Friday's Beta

My HCG on Friday was up to 1557.  I have an early u/s scheduled for Wednesday afternoon.  By that time I will be 5w4d along and it will probably too early to see a heartbeat.  The RE has decided against heparin or lovenox at this point, but I haven't heard why directly from him yet so we plan to discuss that with him on Wednesday if everything is still looking good. 

We spent the weekend out of town visiting my sister and her boyfriend.  I wasn't ready to share the news, but it was nice to at least be preoccupied with something else than wondering if everything is still growing as it should be.  We watched a couple movies, went to a baseball game and did a little shopping.  We just got home a little bit ago and I have a bunch of work to do before tomorrow comes.  Yuck!


Still Doubling

Beta #3 today = 515.  That's up from 175 on Monday.  They want me to come in on Friday to get my levels again and then I will be scheduled for an early u/s next Wednesday or Friday.  By my calculations, I am 4w4d today.  At this point, everything looks good on paper, but I'm still very apprehensive given my past losses.  I am continuing with the progesterone suppositories and baby aspirin, but the RE isn't convinced that I need heparin or lovenox yet - that's according to the nurse anyway.  She didn't call me with today's results until almost the end of the day and I didn't ask to speak with the RE.  I think I am going to call tomorrow and ask to speak directly with him to find out what he is thinking and why.  On one hand, I don't want to do anything unnecessary, but on the other hand I think I would regret not trying something different this time if this pregnancy ends like my others.  I wish there was some magical way that I could look inside my uterus and see what is going on down there.  You know, like some sort of 24 hour video surveillance I could check in on whenever I felt like it just to reassure myself that everything is progressing as it should be.  Maybe I could try to invest in my own personal vag cam!  Wouldn't that be something?  Still hoping that this little one decides to stick around.


Take Four - Beta #2

The results just came in from my bloodwork this morning.  HCG = 175.  According to betabase, my levels have doubled in about 27 hours.  My progesterone was 19.3.  I honestly don't know if that is good or not, but the nurse told me that the RE would like me to start using progesterone suppositories for now and come in again on Wednesday for repeat bloodwork.  Good thing I still have some Endo.metrin left over from last time that will cover me for at least a few days.  The nurse said that they would wait for Wednesday's results before deciding whether to add Lovenox or Heparin injections this time.  I did a little reading up on the difference between the two and honestly think I would be comfortable with Heparin over Lovenox, but I guess that it something I can wait to discuss with my RE on Wednesday.  In the meantime, I am continuing to take my prescription strength folic acid and am going to add baby aspirin to the mix.  I'm still spotting a little, but it has slowed down to almost nothing at this point.  Today, things look good I suppose.  I hope this one sticks around for the long haul.


No IVF This Month After All

Rewind to Wednesday afternoon when it was CD26 - I started spotting dark brown stuff, usually a sign that the red witch is about to make a full fledged appearance in the next day or so.  This continued on through Thursday only a bit heavier, but still dark brownish black and what I would describe as almost tar-like, but lighter. I took a HPT on Thursday evening because I planned to call my clinic on Friday to discuss my concerns with our upcoming first IVF cycle.  Come Friday, the spotting had diminished somewhat, but still the color of "old blood" and no sign of any red.  I spoke with a nurse Friday afternoon, described what had been going on and confirmed that so long as the full flow started on or before Sunday that I should start taking the birth control pills for the IVF cycle.  She told me that even if I got full flow on or before Sunday I could wait until Wednesday to start taking the pills because they were going to have to push back my cycle a bit because their move to the new facility has been delayed (I mentioned my concern with this possibility in my last post, guess my gut was right on that one).  My hubby and I talked about it yesterday and decided that we would rather wait until the clinic has relocated and is up and running and fully functional before we drop a buttload of cash on IVF only to have our cycle disrupted and possibly cancelled because of the move which isn't "set in stone" yet.

Last night we had dinner with one of my co-workers and his long-time girlfriend.   She had an accident a few years ago that has left her paralyzed.  They are truly an amazing couple and after I recently opened up about our fertility struggles, my co-worker confided in me that they also had been trying for over a year without any success.  While we were hanging out, they told us that she had just confirmed earlier in the day that she was miscarrying.  We are heartbroken for them because we are all too familiar with experiencing pregnancy loss and given the struggles she has already had because of her accident, this miscarriage just seems too cruel.  We had a few drinks and spent most of the rest of the night talking about fertility issues and commisserating about how people say the dumbest and most insensitive things.  I shared our plans to start IVF this month and told her about the reluctance I was feeling at this point and the fact that the red witch wasn't really being cooperative at the moment.

This morning I woke up, checked for red and flow before going to the bathroom and when I still wasn't greeted by the red witch, I decided to pee on a stick again as it is CD 29 (one of my longer cycles) and I have been debating about filling the prescription for the birth control pills today.  This put a little kink in our IVF plans for this month:

I went back to bed, where hubby was still half-asleep, and told him matter-of-factly, "there are two lines."  We have been robbed of the joy of sharing pregnancy news by surprise and in some cute way because of our three miscarriages.  It's all very clinical now.

