Dealing with Fears & Doctor Drama

Dealing with Fears

My biggest fear in second trimester has been incompetent cervix. Because I had a uterine septum, I am at slightly higher risk for incompetent cervix (IC).

What is IC?: Basically, your cervix doesn’t function right,  either because of a birth defect (hence the connection to a uterine anomaly) or previous trauma to your cervix.  A normal cervix should stay tightly closed & long until you are ready to deliver in the third trimester. An incompetent cervix will give way under the weight of a growing baby, much, much earlier than it should. Most cases of incompetent cervix occur between 16-24 weeks. Which is terrifying – because your baby has little to no chance of surviving if born this early. Even more terrifying: IC often has no symptoms until it is too late. The cervix just dilates silently, and women often won’t realize there is a problem until they are in active labor and/or their water has broken.

So what are we going to do about it?: I don’t want to be a drama queen here. The good news is, we are just at slightly higher risk, so there isn’t THAT much to be done. The key for us is frequent monitoring: cervical checks every 2 weeks during the high risk period.

If a woman has previously lost a baby/babies to IC, she will often have a preventative cerclage placed early in her pregnancy (sewing closed the cervix). Cerclage, along with bed rest and/or progesterone suppositories, is often very successful in preventing preterm birth. Some women will also have a trans-abdominal cerclage (TAC) placed before they become pregnant again. TAC requires a more extensive surgery, done before a woman becomes pregnant again. It is also permanent (unlike a cervical cerclage, which has to be removed before a woman delivers). However, TACs have the highest success rate.

Cervical Checks & Doctor Drama:

So, we’ve been going to bi-monthly cervical length checks since 16 weeks.  My cervix has looked normal (closed & long) at all of these checks, so my doctor actually wanted to stop at 20 weeks.

This is where shit started to get tricky. As far as I understand, cervical length checks are effective because they are done frequently. Your cervix can change a lot in a month. So, by checking every two weeks, the doctor should be able to catch any potential changes & intervene before your cervix fully opens. We just weren’t sure why our doctor wanted to cease cervical length checks smack in the middle of the high-risk period (16-24 weeks).

To make a long story short, we sent a few questions to our doctor, trying to understand her rationale. We just weren’t on board with the way our cervical length checks were panning out. We had two main concerns.

1 -Why are we stopping cervical length checks so early?

2 – Why were our cervical length scans being done abdominally, and not transvaginally? (Every source we’ve read suggests transvaginal is more accurate, and is generally the standard for cervical screening).

We tried to ask these questions as politely and respectfully as possible. We realize how obnoxious it can be to question a doctor’s judgement, and we didn’t want to be “those patients.”  Unfortunately, we may have been too chill in our approach. Because our doctor never really answered our questions clearly, and brushed off our concerns. She had never been great about answering our questions in detail. But, at this point, we were really starting to feel rushed and written off by her responses to us.

Eventually, we took the attitude of  “This is our baby’s life. We are not going to worry if our doctor thinks we are crazy.”  We let our OB know that we valued her expert opinion and have been very happy with our care, but that our history of infertility and loss causes us to be extra cautious. We then requested to schedule an extra scan at 22 weeks for peace of mind.

False Alarm: Pre-term labor scare

Okay. So you can imagine my shock when I showed up for that 22 week appointment and was told I may be going into preterm labor.

Turns out I wasn’t actually going into preterm labor, but I spent a good 15-20 minutes panicking and believing I might lose the baby.

I laid down for the scan, expecting business as usual. Instead, the tech immediately began telling and showing me that my cervix was significantly open. She explained this in great detail, and even pushed down on my stomach to mimic what happened when I stood – as in, showing me it opened even FURTHER. She then told me in no uncertain terms that I may be going into preterm labor. She said they’d have to do a fFn swab. They would then do a transvaginal ultrasound for greater accuracy.   There was a chance that the abdominal ultrasound was wrong, in which case they said they’d throw out the swab and send me home. However, the tech seemed pretty damn concerned. Despite the doctor being right outside, in the same office, she never came in to explain ANY of this.

