The foetus waved its hands in front of its head, occasionally wiggling and kicking. Although the print outs were a bit poor, seeing the live-action movement on the screen was incredible. With my husband by my side, holding my hand and smiling at me, we could have watched that little thing for hours.

After she had finished, the supervising doctor came in to double-check the measurements. I was a little concerned that the heart rate was a little low (151 bpm) – (the mean rate is 159 +/- 3 bpm at 13 weeks). She did something where she did four different types of doppler heartbeat measurements and said that everything looked fine.

My urine, weight, and blood pressure looked good, so they printed out an official certificate of pregnancy that I need for my work and for securing a childcare position. A few days later I heard that my combined trisomy risk is 1:11 600 for T13 and 1:20 000 for the others.

So, there we are. So far, things look good. Now another three weeks until my next check-up, and another seven weeks until the big anomaly scan.

12w0d

Everything looks great. We have a wriggling 6.5 cm fetus with a 1.5 mm NT measurement. Arms, legs, brain, heart, etc all look good Details and pictures to follow.

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

10w2d Anxious

It is a long slow wait until my next ultrasound in mid-January. I have ordered a doppler, but it seems to be making its way to my home on foot, and is not due here for another week. Although the queasiness, fatigue, back-pain, and swollen breasts continue, it is not the concrete proof that I would like that everything is progressing well with this pregnancy.

My husband, on the other side, seems to have accepted the fact that our family will welcome another member in August next year. He is busy reading "First Time Parent" and making a long list of all the tasks that must be completed before then. He wants to start painting the nursery and buying furniture. The other day he started asking me questions like if we should alternate bottle with breast at night to allow me to get more sleep, and if we should use a crib in the nursery rather than a co-sleeper in our bedroom.

I responded to his thoughtful questions by bursting into tears. For me, it is all I can do to get through the next two weeks until the Week 12 scan. For him, he figures I've got the pregnancy handled, and his job starts in August. I am thinking fetus, and he is thinking newborn. I am so thankful that he realises that he is an equal partner in the upbringing of our child, but sometimes his go-go attitude is a little intimidating, especially when I can barely muster the energy to get off the couch.

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.

8w0d Everything looks perfect

We walked into the shiny new ultrasound department of the hospital, just unveiled a few weeks ago. Lots of space, new machines, and they even called us in 5 minutes early. The doctor was great. She quickly went through our history and confirmed that I had previously miscarried, and then moved immediately to the ultrasound. She delicately stated that at this stage, they get better resolutions with a vaginal scan, and I told her that wasn't a problem, I was used to those.

Pants off and then I was sitting up in the chair, watching my uterus pop up on the TV screen on the wall. A few seconds in, and she said "and there is the heartbeat", and I saw a cute little bean in a gestational sac, with a flicker inside. My poor husband was just confused, I guess he hasn't been watching as many ultrasound YouTube videos as I have, so it took him a bit longer to understand what he was seeing. At one stage he thought he saw whiskers.

She then spent a while measuring everything and checking my ovaries for cysts. She measured the heartbeat at 140 bpm, and told us that they switch the sound on the machine after about 10 weeks. The estimated gestational age was 8w1d, one day ahead. Photo can be found here.

She went away to check the measurements with her supervisor, then came back and said everything looks fine. She said congratulations, enjoy your pregnancy. I said Thank-you. Then we went and made an appointment with a gynecologist for next week, and for a NT scan at 12 weeks.

Afterwards I sat outside in the waiting area with my husband in shock. What a surprise. I am supposed to be starting my Gonal-F injections next week, yet somehow I am already half-way through the first trimester. I am so, so, thankful that we received such wonderful news today.

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.