I called my RE's answering service to request bloodwork.  After the woman who answered my initial call got my name, DOB and doctor's name, I told her that I wanted to speak to the doctor on call.  She responded, "are you pregnant?"  I said, "I might be, that's why I am calling.  I've had three miscarriages and now I have a positive HPT, but I'm bleeding."  She then proceeded to say, "Okay, I'll take your call.  Someone should call you within 20 minutes."  She'll TAKE my call?????  What was that all about???  If I wasn't pregnant or my reason for wanting to talk to the doctor on call wasn't good enough, she wouldn't refer me???  Whatever. 

Anyway, a doctor I've never heard of called me back almost immediately and got me in for bloodwork today.  Based on first impressions, she was awesome.  She didn't treat me like I was crazy or overreacting or blow me off and tell me I should wait to come in on Monday.  She isn't one of the REs so she must be one of the OB/GYNs on staff.  I think I might see if she is accepting new patients since I need to find a new OB/GYN anyway.  She called me back about an hour ago and told me that I'm pregnant.  HCG was 55.  That actually seems like a pretty decent number for me on CD29 based on my past records.  My first beta on my last pregnancy was 109 on CD31 - that was an IUI assisted pregnancy.  The pregnancy before that one was au natural, but I didn't get a positive HPT (which was super faint) until CD33 and my first beta on CD34 was only 37.

I should be happy, right? Instead I feel a bit numb.  Maybe the fourth time is a charm??  I don't know what to think anymore.  Why can't I just miss my period without any signs of bleeding so I don't have to constantly wonder what the heck is going on down there?  Is that too much to ask???


This Month or Wait?

So it looks like the red witch is imminent.  I've had some spotting since yesterday which increased a bit earlier today, but has since slowed down a bit.  Definitely not what I would consider "flow" at this point, but I took a HPT after work today and it was negative.  I took the test just for good measure given my history of three pregnancies all with some sort of spotting and bleeding because, for obvious reasons, I'm never confident that I'm not pregnant at the first sign of blood. 

Assuming my period truly arrives in full force on or before Sunday, I am supposed to start my first IVF cycle beginning with birth control pills on Sunday.  I'm also supposed to call to schedule our nurse teaching, order meds and schedule acupuncture appointments.  But now that IVF has become a reality, I'm not sure I'm ready to do it yet.

Here are some of  the reasons I am reluctant right now:

(1) At our IVF consultation, I asked our RE if I could possibly have endometriosis and if we should try to figure that out before moving onto IVF.  When I read the signs and symptoms of endometriosis, I don't seem to have any of the common, major symptoms, but I do experience some of the "other" symptoms.  But other than examining egg quality, which only seems possible by retrieval, endometriosis is the one thing we have never explored or ruled out.  My RE said that there are many women who have endometriosis and don't experience any of the symptoms at all or the symptoms are mild so it is never detected.  So there is a possibility I could have it and it could be affecting my fertility.  However, he said he doesn't think it is necessary for me to have a laproscopy to find out because even if I do have it, IVF is the best treatment for fertility problems related to endometriosis.  His explanation pretty much follows the information shared in this post.  So at the moment I'm struggling with this issue.  On one hand, I think it is important, and I'd like to know, if I do have endometriosis.  I think it might just be for peace of mind so I know going into my first IVF that it is a potential problem and before we drop thousands and thousands of dollars.  What's another month, right?  On the other hand, does knowing really matter if IVF would be the recommended course of treatment anyway? In that case, I might as well just take the plunge and do the cycle this month like we planned - why wait any longer, right?

(2) No insurance coverage for IVF - now that IVF has become the reality we are facing, I fear that it won't work and we will be throwing thousands of dollars away.  If somebody asked me whether I'd risk $12,000 for a 30% chance of success at a casino, for example, I would say no.  I wish I didn't have to be concerned by the cost of it all, but I do and I don't like thinking about it.  It would be so much easier to accept if we were fortunate to have insurance coverage.

(3) Our clinic will be moving to a brand new facility soon and if the move is delayed during this cycle I am concerned that our retrieval will get messed up.  Actually, our clinic didn't want us to do IVF last month because based on the way my cycle would follow, the retrieval fell right smack dab in the middle of the week of their targeted move so they weren't scheduling any procedures that week.  The targetted week of the move is the second week of August, but we all know about the best laid plans.  What happens if the clinic doesn't move that week and instead moves when my retrieval and transfer should take place based on my current protocol at the end of the month??  Maybe we should just wait until the move is over and done with so I don't have to worry about that, too.

(4) the lupron shortage - when I was calling different pharmacies for price quotes on meds, I learned about the nationwide lupron shortage.  Has anyone out there had problems with this recently?  What happens if I can't get everything I need by the time I need it?? 