They sent me to the bathroom and had me get changed for the transvaginal ultrasound.  Then I just sat alone in a room, wondering WTF was happening, and contemplated losing our baby this far along. Because I knew that if I went into labor now, our baby had no chance of surviving. And I had no idea what “significantly open” meant. Was my cervix shortening,  funneling, dilated, fully dilated? I wasn’t sure if I should text Alex, because I didn’t want to freak him out if it was a false alarm. But I was freaked out. Eventually, I did text him.

The tech came back about ten minutes later, and made an offhand comment that it was too early to do the fFn swab. No explanation offered. Eventually she started the transvaginal ultrasound. The doctor came in, GLANCED at the screen for all of 30 seconds, and quickly deemed that my cervix was closed. There was no funneling. False alarm.

And that was about it. They sent me to another room for weight and blood pressure. The doctor popped in briefly to ask if I had any questions. I was so freaked out, I had trouble getting my thoughts together. But I did ask what my actual length was on the transvaginal ultrasound. The doctor gave an extremely brief/vague response: it was “totally normal” and “just below 3cm.” She did not take any extra time to explain to me what had happened, or ask how I was doing. I felt like they rushed me out of the office, business as usual.

WTF Questions & Follow-Up

When I got home that day, I was really upset. I didn’t understand how my doctor could have told me a 22 week scan wasn’t necessary, and then have THIS happen.  I also didn’t understand how my cervix looked so drastically different on the abdominal vs. transvaginal ultrasound. Not to mention that I was baffled about why the tech told me so much scary info, with little to no involvement from the doctor. The whole situation didn’t make sense.

Alex and I compiled a list of follow-up questions for our doctor, and called to speak to a receptionist. Our doctor took her sweet time in calling us back, and was actually kind of defensive on the phone. Our questions were pretty straight-forward, and very warranted (I think!) after what had happened in their office that day. Like  –

1- How does our current cervical length compare to our measurement at 20 weeks?

2 – What caused my cervix to look open on the abdominal ultrasound?

We were not thrilled with our doctor’s answers. When pushed, she said my cervix was measuring “just under 3” compared to “3.7” at twenty weeks. She was clear that she would not consider any interventions or extra monitoring until my cervix was at or below 1.5cm.

Attitude aside, the numbers she was giving us just don’t gel with anything I’ve read online. I know – this is tricky territory. I am well aware that Dr. Google is not always accurate, and can be a seriously fucked-up rabbit hole to go down. However, every reputable source we’ve checked suggests that average cervical length for 24-28 weeks is 3.5-4cm. My cervix was on the low end of normal. Okay, fine. I could understand how that might not merit any immediate action.

However, her definition of anything above 1.5cm as normal seems way too low to us. Everything else we’ve read suggests that 2-2.5 is considered short, and possibly worthy of interventions like extra monitoring or modified activity restrictions. By the time you get to 1.5cm, there is already a serious risk. But, our doctor stuck to her guns and brushed off our questions about my activity level as a teacher. Clearly, she thought we were nuts.

Breaking up with our Doctor 

After all of this, Alex and I no longer feel comfortable with our OB. We’re not saying that her judgement is necessarily wrong.  However, we would like to get a second opinion.

Our doctor’s behavior, and the behavior of her staff, have caused us to feel uncomfortable in their judgements and lose faith in her treatment plans for us. So, we requested that our medical records be sent for a consult with another OBGYN that was highly recommended by our fertility specialist.  We did not complain to the office, we simply called the receptionist, had a polite conversation, and filled out the necessary paperwork.

