Question: high risk versus regular OB?

I hesitate to even think this question, let alone write it, because I am sure it will doom the pregnancy, but I also know I better get going on this or the best OBs will be booked for my due date.

So, being optimistic for a moment and assuming this pregnancy continues to progress, I'll ask my question. Any and all thoughts/experiences welcome.

Does the fact that I'm on lovenox and prednisone at least through the first trimester (along with all of my other fun meds) mean that I will need to see a high risk OB? Or can a regular OB monitor someone on these meds?

I don't think there's any other reason I'd "need" to see a high risk OB, and I actually think that the low-risk OBs are a little less busy - and therefore a little more available - at the hospital where I'll be receiving care and delivering (ha! as though I would ever get that far). My husband and I work and receive our medical care at a major academic medical center here in New York, so even the "regular" OBs are pretty darn good (as long as they won't flip out about the lovenox/prednisone).

Anybody out there know? I just realized that even though I'll still be in limbo for awhile that I better get a first appointment booked or I'm not going to be able to get one at all with the provider of my choosing. Yikes.

Oh, and another question - can a regular OB measure cervical length? If we can make it out of the first trimester with everyone still alive, that is my other big fear - that I might have cervical issues since I've had 3 D&Cs. So would want to see someone who can regularly (as in every visit probably) check that things are ok in that regard.

This time around, should I get to the point of needing an OB, I've given myself permission to ask for extra visits and extra reassurance. We've been through hell and back, and if a little hand-holding can reduce our anxiety, I'm going to go for it. I suspect our days of once-a-month visits are behind us. I can't imagine just biding my time for a month between visits at this point. Hopefully, I can find an OB who feels that that's acceptable.

Mo

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Moxie weighs in on the HPTs

This past week has had its share of unbounded happiness and extreme anxiety. And several mornings have begun with a ritual peeing on a stick and then snuggling together to watch the lines appear (and to compare with a test from a few days before that).

And when I say snuggling together, I mean me, Will, and our little boxer puppy, Moxie (who's not so little any more). Moxie has even been weighing in with her thoughts on how the pregnancy is progressing.

See how intently she's examining the sticks? That's because she is one smart boxer doggie. Also, she'd really like there to be a baby around the apartment that she can lick and nuzzle whenever the mood strikes her. And whose stuffed toys she can steal and pretend they are her own.

"The line on the bottom definitely smells darker.

Definitely! It's not even a close call!"

Oh yeah. Sanity may be running a bit low over at Mo and Will's (and Moxie's) house. But there is a lot of love - and renewed hope - here.

Mo

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5w5d ultrasound

Thank you so very much for all of your thoughts and your stories of cramping and progesterone. They have been such a comfort to Will and me. We have been, as you know, a little bit beside ourselves.

We had the ultrasound today.

And guess what? There's some hope here.

There is a gestational sac! It is small, measuring about three days behind, but it is there.

There is also a yolk sac!

Squint hard at the picture below (yes, we're back to squinting again, just like with the pee sticks at the beginning). If you look really, really hard, you'll be able to see...well, probably absolutely nothing.

But trust us! There is something there!

Our NYC RE was much more optimistic than I expected. He basically said that everything could turn out ok. That the small size of the gestational sac doesn't worry him so much because it is from a frozen transfer. "Think about it," he said. "If some of the cells die during the freeze and thaw and have to grow back, of course the embryo will be measuring behind." (We didn't even get into the fact that this embryo was also biopsied and therefore lost a chunk of trophoblast cells in addition to whatever was lost in the freeze/thaw). My RE said he's done a study of FET pregnancies and the curve of growth for the FET pregnancies was often 2-3 days behind where you would expect.

So we might be fine. Can you believe it? We might be fine. Wowza.

The NYC RE said that betas are meaningless at this point, now that we are visible on ultrasound. I think they are supposed to continue to rise, but the rate of rise is unimportant.

He also wasn't so concerned about the progesterone. He said the vaginal progesterone doesn't show up as much on bloodwork, so could be ok. He thought it was possible we have a bad batch of PIO, so we will switch vials (ok, to be honest, I came up with that unlikely notion, but he didn't say it was unreasonable). And we will be doing the 3xs a day suppositories plus 1 cc PIO daily from here on out.