(5) some possible work obligations/conflicts - although nothing is definite at the moment, I will probably have to travel out of town at a couple points of time in August and September and I only recently learned about this possibility.  I work for a government agency and come October 1, the beginning of the new fiscal year, we are expecting another freeze on spending.  In the meantime, our agency is trying to squeeze in certain trainings and conferences by September 30 and given my responsibilities I will likely be required to attend one or more.  As an IVF novice, I don't know if I am going to want to have to figure out how to travel with meds especially since I will be travelling with co-workers or will be brave enough to face the injections alone.

So I'm not sure what to do, but it looks like I have to figure it out by Sunday.  I would welcome any thoughts or advice you all are willing to share with me.


The Conundrum of Recurrent Pregnancy Loss

co-nun-drum ~ \kə-ˈnən-drəm\
noun ~ an intricate and difficult problem

Once we officially started trying to make a baby, it took ten months before we saw our first positive home pregnancy test, but, in hindsight, I wouldn't describe it as a BFP.  Our excitement was brief.  I was spotting from the beginning and the series of subsequent blood tests by my OB/GYN revealed that my HCG levels were decreasing instead of increasing.  My first pregnancy ended in my first miscarriage shortly before Christmas 2008.  The pregnancy was over basically at the same time we learned it even existed.  We were sad and disappointed, but we had conceived within a year's time so we weren't technically "infertile" by textbook standards.  If I wouldn't have miscarried, we would be celebrating that baby's second birthday right about now.

We spent the next two years, or 23 months to be exact, trying to conceive again.  First on our own, later with the assistance of various artificial reproductive technologies and then, again, on our own for a bit.  The goal was to just conceive again.  Get pregnant, that's all.  How hard could it be, right?  We technically did it once before even though it didn't result in a take home baby.  We were assured that the chances of a second miscarriage were unlikely.  Month after month the pregnancy tests were negative.  Were we considered "infertile" yet?  Maybe "subfertile" was the more appropriate term.  Month after month I wanted that darn second line to materialize.  It didn't show up again until November 2010.  Needless to say, when it did, we were thrilled.  Our second baby was conceived while we were on a long vacation to celebrate our 10th wedding anniversary.  No clo.mid, no jerking off into a cup, no doctor intervention.  Just the way nature intended.  My HCG levels were doubling.  No signs of spotting like the first time.  Our goal was accomplished!  Surely this was it and miscarrying twice in a row wouldn't happen. A couple of weeks went by.  We attended a pregnancy info session at my OB/GYN's office and had our first ultrasound scheduled.  Then one morning, the unlikely happened.  I rolled out of bed to get ready for work, half awake like I usually am in the morning.  I went to the bathroom before heading into the shower and was jolted awake by the sight of bright red blood on the toilet paper.  Because it was early and no one was answering my OB/GYN's 24 hour call line, we headed to the ER and confirmed that I was miscarrying again.  How could this happen a second time?  This wasn't supposed to be happening.  I think our grief was worse this time.  At moments I felt betrayed and angry.  At moments I felt depressed and numb.  At moments I felt all and none of these things at the same time if that even makes sense.  We wanted answers.  We were still determined to make a baby of our own.  Baby number two's due date would have been next Friday, July 8. 

Another five months pass by and we conceived for a third time after an IUI.  I blogged about the  progression and ultimate demise of this pregnancy in March.  It seemed to start off on the wrong foot right from the get-go.  I had bleeding that started right around 11dpiui and mimicked Aunt Flo despite multiple positive HPTs and the best and most promising HCG levels I've ever had.  The bleeding eventually stopped and my HCG levels continued to rise.  The doctor and nurses at our clinic assured me that many women bleed early in pregnancy and it doesn't mean anything.  Given my history, I don't believe that.

So where does that leave me now?  Three pregnancies, three miscarriages, no babies.  Not technically infertile, but not really fertile either.  I'm left with a problem, the conundrum I don't know how to resolve or reconcile.  You see, after multiple losses, I find myself conflicted.  Still hoping for a miracle take home baby that is biologically ours, but honestly afraid to get pregnant again.  Hoping each month I'll see that second line on the home pregnancy test, but honestly a little relieved when only the control line appears because at least I know I don't have to worry about facing yet another loss.  Testing each month even when I start bleeding and I'm pretty sure it's my period just to make sure I'm not pregnant because based on my past experiences bleeding doesn't mean I'm not pregnant. 

Some people have said to me, "at least you know you can get pregnant."  I'm not sure why anyone thinks that comment is reassuring or comforting.  Is it somehow better to have been pregnant just for a little while than never pregnant at all?  I honestly haven't figured out the answer to that question and don't know if I ever will.  Maybe my inability to stay pregnant is a sign that any new pregnancies or pregnancies of longer duration will only be plagued with complications.  Maybe it doesn't me anything at all and is just bad luck.

As we approach our first IVF cycle, tentatively scheduled for August, I find myself conflicted about the possibilities.  Wanting to believe that it will be successful, but fearing a BFN or another loss, only this time with thousands of dollars involved.  It will be so worth it if it works, but even more devastating and disappointing if it doesn't.  And that's the conundrum I face as a wounded veteran of recurrent pregnancy loss.