The icing on the cake was when our doctor called to scold us for asking to see another OBGYN. Thank god I was teaching and she got Alex. Because I’m sure he stayed a lot calmer than I would have. She nastily told him that she could not write a “referral” to another OBGYN and would not send our records over. Alex very nicely informed her that we weren’t asking for a referral, nor did we need one. He reiterated that we had simply requested that our records be released, and were seeking a second opinion. The doctor huffily said “fine” and that was that. Alex was seriously floored that after her lethargic response times on everything else, NOW she calls us ASAP just to bitch us out. Like, I get it, you aren’t thrilled we questioned you and are now potentially leaving your office. But, grow up! Be a professional to our faces, and then bitch about us later, like a normal person.

I think I have every right to be royally freaked out after what happened this week. But it’s difficult for me to find the right balance between self-advocacy and irrational anxiety. I am having trouble trusting my doctor’s judgement, and even the tech’s measurements, from the appointment this past week.  So, I have been freaking out a bit, imagining my cervix opening over the next few days and losing the baby. However, I know that this is highly unlikely. Our current doctor isn’t incompetent. In fact, the practice she works at is pretty well regarded.  I still think that she exhibited a bizarre lack of sensitivity to our situation, seems to resent answering patient questions, and may be too lax in her monitoring for incompetent cervix.  These are all excellent reasons to look for a new care provider. However, I am trying to remember that it is highly unlikely that her staff sent me home if there was any significant risk to the baby.

Moving to a New Practice & Covering all of our Bases

Alex and I spent Thursday and Friday creating a game plan for next week.

(1) Fetal Echocardiogram: This was already scheduled weeks ago. It’s standard for IVF babies, since they have a very, very slight increased risk of birth defects.

(2) Follow-Up Cervical Length Check with the MFM Specialists at our Hospital – This might be overkill, but my therapist highly recommended them. We asked for a referral from our current doctor, figuring the worst she could do was say “no.” Plus, she already  thinks we’re nuts, so whatever.

(3) Consult with New OB:  Alex spoke at length with the receptionist, who really seemed to know her shit. It’s a single doctor practice, and she’s been working with him for many years. She said that our previous practice’s decisions seemed a bit off to her, and explained how our concerns would be handled in the new office.

23 Weeks

Well, it’s been a while. Just about 4 months since my last blog post. And I’m still pregnant. 23 weeks today. I’ve been staying away from the blog, because writing about this always feels like tempting fate. But, I’m learning that I need to get past those superstitions and hangups.  Because they’re not based in reality. They’re based in the past. And I’m not living in the past anymore.

First Trimester

September, October & November were not easy months for us. I wasn’t far along enough to feel secure in our pregnancy, and the shadow of our last loss was hanging heavily over everything. I spent the first 14 weeks with “one foot in, one foot out.”  I was afraid to emotionally connect with our baby. Being pregnant was just hard, and I wished that I could fast forward to a safer time.  I had legit, all-day  morning sickness (reassuring!), but I also had bleeding/spotting that lasted a week or more at a time (not so reassuring). I tried to remember to live in the moment, and just be thankful that I was “pregnant today.” But, mostly, I just slogged through a haze of nausea and extreme anxiety, ate my weight in carbs, and called out of work a hell of a lot more than I wanted to.

Overall, second trimester has been vastly better than first trimester. In December, we had our nuchal translucency scan. Everything looked great. So, we decided to make the conscious effort to confidently embrace this baby and this pregnancy from that point forward. No more “if we have this baby.” No more “one foot in, one foot out.”  We realize that there is ALWAYS risk – in any trimester, and even after the baby is born.  But we made the decision to stop living our lives in fear, and felt that 13 weeks was as good a time as any to make this mental shift.

We also decided to find out the sex of our baby at 13 weeks.  We had PGS done on our embryos, so we we didn’t have to wait until the anatomy scan. After a few days of back and forth with our fertility clinic, we found out that we are having a little boy.* We are absolutely thrilled.