He wants to check hormone levels on Monday and offered to do another ultrasound on Tuesday to see if the gestational sac is larger (he'll be out of the office the rest of the week after Tuesday). "Would that make you feel better? Why don't you come back in if it would make you feel better?" I love this man. And you guys know us by now - of course we jumped at the chance to peek inside again. It will be too early to see a fetal pole or a heartbeat on Tuesday, but the gestational sac should be larger.

So the main take home message from all of this?

It's not over yet. Things could turn out ok.

THINGS COULD TURN OUT OK.

Repeat to self again and again, as needed.

Mo

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Panicking

I started cramping yesterday afternoon and into today. No bleeding, thank goodness. I have been trying to tell myself that it's ok, that cramping in early pregnancy is normal (although I don't remember it from other pregnancies). But still, it just hasn't felt right. It has felt that there is a problem.

All night I dreamed of miscarrying. Of dropping betas, of blood on toilet paper. I awoke exhausted. And still cramping, still scared.

This morning, my husband Will offered to order another hormone check and another beta.

I gladly accepted, although I was also chastising myself for checking on things again.

But then we got the results.

My hcg is 1,702, which means it is now doubling every 55 hours, a 97% two-day increase. Not thrilled with this, but I think since the level is (finally!) in the thousands now, that this number does not necessarily indicate a deal breaker.

What has me most concerned is the progesterone level. It's only 10.92, which is WAY too low now that I am on suppositories three times a day and injectible PIO every other day (nurse told me it should be at least 20). Estrogen is fine at 543.

I have a call and email in to the nurse in Colorado to see if I should/can up the progesterone. I'm guessing I'm either miscarrying or the low progesterone is causing me to cramp like I am.

I will update when I hear from them. Maybe since we now know the progesterone is dropping, we can do something to save this from disaster. But I am scared. I am afraid this pregnancy may be ending.

Mo

*******

Update: The Colorado nurse finally called. She suggested I add another suppository and said the level wasn't really that low until I reminded her that I am also on PIO every other day. Then she agreed that it's dangerously low. I am now going to be on 1cc PIO daily + 100 mg Endometrin 3xs a day. I tried to get a sense from her about the prognostic implications of the dropping progesterone and the slower to rise beta. She wasn't too helpful in that department, unfortunately. She just suggested we try to be positive, etc. and said she wasn't sure what these changes might mean. Tomorrow we have an ultrasound scheduled with our local RE's office. My NYC RE will do the scan himself so we will get a chance to talk to him - and a chance to see if there is a gestational sac in the uterus - and hopefully yolk sac. It's going to be a long night tonight. Thank you all so much for your reassurances and for your kind words. It means so much to us and it really helps to read your stories and "hear" your thoughts. Will said so too. So thank you. From the bottoms of our hearts.

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What a difference 10 days makes

Ten days ago, I was getting ready for my first beta, staring at the stick on the left, and trying to devine if there was the faintest, faintest of lines there. I was thinking that if we were lucky, maybe I could have a chemical pregnancy (I reasoned that a chemical would be better than no pregnancy at all). The idea that this nearly invisible line (a beta of 27, if you rounded up) could ever become the line on the right did not really enter my mind as a genuine possiblity.

Amazing how things have developed in just ten days, isn't it?

Hard for Will and me to totally comprehend, honestly. I mean, seriously, we're pregnant? Is this really happening? Could it possibly be going to turn out ok?

We have entered a new stage of wonder and incredulity. Of fervent hoping.

Pinch us, but I think we are pregnant.

Wow.

Mo

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17dp5dt beta results

Results just in (finally!)

Beta: 690!!!!!!!!! Doubling every 42 hours!! A 136% increase!

Estrogen: 574

Progesterone: 21.75

Will and I have been stalking the lab today beginning around noon and were so relieved when the results were finally posted! Phew! I was so worried! These numbers seem great to me and at last we heard the magic words from the local RE's office: "Looks good!" Even those sourpusses couldn't say anything negative about these results! no word yet from Colorado but I will post when I hear.

I have a message in to the local RE to schedule an u/s for later this week to check that the gestational sac is in the right place (the right place being the uterus, rather than a fallopian tube). And then the step after that will be the big hurdle: heartbeat.

Over the weekend, Will and I did a lot of reading about immune issues, especially increased natural killer cell activation (which we have) and DQ Alpha sharing (we're a 50% match). Bottom line, I think we may add a monthly intralipid infusion to our regimen, even though Dr. Schl. doesn't give credence to such issues. We're a little late to be doing this - we should have started it before the transfer, but better late than never (this issue could theoretically account for how we transferred three chromosomally normal blasts and ended up with a piddly beta of 27). We've consulted on the side with a couple of reproductive immunologists (not the one we saw before) who felt that I should add intralipids in until my 20th-24th week just to be on the safe side. There don't appear to be any major downsides, apart from another needle stick once a month and the cost. Apparently, if this immune stuff is a legitimate issue (I'm not completely sold on it and the data seems equivocal), my body may be making natural killer cells right now that are attacking those little fledgling connections the embryo is making to my bloodstream. Yikes!

More on that in future posts.

But for now, over the moon with happiness and SO relieved to have gotten more reassurance that things are progressing ok.

We want this to work out so, so badly. Everything crossed.

Mo

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Hallmark Rejects: TV series that never made it

Hallmark Rejects is back again, today with a look at infertility-related television show ideas that never made it onto the air.

Our first Hallmark Reject TV idea is inspired by a popular 1990s show that you may vaguely remember.

Populated with muscled hunks and attractive curvaceous women, filled with romantic intrigue and drama, set on the lovely beaches of Southern California...

Our new television series idea is similar in many ways to the hit formula followed by Baywatch, with just a few tweaks, to make it more, shall we say, infertile.

Brought to you by Hallmark Rejects, please enjoy:

In which two people agonize, staring intently at a small white stick, hoping a second line will appear. Most episodes, the line doesn't appear, but on those rare occasions that it does, our intrepid (and neurotic) couple continue to worry, peeing repeatedly and looking again and again in a vain attempt to see the line darken.

It's just like Baywatch, except, well, no beach, the actors are pasty skinned, nonmuscular, the woman is covered in bruises from multiple injections, and most of the episodes take place in a bathroom. There is also very little sex in our show, which is funny, because this couple is desperately trying to have a baby!

Not sure why this didn't take off and become a runaway sensation... Maybe we need a new agent or something?

Mo

Got an idea for Hallmark Rejects? Submissions welcome at moandwill@gmail.com

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The Saturday pee diaries

I needed a little reassurance this morning as I haven't been feeling much in the way of symptoms. Not very tired, not nauseated, not dizzy, no uterine twinges. All may be quiet on the uterine front, but check out this line!!!

Just for comparison, you can look at the line from 11dp5dt to see the massive difference (it's definitely darker than 13dp5dt line too, but I didn't take a picture of that one).

What a relief! We appear to still be pregnant! I'm sensing the next few weeks (if we're lucky to get that far) will be very long - and slowly passing - ones. So grateful for each day that we are able to experience this, one step at a time.

Thank you so much for all of your thoughts, your well wishes, and your congratulations. We are pretty incredulous to be even a little bit pregnant. And just thrilled.

Mo

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Next steps

Next beta and progesterone/estrogen check is Monday.

Both clinics (New York and Denver) seem to think they are now my primary treaters. So I'm getting calls from both places with orders on when next test is and what to do (although the NY clinic didn't call until 5pm last night with the beta result - I mean, c'mon folks! Thank goodness we have alternate methods to get our results).

Both clinics are (so far) agreeing on next steps, but their styles on how to interpret our situation are quite different. The Colorado nurse emailed me orders for my next blood draw and titled it "orders for MOM." She even said she might not check the beta anymore because it has been so great, but threw it in just because. The New York clinic on the other hand called (finally!!) and said, "Hi, this is nurse so-and-so, and I have somewhat good news." Wow. Somewhat? I'd call it great news. Since I can't undo the first beta level, I think we're doing great given where we started!

So those are next steps. We will be focusing on staying sane - and staying pregnant! - over the weekend.

Oh, please please please let this one stick.

Mo

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