*funny story: The records department at our IVF clinic actually told us we were having a girl first, based off of an incorrect assumption from our PGS report. I had a hunch they were wrong, and emailed our doctor directly, who immediately confirmed that we were in fact having a BOY. Of course, we were thrilled either way.  

Easing into Second Trimester

So, despite our resolution to “confidently embrace” this pregnancy – I’ve got to be honest: it was still a process to change the fear-based-mindset. And, I still  do experience setbacks where I am overcome with fear and anxiety. I’m talking full-on, crying freak-outs where I am convinced that something is horribly, terribly wrong.

But, the farther that we get into second trimester, I am amazed at the increasing number of days where I am able to relax and enjoy this pregnancy. This is a feeling that I never thought I’d be able to experience, and I am grateful for it every day. I’m sure that the timing of our previous loss is a factor here. Because I’ve only experienced a first trimester loss, I believe it is easier for me to move forward at this point. I can only imagine how challenging second trimester can feel for women who have experienced second trimester losses or stillbirths.

Baby Kicks  AKA This Shit is Getting REAL

While my first trimester was tough, I have been pretty lucky in second trimester. All throughout my infertility journey, people would say “You deserve to have the easiest pregnancy and birth after all of this!.” And I would smile and nod, and silently think, “If only that was how this stuff worked.” For a while, Alex and I just had a lot of challenges thrown our way. At times, it felt like we couldn’t catch our breath.  So it’s difficult for me to accept that the universe may want to throw a few easy breaks my way.

One of the greatest, and most unexpected, gifts of this pregnancy has been feeling the baby move early on. I started feeling small movements at 16 weeks, 6 days. Since most of my friends didn’t feel their babies until almost 20 weeks or after, I wasn’t holding my breath waiting for early “fluttering.” But then it happened, out of the blue, the night before New Year’s Eve. Alex had a bad cold, so we had picked up some authentic northern Chinese food (dumplings, noodles, the works) and some bubble tea for me. After dinner, I was sitting on the couch watching TV, and I felt two distinct flicks. Like, someone tapping me from the inside. Alex, who had no idea that he wasn’t supposed to be able to feel the baby until much later, immediately put his hand on my abdomen, and it happened one more time. Alex swears he felt it. I guess it’s possible. Regardless, it was a very distinct and very different feeling. It did not feel like gas. It felt like a tiny flick. While part of me was skeptical, it was still pretty magical.  I now know that it was, in fact, baby.

Initially, I would feel the “maybe movements” – like little muscle twitches and flicks – about once or twice every two days. And only when I was sitting quietly, just after I ate. By 18 weeks, I was feeling movement every day, sometimes twice a day. By 19, he would move after most meals, and I started looking forward to those moments on a somewhat regular schedule.  By 20 weeks, there was no mistaking his movements for anything else – and I started feeling him when I was standing up and walking around.  Since then, I’ve started to feel him pretty much all day, regardless of what I am doing.

This kid is ACTIVE. There are 1-2 hour periods where he’s quiet. But, for the most part, he is regularly reminding me of his presence throughout the day. He usually starts kicking when I eat breakfast, then quiets down for an hour or two. He starts flipping around again at some point when I’m teaching my morning classes. Then again after lunch. Then again in the later afternoon.

He really goes to town after dinner, though. Usually, between 7-10 PM, he is kicking the shit out of me. Like, big thuds that sometimes startle me if I am starting to fall asleep. It is the coolest thing EVER. And I love every minute of it. It’s hard to worry when he’s kicking me. It’s like he’s saying “Hey, Mom. I’m right here! Chill out.” And that’s exactly what I’m trying to do.

I spoke to soon

I have this stupid superstitious worry about blogging while pregnant. As if typing that I had a successful IVF cycle will tempt fate and bring on bad news. This is probably the reason behind the 3+ months of radio silence on my blog last September 22nd – January 5th.

Well, thanks universe, for reinforcing my stupid superstitions. Today, I woke up bleeding and cramping like the first day of my period. It was like a bad dream. A bad dream that just happened to have occurred on the EXACT FREAKING SAME DAY as last year. Seriously. Last year, at just about 6 weeks pregnant, I started bleeding and cramping out of nowhere. I was convinced I was miscarrying. Instead, the emergency ultrasound revealed a tiny speck of a baby measuring 5w6d and a little flickering heartbeat. Unfortunately 3 weeks and 3 excellent ultrasounds later, we suddenly lost the pregnancy.

Fast forward to today. I am just about 6 weeks pregnant. Bleeding & cramping began out of nowhere. I was convinced I was miscarrying. Then the bleeding slowed down and I started to realize that AT BEST I was going to reenter the same stupid limbo I know so well. Answers? HA. I need a giant poster that says “We have NO FUCKING IDEA.” Unexplained infertility? Check. Unexplained Miscarriage? Check. Unexplained IVF failure? Check. Unexplained Bleeding in Pregnancy? Check.

As I’ve mentioned before, infertility can feel like a decidedly less humorous version of the movie, Groundhog Day. Pregnancy after infertility and miscarriage apparently also follows this rule.  At least this time, I started bleeding at home instead of at work. Other than that, it was like reliving October 14th 2015 all over again.

The same exam room. The same ultrasound results. The doctor saying how excellent the ultrasound looked and telling me not to worry. The call from the nurse with hormone levels that she says are great but that I will continue to nitpick and fret over every day.

I know I should be happy. I know I should be thankful. But I am running out of things to hold onto to convince myself that this pregnancy is different.  The bleed just seems like too much of a coincidence, too strange.

I was almost angry at the doctor for being so enthusiastically positive.  I feel like she was looking at me like, “Hello!?! What is wrong with you? This is amazing news. This is your baby.” And all I felt was frustration and a giant lack of trust.  Everyone told me it was going to be okay last time. And it most definitely wasn’t. Detachment is my only protection. It’s like the doctors are taking away my only armor and leaving me vulnerable to the loss I’m so dreading.

I keep closing myself off and avoiding any emotional connection with this pregnancy. When I started to bleed, I said a little prayer to the universe that if a miscarriage was inevitable, to please let it happen quickly instead of drawing it out over weeks and weeks.

I still have my appointment with the adoption counselor this Saturday. I made the appointment over a month ago and purposely scheduled it a few weeks after my BETA blood draw.  Over the summer, Alex and I decided that this FET would be our last (for now). Adoption has been on the table for a while.  In fact, I’ve been antsy to move on to that new path for months. But, we both agreed on one more FET with a PGS normal embryo. So we did that. And thanks to a series of delays, we transferred in September instead of the summer. Hence the plan to immediately jump on the adoption thing if FET #3 was a bust.

As we all know,  FET #3 wasn’t a bust. But my regular therapist has encouraged me to keep the adoption counselor appointment anyway.  Essentially, the counselor is a 3rd party who specializes in counseling couples through various aspects of the adoption process. She will help us identify agencies or attorneys that will be the best fit for us and get us started on the process. We figured we could at least start the paperwork while waiting for a more definitive outcome for this pregnancy.  This way, If god forbid I did miscarry, I could throw myself immediately into the adoption application process.  You can’t actually complete an application or start a home study if you are pursuing fertility treatments (or pregnant). Most agencies, for obvious reasons, want you to be fully committed and able to adopt before entering the pool. BUT – I strongly feel that even if this pregnancy results in a healthy baby in June, I may very well want to pursue adoption in the future. So, I think it is good to familiarize ourselves with the process regardless.

So, that’s the ridiculous emotional limbo I’m living in right now. I know I am pessimistic about my body’s ability to carry a pregnancy to term. I can’t help it – no one can know until we have a successful pregnancy. My fear is actually pretty normal and rational. BUT – I have complete, unshakeable faith that I will become a mom.  I know that our child is out there somewhere, and we will make our way to her (or him). That is something worthy of hanging my hope on.

FET #3 Results

FET #3 worked – I’m pregnant. I’m shocked and incredibly grateful to have made it this far a second time. I know how lucky I am.

But I’m also scared. Every single day. I’ve been sitting on this news for two weeks now, because even typing it feels like I’m tempting fate. I’ve been here before – pregnant after an FET. And it didn’t end well.

I know this time is different. Every pregnancy is unique, and one loss does not necessarily indicate future problems. But it sure is hard to remind yourself of this when the memories overwhelm you. The timing of this pregnancy is exactly-to-the-freaking-dayidentical to my first FET pregnancy: September 22nd transfer, October 1st BETA.  Every milestone will align exactly with my first pregnancy. There are certain dates and numbers that are ingrained in my mind: my first bleed at 6 weeks, every HCG & progesterone level from that point forward, and the miscarriage at 9 weeks.  The other day, my best friend casually asked me if I knew a due date yet, and I freaked out. I gave her some round-about-answer. Of course I know what my due date would be. It would be exactly the same as it was last year. But I can’t go there yet. I need to stay in the here and now, because I am painfully aware of how uncertain the future can be.

So, before I get too deep into my own anxieties, let’s return to the logical and optimistic version of things.

Today, I’m 5 weeks and 4 days pregnant.

How did I find out?

I wish I could say I am one of those reasonable, grounded women who wait patiently for their BETAs and resist the magnetic pull of the home pregnancy test. That was my plan – really, it was.  After the fiasco that was early testing in FET #2, I swore that we would wait to test. And then we had our embryo transfer and I lost my damn mind.

I got my first, faint BFP at 4dp5dt. I am ashamed of myself. I really am.

If the definition of insanity is doing the same thing and expecting different results, then I  am nuts.  I tested that early during FET#2 and got a whole lot of negatives and heartbreak. But somehow, I rationalized doing it again. For the record, I still think that testing early is a bad idea.  It doesn’t really tell you anything in the end, even if you are lucky enough to get a positive.You just don’t know what your  HCG level is going to be on BETA day.

So, I got a faint line at 4dp5dt. I retested again at 5 and 6 days post transfer, and the line darkened. At that point I stopped testing and waited the remaining 3 days for my BETA.  I was afraid to believe I was actually pregnant. Instead, Alex and I just kind of went “Well, that’s a good sign” and avoided the p-word until we had our BETA results.

Infertility and miscarriage will do that to you. In fact, I think I avoided referring to myself as “pregnant” until we received the results of our second BETA.

BETA Results & Beyond:

BETA #1 at 9dp5dt was 179.

BETA #2 at 11dp5dt was 477.

I know those are great numbers. But that little voice in my head says, you had great doubling times last year.  I’ve spent the past week + 2 days trying to stifle that voice. Spoiler alert: I haven’t managed it yet. In fact, yesterday night I convinced myself that I had an ectopic pregnancy (spoiler alert: I don’t).

Today was my first ultrasound at 5 weeks 4 days. We saw the sac and yolk.  Everything was right on target.  But still, the voice in my head whispered you’ve been here before but it still ended in loss. The doctor filling in for my regular RE this morning was SO NICE. He enthusiastically explained everything (of which there isn’t much at 5w4d) and went out of his way to stress that these were great results.  I tried to muster up equal enthusiasm and react like a normal human being, even though inside I’m maintaining cautious detachment and holding my breath until 10 weeks.

I know I am lucky to make it this far. And I will try to focus on the fact that I am pregnant today. Who knows what tomorrow will bring. I have every right to be afraid and even pessimistic. But, today I am pregnant and I am thankful.

 

 

 

 

 

 

 

 

 

On Rabbits & Frozen Embryos

It’s about time I posted an update (as opposed to an uncharacteristically negative vignette).

The summer of 2016 has been the summer of waiting. I didn’t write much, because there hasn’t been much to report on the infertility-front. We did finally receive the PGS testing results in August. But this was immediately followed by the sudden death of our rabbit, Mr. Rochester. Sometimes the universe has to remind us that infertility is not everything.

A Note on Rabbits:

People seem perplexed when I speak about our rabbits as if they are cats or dogs. Rabbits are actually extremely intelligent and fun pets. Unfortunately, most people are unaware of this, as the only rabbits they’ve met were confined to tiny cages or outdoor hutches. No wonder so many people believe the stereotype that rabbits are boring, low-maintenance pets.

In April of 2010, Alex and I adopted two baby rabbits from the Linden Animal Shelter. We named them Spike and Mr. Rochester. They’ve been at the center of our household ever since. Our rabbits live indoors. They are litter-boxed trained. They do not live in a cage. They come when you call them (most of the time), beg for food, play in our living room, and then snuggle down next to you to be pet. They have been wonderful pets for 6 1/2 years. Spike is still going strong. Unfortunately, Mr. Rochester suddenly died of GI stasis, despite emergency veterinary care. Here’s a pic of our boys from a few years back:

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They’re lion head rabbits – a breed with a mane. Hence,  they look like weird hairy muppets.

PGS Results

So, as I mentioned, we received our PGS results right before Rochester suddenly died.   Because I am a crazy lady, the PGS stuff got put on the back burner and I immediately began the process of adopting a new rabbit companion for Spike. Her name’s Megan. She’s a sweetheart. Mr. Rochester will never be replaced. But, after a year of a lot of loss, I am thrilled to have some new life and energy in our house. I wish that moving forward in the infertility process was this easy.

Without further ado, our PGS testing results were great! Of our seven embryos, five were normal. Of those five, three are male and two are female.  

I somehow find the 5/7 number reassuring. We’ll never know why our first two transfers ended in miscarriage or failure. I like to believe that those first two embryos were abnormal too. A girl’s got to do what a girl’s got to do to stay hopeful.

 

 

 

Summer Blues

A funny thing has been happening. People keep asking me, “What are you DOING with yourself this summer?”  Now, this question alone is not unusual. It’s a semi-annoying question addressed to most teachers who have the summer off. It never really bothered me much before. Most people who ask me this are friends and family with a genuine interest in my life. Of course I have, on occasion, been asked this question by people who DO want to denigrate my profession or insinuate that my life is easy. But, the other 99% of the time?  It’s just a friendly way to start a conversation.

However, this summer, this innocent question has been infuriating me.

Over and over again, I am asked: “So, what are you doing to stay busy this summer?” and “What did you do today?”  In trying to answer, I  end up feeling like a lazy, friendless, incompetent loser with too much time on her hands.

No one seems to realize that constantly asking me to justify what I’m doing with, “all my free time this summer” is like ripping the scab off the just-healed wound that is my miscarriage. Is it that much of a stretch to realize that I should have given birth to our first child in June? By incessantly pointing out how much free time I have, people constantly remind me of that empty place in my heart and in my arms.

No one is asking my Mom Friends & Coworkers what they could POSSIBLY be doing with themselves this summer.  That would be stupid. Clearly, these Moms are busy being MOMS. It’s a 24/7 job.  My Mom Friends have been taking their children to zoos, farms, play dates, indoor playgrounds, story time, and children’s museums. Their schedules are jam-packed. I also realize that a large chunk of their life is consumed by the less-Facebook-friendly toddler tantrums, cleaning up poop & vomit, sleep deprivation, and a constant soundtrack of Daniel Tiger or Angelina Ballerina or whatever kids watch today.

Do people realize that I should have been doing all of those things too? Sometimes I just want to scream. Fuck the lack of empathy that comes from NEVER having to make the kinds of decisions that infertile couples have to make every day. I know, logically, that no one can ever fully understand what it is like to be infertile or to miscarry unless she has experienced it herself.  Actually, who am I kidding? If in some parallel universe, I was able to get pregnant easily, I’d be the one asking the same stupid questions to infertile women and prompting them to write bitchy blog posts about it. I’m only knowledgeable about this one tiny corner of human experience because I’ve lived it. I know that, and should probably just get off my high horse. But, I just wish that the people around me could understand this without having to go through it themselves.

To PGS or not to PGS: That is the Question

PGS = Preimplantation Genetic Screening

This is the third time PGS has been put on the table.We discussed it before our August 2015 IVF. We discussed it again in February 2016, before moving toward FET#2. We rejected it both times.

Why? Well, it’s complicated – as is everything in this process.

What is it?: PGS tests embryos to make sure they have the correct # of chromosomes, thereby reducing the risk of miscarriage and increasing the odds of IVF success. Up to 70% of miscarriages are caused by chromosomal abnormalities.

Why did we reject it previously?: Our age is on our side. Or so we thought. Based on stats for a 30 year old woman, most of our embryos should be normal. Most doctors recommend PGS strongly for women over 35 OR women with repeat IVF failures or miscarriages. Alex and I do not fit that description. Nothing about our case necessarily justifies PGS. Oh, and it costs $4,500 out of pocket.

Why are we considering it now?
Again, it’s complicated.  We basically LIVE in a gray area.  Of our two IVF transfers,  #1 ended in miscarriage and #2 was a failed implantation.  What does this mean? Nobody really knows. It may be a fluke. We only transferred one embryo each time, so we could just be unlucky.

We don’t even know if our miscarriage was caused by a chromosomal abnormality. The lab was unable to test the sample we sent in because there was not sufficient fetal tissue.

We don’t know if the rest of our embryos are normal. With women over 35, finding the “normal” embryo can be like finding a needle in a haystack. But, for us, this shouldn’t be the case. Our chances of picking a “good” one should be high. So. Were we just super unlucky that the first two embryos we selected were duds? Again, nobody knows.

But here’s what we do know: A whole year has passed since our first IVF attempt. During this year, we learned that pregnancy after IVF is scary and that miscarriage sucks. We’ve learned that infertility throws a lot of curve balls that result in a hell of a lot of waiting and heartache. We know that we are tough, but we also know that we don’t want to put my body and our relationship through much more of this.

PGS will give us a missing piece of the puzzle. It will actually provide some facts and take the guesswork out of the equation. If we do another transfer, I want to be sure that the embryo being put back in is normal.

So, that was easy, wasn’t it?

Well, not necessarily. PGS is another tool in our toolbox, but it is not an answer or a promise of success. I think the success rate of IVF with PGS is close to 70%.

It will give us some peace of mind, definitely. Less guessing is good.

Is it possible that we are spending thousands of dollars on PGS for no reason? Yup. There is no way to know if we would have been successful had we tried one more time before moving on to PGS.  There’s a chance that all or most of our embryos will come back normal. In that case, PGS may not change the outcome of future cycles.

And then there’s the possibility that scares me the most: What if our miscarriage was caused by me and not the embryo? I know that there are some tests for uterine receptivity, but I’m not sure how reliable or available these tests are. I am also going to ask my doctors office if I have been tested for autoimmune diseases or clotting disorders (I think I have been tested for some of these). I’m already on a low dose of thyroid medication since my last pregnancy, so that’s not an issue. And, at the end of the day, I know that there is only so much that doctors can do.  I’ve only had one miscarriage, so many doctors wouldn’t even run tests on me yet. Even for women with repeat losses, it is often difficult to pinpoint the causes behind their miscarriages.  I know I should just believe the first miscarriage was a fluke and have confidence that I can carry a healthy baby to term. But, the “what if” still keeps me up at  night.

What’s the verdict?

It looks like we are going to move forward with PGS. If we get on this ASAP, we will probably be able to do a transfer in August. I just hope we get good results.